The 28Th Annual Meeting of Japan Association for International Health 2013

Journal of International Health Vol.29 No.3 2014

THE 28TH ANNUAL MEETING OF JAPAN ASSOCIATION FOR INTERNATIONAL HEALTH 2013

November 2 (Sat) - 4 (Mon), 2013, Meio University, Nago, Okinawa

Key Note Speech by Chairperson OGAWA, S.

Encouragement Prizes Making schools healthy among Burmese migrants in Thailand AKIYAMA, T.

STUDY 1: Increased use of maternal health services and women’s empowerment in rural Egypt STUDY 2: Barriers to the use of basic health services among women in rural southern Egypt CHIANG, C.

Oral Presentations Or-Cambodia Or-As-A01 Changes in utilization of emergency obstetric care service in Cambodia, from 2007-2009 MATSUI, M. Or-As-A02 Relationship between oral health and socio-economic status in young people of Cambodia NONAKA, M. Or-As-A03 Cambodian core trainersʼ understanding of midwifery capacity development NOGUCHI, M. Or-As-A04 The impact of womenʼs empowerment on maternal and child heath: a comparative empirical analysis using household surveys and experimental data from Bangladesh, Cambodia and Laos KAMIYA, Y.

Or-Bangladesh, Nepal Or-As-B01 Actual Condition Survey of Dental Caries among Children in the Urban and Rural Communities of Bangladesh and the Necessity for Dental Health Education OTA, K. Or-As-B02 Determinants of Antenatal Care Service Utilization in Bangladesh: Analysis from Bangladesh Demographic Health Surveys RASHID, H. Or-As-B03 Prevalence of Diabetic Retinopathy and Associated Factors in Chitwan District, Nepal SHRESTHA, S. Or-As-B04 Mothersʼ health seeking behaviors: Does mothersʼ education background influence the selection of modern medicine or traditional medicine? -An interview survey in Dhading district of Nepal- UEZUMI, J.

Or-Laos 1 Or-As-C01 Development and dissemination of childrenʼs health check up system by using School Health in Lao PDR -understanding about importance of health check up and utilizing its data into health education – TOMOKAWA, S. Or-As-C02 Capacity development for administration in the provincial health development, Lao PDR HORIUCHI, S. Or-As-C03 Challenges on managing the operational cost in the provincial health department, Lao PDR HORIUCHI, S.

─ 153 ─ 国際保健医療第 29 巻第 3 号 2014

Or-As-C04 Historical transition and future on nursing education in Lao P.D.R. HASHIMOTO, M.

Or-Laos 2 Or-As-D01 Present Situation and Future of Emergency Medical System in Lao PDR WATANABE, Y. Or-As-D02 Factors associated with the number of services provided through out-reach activity in the southern four provinces in Lao PDR IWAMOTO, A. Or-As-D03 Experience of Providing a Seminar on Mass Casualty Incident in Lao PDR SATO, R.

Or-Myanmar, Thailand Or-As-E01 Model development of community-based DOTS and health system strengthening in Myanmar-Successful outcome of the JICA Major Infectious Disease Control Project ISHIKAWA, N Or-As-E02 The activities for strengthening the capacity of Basic Health Staff (BHS) in Myanmar -Through the introduction of systematic training management- HASHIMOTO, C. Or-As-E03 South-South cooperation on HIV/AIDS program -A case study of the support from Thailand to Uganda- WATANABE, T. Or-As-E04 Cluster Randomized Controlled Trial on Salt Reduction Intervention in Chiang Rai, Thailand YUASA, M.

Or-Japan 1, etc. Or-As-F01 The recognition of medical coordinators participated in disaster relief operations MINAMIJIMA, R. Or-As-F02 On Humanitarian Medical Assistanceʼs (HuMAʼs) 2012-13 Philippine Typhoon Bopha disaster victim medical support activities: Making a significant contribution even in short-term medical support KUNO, M. Or-As-F03 Role of Rehabilitation Specialists in Reconstructing Period after Disaster- Through Experiences from the Great East Japan Earthquake- KONO, M. Or-As-F04 The social vulnerabilities of older people after the Great Eastern Earthquake OKAMOTO, N.

Or-Japan 2 Or-As-G01 International Town Health Care Room in Hyogo: health promotion for foreign residents NASU, J. Or-As-G02 Medical Interpreter Services in Japan; For Residents with Limited Japanese Proficiency vs. For Medical Tourists from Foreign Countries OGASAWARA, R. Or-As-G03 The relationships between stress of living in Japan and premenstrual syndrome (PMS) among international female graduate students HIGASHI, C. Or-As-G04 Current situation of health care in prisons in Japan YANAI, K.

Or-SE Asia & Pacific Or-As-H01 Delivery mechanisms of antenatal care: a multinational comparative study in Japan, Lao PDR and Vietnam. TANAKA, Y. Or-As-H02 The role of maternal and child health handbook in Central Java in the effort to ensure equity in health services OSAKI, K. Or-As-H03 Preliminary study on visualization of attained performance of timely and complete reporting in the routine health information system: A case study of Field Health Services Information System in the Philippines MURAI, S.

─ 154 ─ Journal of International Health Vol.29 No.3 2014

Or-As-H04 A mixed methods comparative study of healthcare workers and mothers on experiences of treatment-seeking behavior in children under five years old in urban East Sepik Province, Papua New Guinea SEKIHARA, M. Or-Kenya, etc. Or-Af-A01 Implementation of Pilot Project for Electronic Medical Record on Basic Health Care Services in Kenya SAITO, K. Or-Af-A02 Health Systems Management towards achieving Universal Health Coverage in Kenya SUGISHITA, T. Or-Af-A03 The role of birth attendants in rural area in Sierra Leone FUJII, C. Or-Af-A04 Health system revue in Republic of Burundi KANEKO, K.

Or-Zambia, etc. Or-Af-B01 Linkages of HIV care process and factors of Lost to follow up at primary health facility in Zambia. UTSUSHIKAWA, M. Or-Af-B02 Assessment of diet and nutritional intake of rural children living in the semi-arid regions of Zambia, sub-Saharan Africa MITSUNAGA, A. Or-Af-B03 Malaria prevention strategy through the capacity development of community health volunteers in urban communities in Ndola, Zambia OTANI, S. Or-Af-B04 Local health surveillance assistantsʼ awareness of people with disabilities in Malawi HASEGAWA, J.

Or-Sudan, etc. Or-Af-C01 Rabies Situation in Amhara Region, Ethiopia MATSUBAYASHI, N. Or-Af-C02 Does it need Doctor Cars in Sudan? NINOMIYA, N. Or-Af-C03 MCH service by Village midwife in Sudan SAKURAI, F. Or-Af-C04 Antimalarial drug use of health workers at the time of negative malaria testing: a qualitative study in Madagascar TSUKAHARA, T.

Or-Tanzania, etc. Or-Af-D01 Progress of Strengthening Regional Health Administration System in Tanzania KOMASAWA, M. Or-Af-D02 Development of Versatile Antenatal Education Program for Pregnant Women and Family in Rural Tanzania SHIMPUKU, Y. Or-Af-D03 Population structure and fertility of African rainforest hunter-gatherers: Baka in southeast Cameroon HAGINO, I. Or-Af-D04 The predictors to the female genital mutilation (FGM) practice and its succession to a daughter in Nigeria NISHITANI, J.

Or-Europe, etc. Or-Oth-A01 Community Care in the United Kingdom TANAKA, H. Or-Oth-A02 The Role of Community Hospitals in the United Kingdom TANAKA, H. Or-Oth-A03 Reclaiming the Contextual Analysis of the Spanish Flu Pandemic KURONO, R. Or-Oth-A04 Mental health research for Japanese living in overseas countries (Interim report) YODA, T.

Or-General Or-Oth-B01 Epidemiological study of reproductive health in Haiti after the earthquake in 2010 MATSUCHIKA, M.

─ 155 ─ 国際保健医療第 29 巻第 3 号 2014

Or-Oth-B02 Medicines sans Frontiersʼ challenges in Syria CHIKWANHA, IT. Or-Oth-B03 A trial of distance education to support education of co-medical professionals in developing countries MORI, Y. Or-Oth-B04 The ripple effect from school-based interventions to the broader community: a multi-agent-based simulation. TANIMURA, S.

Or-JICA, etc. Or-Oth-C01 JICAʼs efforts and directions in introducing impact evaluation to health sector cooperation KAMIYA, Y. Or-Oth-C02 Analyses of JICA health projects contributing to health system strengthening YUASA, M. Or-Oth-C03 Development of an integrated framework for analyzing international public- private partnership (PPP) programs SHIRAYAMA, Y. Or-Oth-C04 Promoting Global Health from The Studentsʼ Points of View in Kagawa University HIWATASHI, K.

Or-Global Or-Oth-D01 Population Ageing and Family Policy in Africa MOGES, A. G. Or-Oth-D02 Mental Well-being, Disability, and Development: Outcomes of the UNU - United Nations Expert Group Meeting TSUTSUMI, A. Or-Oth-D03 Antenatal nutritional interventions for preventing low birth weight: an overview of systematic reviews OTA, E. Or-Oth-D04 The 1st International Conference on MCH Handbook at African continent BANDO, A.

Poster Presentations Po-Africa1-Francophone Africa Po-Af-A01 Changes in patientsʼ self-perception and reconciliation with the disease after receiving antiretroviral therapy (ART) -A survey conducted in the Central African Republic- TAKATSUKA, A. Po-Af-A02 Health Care Check in elementary school in DRC MIZUTANI, S. Po-Af-A03 Introduction of drug insurance system for children in Tambacounda district, Senegal SUZUKI, Y. Po-Af-A04 The management of a elementary school and the result of house visiting in Democratic Republic of the Congo by medical, architecture and education faculties. KAMATA, M. Po-Af-A05 Teenage girlsʼ perception and significance toward pregnancy and childbirth in the Central African Republic KATO, S. Po-Af-A06 Establishment and challenges of the regional platform for French speaking African countries on human resources development in health TAMURA, T. Po-Af-A09 Health facilities data quality improvement study in Analamanga region, Madagascar OKAYASU, T. Po-Af-A10 An evaluation of the significance of TB/HIV operational research in Madagascar NAGAI, S.

Po-Africa2-Anglophone Africa Po-Af-B01 Primary School Teachersʼ Role on Health Education and Promotion among Semi-Traditional Maasai Students in Narok, Kenya S DE LOS REYES, C. Po-Af-B02 The Ideal Diet of High School Students in Tanzania Based Upon the Drawing Method HASEGAWA, M.

─ 156 ─ Journal of International Health Vol.29 No.3 2014

Po-Af-B03 Relationship of HIV infection, and nutritional condition between HIV positive people, their family, and HIV negative people TAKAHASHI, H. Po-Af-B04 Impact of 5S Practice on Quality of Health Services in Regional Referral Hospitals in Uganda: Results of Mid-term Assessment TAKE, N. Po-Af-B05 Spatial Analysis Of Cambridge Road Traffic Accidents For Injury Prevention In Sub-Sahara Africa HORI, K. Po-Af-B06 The improvement of immunization coverage through an intervention of Growth Monitoring Program Plus (GMP+) in urban communities, Zambia SASAKI, S. Po-Af-B07 Interventions to reduce diarrhea cases through the capacity development of community health volunteers in urban communities, Zambia OTANI, S.

Po-Africa3-Arabic-phone Africa Po-Af-C01 Trend of Childbirth Delivery by Skilled Birth Attendant (SBA) in African Countries and Related Factors.- Comparison in the age groups using Demographic and Health Surveys (DHS) - YAMADA, K. Po-Af-C02 Strengthening capacity of Village Midwife (VMW) in the Republic of the Sudan -Experiences from JICA Project, 'Mother Nile Project'- MIYAKE, S. Po-Af-C03 The final evaluation of maternal and child health activities in the eastern villages of Sudan YANO, K. Po-Af-C04 South Sudan: Report of Technical Cooperation for the Development of Human Resources for Health KASAHARA, H. Po-Af-C05 A study on factors affecting the impact of midwifery in-service training in South Sudan HIRATA, M. Po-Af-C06 Medical Operation of United Nations Peacekeeping Operations in South Sudan –A report from a Japan Ground Self-Defense Force nurse- NOGUCHI, N. Po-Af-C07 Ethnographic Approach to Medically Pluralistic Environment: Cases of Medico-Anthropological Researches at the School of International Health Development, Nagasaki University. MASUDA, K.

Po-Pacific Rim Countries Po-Oth-A01 A Report of international health activity in Pacific Partnership 2013 in Papua New Guinea YAMAMOTO, A. Po-Oth-A02 Nutritional status from the aspect of the bone density in residents living at Asia-Pacific area HAGIHARA, J. Po-Oth-A03 A Study on Lifestyles among Upper Graders of Primary Schools in Urban and Rural Areas of Vanuatu NAKASEKO, E. Po-Oth-A04 The research of maternal death and newborns death in Majuro hospital, The Marshall Islands YAMASAKI, R. Po-Oth-A05 Integration of Medics, trained health/medical volunteer in conflict area, to the government health system. “Kaiho Seido”, “Medical Service Man system” of Okinawa of Post World War II, and Challenge & Practice in Myanmar-Thai Border. HAYASHI, K. Po-Oth-A06 The Health Issues of the Brazilian in Japan SUZUKI, S. Po-Oth-A07 AIDS policy in Brazil and the movement by people with HIV ARAI, S. Po-Oth-A08 Assessment of a Skype-based international distance-learning program in Nicaragua on nursing techniques for postural change MIYAKOSHI, S.

─ 157 ─ 国際保健医療第 29 巻第 3 号 2014

Po-Japan, Global Po-Oth-B01 The relation between perceived social support on depression of carers of community-dwelling elderly people from a nationwide survey in the Republic of Chile SANDOVAL, F. Po-Oth-B03 Possible determinants to acquire a career pass in the field of nutrition for international medical cooperation MIYOSHI, M. Po-Oth-B04 Study of diagnosis and treatment of BODY PACKER (drug body packing patient) in the Emergency Shock and Trauma center closest to the Narita International Airport KAMEYAMA, D. Po-Oth-B05 The activities of Saku Central Hospital Global Health Committee - Strategies for the human resource development on global health in a rural hospital HIRATA, T. Po-Oth-B06 Ten years experience of training to control health care associated infections in developing countries and observed problems HANEISHI, Y. Po-Oth-B07 Introduction of phase for evaluation of vector control trials TSUZUKI, A.

Po-Asia 1-Japan, Philippines Po-As-A01 Systematic review on care burden of family caring for the elderly in Asia MIYASHITA, Y. Po-As-A02 Barriers to Disaster Medical Information Dissemination in Multicultural Society KANBARA, S. Po-As-A03 Foreign single-female-parent household is the highest in those getting public assistance among registered foreigners in Japan (except for south and north Korea nationalities) KOBORI, E. Po-As-A04 Current situation and challenges regarding legal frameworks and qualification systems in nursing TAMURA, T. Po-As-A05 Values of young Korean living in Japan in relation to family and marriage, and opinions of premarital sex TSUBAKI, C. Po-As-A06 Collaboration work of Non-Profit Organization (NPO) and a governmental office of Rikuzentakata-city post Tsunami disaster HIRANO, S. Po-As-A07 The State of Domestic Violence and Support among Filipinas Residing in Japan SAKAI, H. Po-As-A08 Factors Related to Desire to Work Abroad Among Filipino Nurses TAKAHASHI, M. Po-As-A09 Factors Related to Desire to Work In Japan Among Filipino Nurses TAKAHASHI, M. Po-As-A10 ASSESSMENT OF THE EXTENT OF COUNTERFEIT MEDICINES IN CERTAIN AREAS IN BATANGAS, PHILIPPINES ITOH, T. Po-As-A11 Self-Rated Health and Social Environment for Elderly in the Philippines KASHIWAGI, S. Po-As-A12 Social Determinants of Maternal and Child Health among Indigenous Peoples in the Philippines: Case of Tagbanua Mothers and Children of Coron, Palawan S DE LOS REYES, C.

Po-Asia 2-Vietnam, Laos Po-As-B01 A qualitative interview study exploring HʼMong ethnic group womenʼs lifestyle during pregnancy and birth custom in the mountainous area of Vietnam SHIMOKOSHI, T. Po-As-B02 A profile of hospitalized patients of acute diarrhea in Nam Dinh province, Vietnam TOKIZAWA, A. Po-As-B03 The support of children in the south of Vietnam KOIKE, M.

─ 158 ─ Journal of International Health Vol.29 No.3 2014

Po-As-B04 Nursing care provided by the family and the roles of the nursing in developing countries -Analysis on reports of Japan Overseas Cooperation Volunteers in Vietnam – SAITO, K. Po-As-B05 Knowing the challenges regarding health for children in Pakse, Lao P.D.R. through the project of free healthcare service for children under 5. SUZUKI, A. Po-As-B06 Effects of Inter-Professional Education in the Laos Study Tour KOIKE, T. Po-As-B07 Comparative case study on supportive supervision in Laos and Kenya NODA, S. Po-As-B08 Relationship between information exchange and Quality of Life (QOL) of women in community, Lao PDR SONE, K. Po-As-B09 The present situation of intestinal parasite infection in a small village in Lao PDR and exam the further methods to control the parasites YAMAZAKI, H. Po-As-B10 Factors affecting childhood immunisation in Lao Peopleʼs Democratic Republic: case-control study from nationwide, population-based, multistage cluster sampling KITAMURA, T. Po-As-B11 Descriptive study on people with mental disorder and care Descriptive study on situation and care for the people with mental disorder in Songkhone District, Savannakhet Province, Lao PDR KOMAGATA-ABE, T. Po-As-B12 Efficacy of a single-dose administration of Mebendazole against intestinal parasitic infection in rural areas, Lao P.D.R. HANDO, K.

Po-Asia 3-Thailand, Myanmar, Cambodia, Indonesia, etc Po-As-C01 Situations of HIV care prior to TB diagnosis of HIV co-infected TB patients and its influence on prognosis in a province of northern Thailand: YAMADA, N. Po-As-C02 Healthcare service utilization among rural elderly in North Thailand RIABROI, W. Po-As-C03 The current situation and problems facing the school lunch system in Myanmar temple schools SHIMAHARA, S. Po-As-C04 The Problem of Former Leprosy Patients in Republic of the Union of Myanmar: Consideration by Semi-Structured Interview Methods NAKA, Y. Po-As-C05 Introduction of case study to develop capacity of midwives in Cambodia FUKUSHIMA, K. Po-As-C06 The survey on the complementary food intake of inpatients at the National Pediatric Hospital in Cambodia and their eating habit at home SAITO, S. Po-As-C07 A new challenge of building up a sustainable clinical support system using Tele-conference at the Neonatal Care Unit of National Maternal and Child Health Center, Phnom Penh, Cambodia IITAKE, C. Po-As-C08 Self-evaluation of simulation-based continuing education nursing workshop participants in urban area of Bangladesh OSHIDA, Y. Po-As-C09 Health System Assessment Targeting Preventable Noncommunicable Diseases and Health Promotion in Indonesia MIZUTANI, M. Po-As-C10 Current situation of school health at South Sulawesi Province in Indonesia -Preparation status of the school health rooms and actual condition of utilization of them- HATTA, S. Po-As-C11 Research on Value of Children in the Province of West Nusa Tengara, Area of West Timor SHINKAWA, K. Po-As-C12 First-line screening with non-blood profiles to identify individuals needing further follow-up for diagnosis of type 2 diabetes mellitus in resource-limited setting KASHIMA, S.

─ 159 ─ 国際保健医療第 29 巻第 3 号 2014

Po-Asia 4-Nepal, Sri Lanka, Central/West Asia Po-As-D00 Establishing Regional and District Health Mapping System using Open Source Geographical Information System (GIS) in Madagascar OKAYASU, T. Po-As-D01 Nursing care provided by the family and the roles of the nursing in developing countries-Analysis on reports of Japan overseas Cooperation Volunteers in China- TSUJIMURA, H. Po-As-D02 Brended Methods intervention for strengthen the continuing nursing education program in the developing countries YOSHINO, Y. Po-As-D03 Activities Report on Improving of living conditions by promoting safe water supply, based on the concept of Primary Health Care in Dhital village of Kaski Country, Nepal. UENO, R. Po-As-D04 Cross sectional study of motherʼs care seeking behaviors toward their childrenʼs illness on a hilly area in Nepal KAKINOHANA, S. Po-As-D05 Study of the process which women result in a home birth on a hilly area in Nepal KAKINOHANA, S. Po-As-D06 Cost Analysis Trial for Prevention of Lifestyle-Related Diseases in Sri Lanka SUGIMOTO, T. Po-As-D07 Effect of continuous cooperation for Community Based Rehabilitation (CBR) in Sri Lanka TOBINAGA, K. Po-As-D08 Assessment of patients with thoracic spinal cord injury in Uzbekistan OMURO, K. Po-As-D09 Present Situation and Problem of Stoma Care in Uzbekistan SUMIDA, S. Po-As-D10 The Basic Study on Terminal Care in the Republic of Kazakhstan OANA, S. Po-As-D11 The efficacy of Health Education on the reduction of infectious diseases in an illiterate community RESHAD, K.

─ 160 ─ Journal of International Health Vol.29 No.3 2014

Key note Speech by Chairperson

Design and Act together for Global Health – Lessons Learned from Community-based Activities in Okinawa

Sumiko Ogawa M.Med.Sc., MPH, Ph.D

Professor, Meio University, Okinawa

Indochina countries started opening up and es, the trainees seemed to pay more attention to it. allowing access to the outside world since the early Based on this experience, I started preparing lectures 1990’s after the dissolution of the Soviet Union. and textbooks on postwar Okinawa’s health sector Shortly after that I was posted to rural Laos as a transition in order to attract the trainees and expect- JICA primary health care expert for 3 1/2 years, to ing them to put these ideas into practice. This is one work in international health. From the outset I of my main research areas. One of my key findings became aware of the difference in people’s attitudes through research was that the attributes of success- whether you were involved in an official or unofficial ful development might be lessons learned from organization. Some friends, who used to be members postwar Okinawa’s health sector experience; the of the same NGO along with myself, at the university, faithful attitude of public health administrators who ignored me since I had started working under an were full of empathy and understanding towards the official development assistance agency. There seemed population, and not showing off themselves as to be a sort of conflict between GO and NGO at that American donors under the US military regime. time. By the way, the term “International Health” that Khammouane Province in Laos where I used to is also in the title of this congress, is sometimes work was considered an “Isolated land” (1990’s), 350 replaced by the term “Global Health”. It is said that kms away from the capital city of Vientiane. I had the World Health Organization has addressed new imagined they were poor unfortunate people with trends by replacing the words with the more politi- inadequate social security; however, they were all full cally correct international health. Recently I attended of energy and optimism for living. The more I kept the 8th European Congress for Tropical Medicine and working with these communities, the more I felt International Health in Copenhagen, where the enriched myself, absorbing their “power of life” and participants often discussed the differences between by developing my insight for that society that existed international health and global health; one of the as a simpler system than those of developed societies, points they emphasized was that the former denotes and by experiencing different cultures and rules that more of a one way cooperation between donors and allowed me to break free of my own prejudices. recipient countries, and the latter indicates more of a These inseparable feelings of both comfort and collaborative relationship among donors and recipi- discomfort in the process of my own development ents. motivated and inspired me to get involved in interna- Trends in international health have been shift- tional health and development. ing in many ways. Collaboration between GOs and The theme of this Congress is “Design and Act NGOs is taken for granted. Currently, low-and middle- together for Global Health” and “Lessons Learned income countries have simultaneous burdens of both from the History of Community-based Health Activi- communicable and non-communicable diseases. What ties in Okinawa.” Shortly after I returned from Laos, we should do is to act together with collaborative I had an opportunity to give a lecture to trainees relationships between donor and recipient countries from the recipient countries. Then I felt that their aiming at healthier world societies, and learning from needs were compatible with past issues in Japan’s each other, with flexible and creative ideas. Thank health sector and not with the present situation. you. When I gave a lecture about Japan’s past experienc-

─ 161 ─ 国際保健医療第 29 巻第 3 号 2014

Encouragement Prizes

Encouragement Prize 1 : Making schools healthy among Burmese migrants in Thailand

TAKESHI AKIYAMA1, THAR WIN2, CYNTHIA MAUNG2, PAW RAY3, AIKO KAJI4, AYA TANABE4, MASAMINE JIMBA5, and JUN KOBAYASHI6

1Kenya Research Station, Institute of Tropical Medicine, Nagasaki University, 2The Mae Tao Clinic, 3Burmese Migrant Workers’ Education Committee, 4Japan Association for Mae Tao Clinic, 5Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 6Department of Global Health, School of Health Sciences, University of the Ryukyus

To ensure the feasibility of the implementation scores ranged from 0 to 3. We compared the results of a health-promoting school (HPS) program, we of the two surveys (performed before and after the conducted evaluations and an intervention on school intervention) by calculating the mean score of each health in Burmese migrant schools in the Tak item. A 1.3-fold increase was seen in the mean of all province of Thailand. In Thailand, a health-promoting items measured in the evaluation (from 1.7 to 2.2, n school (HPS) program is in place nationwide while ＝ 43). Out of the five components, the greatest differ- this policy has not covered Burmese migrant schools. ence was detected in ‘school and community partner- We included 44 primary-level schools in 2008. We ship’, which increased from 1.0 to 2.4. Notably, the were able to evaluate the results of the intervention mean score of item 4 of component 5, ‘clear definition in 43 of 44 schools in the subsequent year. For of the roles and responsibilities with the Burmese measurement, we used a comprehensive school- community’, increased from 0.4 to 2.7. Although health checklist with five components: ‘personal further study is necessary to investigate the associa- health and life skills’, ‘healthy school environment’, tion between our intervention and the improvements ‘health and nutrition services’, ‘common disease among schools, our school health evaluation and control and prevention’, ‘school and community intervention were successfully implemented in partnership’. The checklist contained 59 items; item Burmese migrant schools.

Encouragement Prize 2

CHIANG Chifa

Nagoya University Graduate School of Medicine, Department of Public Health and Health Systems

STUDY 1: Increased use of maternal health servic- empowerment. The association between service es and women’s empowerment in rural Egypt utilization and women’s empowerment related The relationship between women’s empower- variables was statistically analyzed. Older ages at ment and the use of health services has been reiter- first marriage and higher education levels showed ated in the developing world, especially in rural significant positive associations with the three areas. However, limited evidence from Egypt has outcome variables—regular antenatal care (ANC), been revealed in publications. This study investigated deliveries attended by skilled health professionals, the association between women’s empowerment and and deliveries at heath facilities—of the use of mater- the utilization of maternal health services in rural nal health services. Women who had not experienced Egypt. Face-to-face interviews with a structured physical assaults by husbands and had knowledge of questionnaire to 201 married women were carried community activities were more likely to receive out in a village in November 2007. Women were ANC regularly; however, there were no significant inquired about their health service utilization and association with the two variables of delivery care. corresponding questions to different dimensions of Participation in household decision-making and

─ 162 ─ Journal of International Health Vol.29 No.3 2014

having a job with cash income had no statistical questionnaire were carried out on 205 currently- significance with the use of maternal health services. married women in November 2009. The association Marriages to husbands with higher levels of educa- between three primary dimensions of barriers and tion and residence in extended families were signifi- the use of basic health services was analyzed by cantly associated with greater use of maternal health regression models. Our findings indicated structural services. Our findings suggest that women’s barriers had an inverse association with the use of empowerment may have different influence on the health services. Financial barriers showed a strong use of ANC and delivery care. Moreover, moral sup- association with the use of curative services (medical port from family members may play a vital role in treatment), but not with the use of preventive servic- the increase of maternal health service utilization. es (regular ANC). Contrary to our expectation, personal/cultural barriers had no statistical signifi- STUDY 2: Barriers to the use of basic health ser- cance with women’s use of health services. Although vices among women in rural southern Egypt basic health service delivery networks extended This study dissected the potential demand-side throughout the country, women in rural Egypt were barriers to women’s use of health services in rural still facing various barriers to the use of the services, southern Egypt. Interviews based on a structured especially structural and financial barriers.

Oral Presentations

Or-As-A01 Changes in utilization of emergency obstetric care service in Cambodia, from 2007-2009

MITSUAKI MATSUI1, Sokhan UONG2, Ly Sotha KETH2, Rathavy TUNG2

1Bureau of International Cooperation, National Centre for Global Health and Medicine, Tokyo, Japan, 2National Maternal and Child Health Centre, Phnom Penh, Cambodia

Introduction and Objective Cambodia has recently major obstetric interventions (MOIs: caesarean diminished its maternal mortality ratio rapidly: from section and hysterectomy for postpartum haemor- 472 in year 2005 to 206 in 2010. Possible explanations rage) is collected in all public hospitals and private for this achievement are improvement of traffic clinics in the target area. The data were classified by network, increase of government budget to health areas of residence and indications of intervention. sector which resulted in augment provision of Results and Conclusion We have confirmed an in- emergency obstetric care (EmOC), and other efforts creasing trend in the rates of MOIs for absolute such as conditional cash transfer for facility-based maternal indications (AMIs: placenta praevia, abrup- delivery. We hereby report recent trend of utilization tio placentae, abnormal presentations, uterine of EmOC services in selected provinces in Cambodia rupture, severe postpartum haemorrage), which were from year 2007 to 2009. 0.63%, 0.75%, and 0.85% in year 2007, 2008 and 2009, Material and Methods The target areas of this respectively. Although the same trend is observed in study were Phnom Penh city (capital) and five prov- every province, there are substantial variations inces (Kandal, Kampong Cham, Kampong Chhnang, among the areas. Further effort to reduce this equity Kampong Speu, Kampong Thom). We have applied gap should be put, and this UON method is useful to “unmet obstetric need (UON)” indicator proposed by monitor the trend. De Brouwere to measure the utilization. Data on

─ 163 ─ 国際保健医療第 29 巻第 3 号 2014

Or-As-A02 Relationship between oral health and socio-economic status in young people of Cambodia

MANAE NONAKA1, MICHIKO FURUTA1, YOSHIHIRO SHIMAZAKI1, 2, YOSHIHISA YAMASHITA1

1Section of Preventive and Public Health Dentistry, Faculty of Dental Science, Kyushu University, Fukuoka, Japan, 2Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi-Gakuin University, Aichi, Japan

The purpose of this study was to determine the for the number of decayed, missing, or filled teeth relationship between the pre valence of dental caries, (DMFT) per person was 4.3 (95% confidence interval gingivitis, and socio-economic status among young [CI] 3.8-4.7). In addition, the prevalence of periodontal people in Cambodia. disease was 11.7%. A mean of 34.6 (95% CI 31.6-37.6) A total of 388 first-year students who were was found for BOP (%). Logistic regression analysis enrolled at Kampong Cham Regional Training Center showed high incidences of caries (DMFT4 and over) in 2012 were invited to participate in oral examina- among participants who consumed a sweet beverage tions and questionnaires between February and April daily (odds ratio [OR] 2.9, 95% CI 1.1-7.7) and those 2012. The questionnaires gathered information on the whose mothers had relatively high levels of education students’ socio-economic status, determined through (OR 4.0, 95% CI 1.8-8.8). Meanwhile, participants household income and the education level of parents, whose mothers had high levels of education as well as oral health behavior. Participants’ perio- presented with less gingival bleeding (BOP (%) ＜ ;30; dontal status was evaluated through the Community OR 0.3, 95% CI 0.2-0.7). Periodontal Index (CPI) and bleeding on probing Findings from this study are in contrast with (BOP). Multiple logistic regression analysis was used previous studies. Other factors, such as region to analyze the data. -specific background could be responsible for these The final sample included 307 students aged 17 discrepancies. to 24 years old; 92 men and 215 women. The mean

Or-As-A03 Cambodian core trainersʼ understanding of midwifery capacity development

MAKIKO NOGUCHI1, MITSUAKI MATSUI2, YOUICHI HORIKOSHI2, MIDORI KAWAGUCHI3, SACHIKO KONAGAI4, KENJI TAKEHARA5, YASUYO OSANAI2, 6

1Faculty of Health Sciences, Hokkaido University, Sapporo, Japan, 2Bureau of International Medical Cooperation, Japan National Center for Global Health and Medicine, Tokyo, Japan, 3Kuwanoki birthing house, Sagamihara, Japan, 4Fujieda daiichi birthing house, Fujieda, Japan, 5National Research Institute for Child Health and Development, Tokyo, Japan, 6National College of Nursing, Tokyo, Japan

Background One of the activities of the “JICA Results I interviewed five midwives and two Project for Improving Maternal and Newborn Care obstetricians individually who were core trainers in through Midwifery Capacity Development” is a February 2013. Six categories emerged from the training program at a workshop for women-friendly analysis: problem of work environment; reference to care. The workshop is operated by Cambodian core evidence; respect toward women and their families; trainers together with JICA experts. The aim of this identity as a midwife; making good use of the research is to clarify the core trainers’ understanding midwifery process; and realization of improvement of midwifery capacity development to promote women- and imperfectness. The core trainers were convinced friendly care. of evidence-based women-friendly care as a direction- Method A qualitative research, in the form of semi- al target to work toward and wanted to disseminate structured interview asking about their experience it. as core trainers, was used. After the interview, the Discussion The core trainers accepted women- contents were analyzed. friendly care. I propose that there are two reasons

─ 164 ─ Journal of International Health Vol.29 No.3 2014

why they could accept this new care. First, they consciousness of the impacts reinforced their motiva- could have their own interpretation of women- tion to adopt women-friendly care. These points are friendly care at childbirth. In this research, their important when introducing new practices and are understanding is respect for women and women’s applicable to other technical cooperation projects as physiological process of birth. Second, they realized well. the clinical improvement achieved by the care. Their

Or-As-A04 The impact of womenʼs empowerment on maternal and child heath: a comparative empirical analysis using household surveys and experimental data from Bangladesh, Cambodia and Laos

YUSUKE KAMIYA1, Keitaro Aoyagi2

1Osaka School of International Public Policy, Osaka University, Osaka, Japan, 2Evaluation Department, Japan International Cooperation Agency, Tokyo, Japan

Womenʼs empowerment is widely recognized to Empirical results reveal that different dimensions have a positive impact on maternal and child health of women’s empowerment affect MCH differently, (MCH), but there is no conclusive evidence to support both positively and negatively, depending on the SES this claim. An important problem in the past re- of wife and husband. For instance, data from Bangla- search is they do not fully capture multi-dimensional desh show that a woman with higher self-esteem is characteristics of empowerment and thus do not more likely to access to MCH services as long as she examine which dimensions of womenʼs empowerment is well educated. In contrast, a woman with less actually relate to MCH. This study therefore aims at mobility has a higher access to adequate MCH bridging this evidence gap by analyzing micro-data services if the education level of her husband is from Bangladesh, Cambodia and Laos. higher. We categorize dimensions of women’s empower- As a conclusion, we confirm that: women’s em- ment within the household into self-esteem, self- powerment does not always lead to MCH improve- efficacy, decision-making power, control over ment; whether or not women’s empowerment con- resources, mobility and internal locus of control. We tributes to MCH improvement depends on SES of then construct quantitative indicators for each di- wife and husband; and a husband plays a key role in mension. Data are from nationally representative realizing a positive pathway from women’s empower- household surveys. In addition, we use unique data ment to improved MCH. from economic experiments conducted in Bangladesh.

Or-As-B01 Actual Condition Survey of Dental Caries among Children in the Urban and Rural Communities of Bangladesh and the Necessity for Dental Health Education

KATSUKO OTA1, SHUICHI TAKINAMI2, KHAN HAIDER3, NAZNIN KHADIZA3, SHAMA SHAILA3

1KIBI International University Graduate School of International Cooperation and Development, Okayama,Japan, 2Division of Oral Radiology, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Hokkaido, Japan, 3Dhaka Dental College

＜Objectives＞ To acknowledge the actual conditions ＜Method＞ We conducted a questionnaire survey, of childrenʼs dental caries and periodontal disease in RD test, and dental health examinations, provided Bangladesh and consider measures for improving instruction of brushing techniques, and told stories dental health and the necessity for dental health using illustrated picture cards to 40 second graders education and 56 third graders of S School in urban area of

─ 165 ─ 国際保健医療第 29 巻第 3 号 2014

Dhaka City and 30 second graders and 31 third In the RD test, the ratio of High at S School and the graders of T School in rural area who live traditional- ratio of Low at T School were high. Improvement of ly. The survey was conducted in January and June the status of oral cleanliness was recognized among 2013 at the same schools. students of S School in the survey conducted 5 ＜Results and Discussion＞ There were no significant months later. differences in frequency and time required for brush- Based on this research, it was recognized that dental ing teeth between S School students and T School health education that matches the local culture and students. However, the status of oral cleanliness, cultivation of human resources to exercise that gingivitis, and tartar deposition of S School students education are required for improving the dental was significantly worse than that of T School stu- health of people having different lifestyles/eating dents. habits.

Or-As-B02 Determinants of Antenatal Care Service Utilization in Bangladesh: Analysis from Bangladesh Demographic Health Surveys

Harunor Rashid1, Aminur Rahman2, Monjur Rahman2, MDH Hawlader1, Enbo Ma3, Yukiko Wagatsuma3

1Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan, 2Center for Reproductive Health, icddrb, Bangladesh, 3Faculty of Medicine, University of Tsukuba, Japan

Antenatal Care (ANC) has been advocated by three or more ANC from 12.4% to 26.0%. The rate World Health Organization (WHO) for safe pregnancy was significantly higher in urban mothers, educated, and birth throughout the world. Currently four younger, richer, and primi-grave mothers Those who focused ANC is advised by WHO for developing attended three or more ANC were more attended by countries. The rate is, however, not satisfactory in skilled birth attendants (65% vs. 17.4%) and showed Bangladesh. This study aimed to determine the higher facility delivery rate (69.6% vs. 18.6%). factors related to ANC service utilization. The study Adjusted odds ratio was 2.04 in urban, 8.77 in higher used the Bangladesh Demographic Health Survey educated and 2.10 in richer mothers. In conclusion, (BDHS) database from 1994-2011 surveys and there was a huge rich-poor gap in attending three or extracted maternal cases of 30,944 women. The more ANC. These information would be useful for BDHS had a large sample and used internationally policy makers to improve ANC service utilization in accepted method. The time trend was observed for rural Bangladesh.

Or-As-B03 Prevalence of Diabetic Retinopathy and Associated Factors in Chitwan District, Nepal

Shyam Shrestha1, Chitra Grung2, Shiddhart Josi2, Shinsaku Sakurada3, Takanori Hirayama4

1Friends of Shanta Bhawan, Nepal Medical Outpatients Clinic Research Group, Kathmandu, Nepal, 2 Department of Community Medicine and Public Health, Institute of Medicine, Tribuvan University, Kathmandu, Nepal, 3Bureau of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan, 4Department of Programme Support, Japan Anti-tuberculosis Association, Research Institute of Tuberculosis, Tokyo, Japan

Background Diabetic retinopathy (DR) is an emerg- and associated factors among known diabetics of 40 ing public health problem that is affecting all age years and above in Chitwan district, Nepal. groups, which leads to sight threatening complication Materials and methods Sample of 352 diabetic cases among diabetes. Community based, cross sectional were assessed from the pool of 1660 diagnosed cases, study was designed to assess the prevalence of DR by conducting six camps in Chitwan district. System-

─ 166 ─ Journal of International Health Vol.29 No.3 2014

atic random sampling method was adopted in each 12.76) chances of developing DR than those whose camp. Comprehensive eye examination was per- systolic blood pressure were controlled (＞ 140 formed by an ophthalmologist and DR was graded mmHg) (p ＞ 0.01). Similarly, chances of developing using a standard protocol- Early Treatment Diabetic DR was found to be 3.6 times higher (OR ＝ 3.6, Retinopathy Study (ETDRS). Bivariate and multivari- 95%CI: 1.898-7.083) among those whose blood sugar ate analyses were carried out for inference and alpha was not controlled (＜ 200 mg/dl) than among those error was set at 0.05. whose blood sugar level was controlled (＞ 200 mg/ Results The prevalence of DR was 16.5 percent. Age dl) (p ＞ 0.01). at onset of diabetes, uncontrolled blood pressure, Conclusion Uncontrolled blood sugar level and blood poor blood sugar control and duration of diabetes pressure are the associated key factors of DR, hence were found significantly associated with DR. Uncon- health promotion and comprehensive intervention are trolled systolic hypertension (＜ 140 mmHg) had recommended. more than six times higher (OR ＝ 6.00, 95%CI: 2.82-

Or-As-B04 Mothersʼ health seeking behaviors: Does mothersʼ education background influence the selection of modern medicine or traditional medicine? -An interview survey in Dhading district of Nepal-

UEZUMI JUNKO1, YASUHIDE NAKAMURA2

1ISHII MEMORIAL Aizen en Aizenbashi hospital, 2Department of International Collaboration, Graduate school of Human Sciences, Osaka University

The purpose is to clarify mothersʼ health seeking to treat sickness, they wanted to know whether any behavior in modern medicine and traditional evil spirit caused the sickness, and they were not medicine and to discuss the role of traditional medi- satisfied with MMP from their past experience. Some cine and modern medicine. Semi-structured inter- mothers said that she always went to see TH views were conducted to the Twenty eight mothers because her mother-in-lawʼs made her to do so. with under five children, Five THs (Traditional Mothers with less education tend to prefer TH Healers), and nine MMPs (Modern Medical Practition- because they were afraid that they could not ers) from village of Dhading district. The result understand MMPʼs instruction and dissatisfaction showed that most mothers used both TH and MMP with MMPʼs attitude. In the village in Nepal, where depending on the situation. Three mothers who had the modern medicine and the traditional medicine more than five years of education visited TH for the coexist, TH, who will be properly able to refer pa- first choice, whereas five mothers preferred MMP. tients to MMP, play an important role as a mediator Eleven mothers who had less than five years of between mothers and the modern medicine for education preferred TH for the first choice, whereas mothers to enhance the sense of security and the six mothers preferred MMP. The reasons for moth- satisfaction ers to visit TH included they needed an advice how

─ 167 ─ 国際保健医療第 29 巻第 3 号 2014

Or-As-C01 Development and dissemination of childrenʼs health check up system by using School Health in Lao PDR -understanding about importance of health check up and utilizing its data into health education -

SACHI TOMOKAWA1, TAKASHI ASAKURA2, SHOHEI KOKUDO3, Keosada NGOUY4, KHAMHEANG UTTHA4, LUDETMOUNSONE BOUAPHANH4, KANHAVONG BOUNSENG4, DOUANGCHANH PHOUMY4, KAZUHIKO MOJI5

1Faculty of Education, Shinshu Universiy, Nagano, Japan, 2Faculty of Education, Tokyo Gakugei, Tokyo, Japan, 3Graduate School of Human Development and Environment , Kobe, Japan, 4Faculty of Education, National University of Laos, Vientiane, Lao PDR, 5Research Institute for Human and Nature, Kyoto, Japan

Objectives This study aimed at development the schools. executable health checkup methods and its teacher’s Results and Discussion The data which unknown training in upper, lower secondary, and primary sex, insufficient records data were excluded. 1124 school in Lao PDR. In addition, the study aimed at boys (6years to 20 years) and 1288 girls (6years to 19 teachers has become possible to understand the years) data were analyzed. 64.4% in boys, 69.0 % in children’s health status and utilize the data to make girls were malnutrition (BMI score was less than an effective school health activities plan in the school. 18.0) .Low eye sight score (less than 1.0) in boys (right; Methodology This study was conducted in Septem- 9.2%, left 9.2%) and girls (right; 14.2%, left 14.0%) were ber, 2012, Vientiane, Lao PDR under the cooperation founded. Then, hearing disorder was clarified 3.9 % by faculty of education, National University of Laos. (right), 3.1% (left) in boys and 3.1 % (right), 3.2 % (left) The teacher’s training program was consisted by in girls. importance of health checkup and its data utilization, Conclusion Based on the results obtained, it was methodology and practical training in the school. In cleared that the necessity of malnutrition control and the health checkup, height, weight, eye sight and prevention of myopia through the school health in hearing ability were tested. Moreover, trained the future. In addition, it need that clarify the risk teachers were conducted health checkup in their factors to malnutrition and myopia.

Or-As-C02 Capacity development for administration in the provincial health development, Lao PDR

SAYAKA HORIUCHI1, 2, Boualai Ketchan3, Phosy Thongdy4, Shogo Kubota1, 5, Hironori Okabayashi1, 6

1The Project for Strengthening Integrated Maternal, Neonatal and Child Health Services/JICA/Lao PDR, 2Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan, 3Provincial Health Department of Sekong province, Lao PDR, 4Provincial Health Department of Attapeu province, Lao PDR, 5School of International Health, Graduate School of Medicine, The University of Tokyo, Japan, 6Bureau of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan

The Project for Strengthening Integrated Mater- improve the situation and avoid overlapping or slant- nal, Neonatal and Child Health Services works for the ing of activities, we supported establishing the plan comprehensive management of Maternal, Neonatal and monitoring system. Those tools helped the and Child Health (MNCH) affairs in four southern provincial MNCH section to understand the overall provinces of Lao PDR. Before initiating the project, affairs and coordinate with stakeholders. We have each activity was managed by the related develop- supported to extend this system to entire PHD in ment partner without a comprehensive plan or moni- Sekong and Attapeu provinces. Recapitulation: PHD toring of Provincial Health Department (PHD). To set up the Sector Working Group (SWG) forward to

─ 168 ─ Journal of International Health Vol.29 No.3 2014

the comprehensive management system and assigned the monitoring. However, this new system also leads the SWG secretariat to establish a comprehensive to the duplication of management systems because of plan and monitoring system. This new system re- insufficient integration with the vertical program, vealed eccentrically-located resources and promoted which discourages sections to participate in the SWG provincial staffs to coordinate with development activity. SWG needs to achieve compliance with the partners, fill the gap with the government budget or vertical program to involve more sections. Lesson work together with other sections which have learn: It is essential to think how to utilize the exist- operational cost. Furthermore, provincial staffs can ing system for the comprehensive management supervise districts according to problems found in rather than initiate a new system.

Or-As-C03 Challenges on managing the operational cost in the provincial health department, Lao PDR

SAYAKA HORIUCHI1, 2, Bounthanome Nakdouangma3, Somphanh Ouanvylay4, Hironori Okabayashi5

1The Project for Strengthening Integrated Maternal, Neonatal and Child Health Services/JICA, 2Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 3Provincial Health Department of Sekong province, Lao PDR, 4Provincial Health Department of Attapeu province, Lao PDR, 5Bureau of International Medical Cooperation, National Center for Global Health and Medicine

The Project for Strengthening Integrated low sense of responsibility to explain their activity Maternal, Neonatal and Child Health Services in Lao and request budget to the administrator. Second, the PDR/JICA has supported integrated MNCH services administrator didnʼt understand the activity well or provision at the outreach activity of National Immu- communicate enough with sections to ask for submit- nization Program in Sekong and Attapeu provinces. ting budget plan. To improve this situation, our Although the integrated service outreach was to be project explained the importance of managing budget initiated after getting sufficient budget, it didnʼt go as to the MNCH section and encouraged communicating planned because of inadequate budget allocation in with the administrator. The MNCH section has come the provincial health department (PHD). Previously, to checking and requesting needed budget and moni- operational budget was managed by each related toring budget allocation since they understand the section. On the other hand, the budget for the inte- budgetary procedure. The administrator also can grated service outreach is transferred to the PHD understand the activity through the discussion with together with other operational, administrative the section and allocate budget properly according to budget and the administrator, who is separated from the request. In case one administrator manage sections in charge of activity implementation, allo- several operational budgets, good communication in cates budget for each section. There are two main the PHD and close monitoring from sections are reasons the budget was not allocated properly. First, essential. the section in charge of activity implementation had

─ 169 ─ 国際保健医療第 29 巻第 3 号 2014

Or-As-C04 Historical transition and future on nursing education in Lao P.D.R.

MAYUMI HASHIMOTO1, 2, Phengdy Inthapanith3, Shengmany Khambounheng4

1Bureau of International Medical Cooperation, Japan, National Center for Global Health and Medicine, Tokyo, Japan, 2JICA project for Sustainable Development of Human Resources for Health to Improve MNCH Services, Vientiane, Lao PDR, 3Department of Health Care, Ministry of Health, Vientiane, Lao PDR, 4Department of Training and Research, Ministry of Health, Vientiane, Lao PDR

Background: One of the main challenges in health was launched in 2009 to achieve MDGs. Master’s and systems in Lao is human resources for health. Nurse Doctoral programs have not set up yet. About half of is the largest group of health professionals. the nursing teachers are technical diploma holder, Objectives: Overview the historical transition of and five percent of them are auxiliary nurses. In nursing and midwifery educations and discuss issues accordance with the Health Personnel Development for professional educations in Lao. Strategy and ASEAN Mutual Recognition Arrange- Methods: Documents review and key informants ments on Nursing Services, the MOH plans to interview develop a national competency for professional nurs- Results: The first nursing education was auxiliary es and competency based nursing education. nurse program in 1960. It did not have any entry Conclusions: Nursing and midwifery education requirements and any standards for curriculum and programs have several changed, and there are many training length until 1993. Several nursing education types of education curriculums. The MOH may need programs have been conducted since1970’s. Although to focus the development of competency based nurs- technical diploma with 2.5 years training length ing education on diploma with three years training accounts for the majority of current nursing educa- length for professional nurse production. The urgent tion, there are eleven nursing and midwifery educa- issue is quality of nursing teachers for the graduates tion programs. Midwifery education was combined who are the professionals and eligible to take national with nursing in past. Distinctive midwifery education licensing examination.

Or-As-D01 Present Situation and Future of Emergency Medical System in Lao PDR

YUSUKE WATANABE1, RIKI SATO1, TAKETO YAMAUCHI1, KEN KUBOMURA1, SHOTA FUKAI1, MIYUKI NISHIMAKI1, YUKI YOSHIDA1, AKIKA SAITO2, KENSUKE SUZUKI3, YUTAKA IGARASHI4, YUZURU KAWASHIMA5, MASAMUNE KUNO3, HISAYOSHI KONDO6, YUICHI KOIDO6, HIROYUKI YOKOTA4

1Dept of Medicine, Faculty of Medicine, Nippon Medical School, Tokyo, Japan, 2Graduate School Kokushikan University, Tokyo, Japan, 3Emergency and Critical Care Center, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan, 4Advanced Critical Care Center, Nippon Medical School Hospital, Tokyo, Japan, 5Mental Health and Disability Health Division, Department of Health and Welfare for Persons with Disabilities, Social Welfare and War Victims’ Relief Bureau, Ministry of Health, Labour and Welfare, 6Emergency and Critical Care Center, National Disaster Medical Center

Background: In Lao People’s Democratic Republic medical system in Laos. (Laos), emergency medical system is still developing Methods: A seminar on mass casualty incident was even though the number of traffic accidents is held for 78 health care providers in Laos in 2013, and increasing. According to the World Health Organiza- a questionnaire survey was conducted. tion in 2012, the mortality rate is 20.4 per 100,000 Results: The response rate was 95%. 87.8% of the people that is 3.9 times higher than that in Japan. respondent agreed with the introduction of an emer- Objectives: To analyze the present situation and clarify gency medical transportation by paramedics without demands and problems of introduction of emergency payment. The reasons why they agreed are as

─ 170 ─ Journal of International Health Vol.29 No.3 2014

follows: Allows immediate treatment of patients and are as follows: shortage of government budget (92.9%), improves their prognosis (96.4%), eliminates the need shortage of medical equipment in the ambulances and difficulties associated with family members (71.4%), shortage of doctors, nurses and staff in the bringing unconscious patients to the hospital, (82.1%), hospital (64.3%), long transport times due to traffic in reassurance of guaranteed patient transportation by the city (44.6%), difficulty in training emergency emergency medical technicians from home to the medical technicians (26.8%). hospital (82.1%), provides healthcare to those without Conclusion: Emergency medical system with free transportation (75.0%), provides transportation to transportation is desirable, but there are many issues those without knowledge of local hospitals (67.9%). to be addressed. The problems of the implementation of this program

Or-As-D02 Factors associated with the number of services provided through out-reach activity in the southern four provinces in Lao PDR

AZUSA IWAMOTO1, HIRONORI OKABAYASHI1, MITSUAKI MATSUI1, Kaisone Boupha2

12nd Expert Service Division, Bureau of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan, 2Ministry of Health, Laos.

Introduction and objective: The government of Lao centers provided all main components (five vaccines, PDR developed the 'Maternal Neonatal and Child vermicides and vitamin A, iron and folic acid and Health (MNCH) integrated package strategy 2009- four items of family planning) in their out-reach 2015', which intends to increase the number of health activity. However, 12% have deficit of some vaccines. services provided via first-line health facility and out- Non-availability of basic vaccines is related with the reach activity. Therefore, it is expected that the number of health staff in health center: four times number of health services will be increased after the higher (24% versus 6%) if the staff is two or less. To implementation of this strategy. Objective of this reiterate, main courses of 'deficit of vaccines' would study is to determine the factors associated with the be less number of the labour force in a health center provision of health services, especially through out- and/or inappropriate management at district health reach activities. Methods: Quantitative method with office/health center. Conclusion: To provide MNCH self-administered questionnaire was employed to services at health centers, we should consider the measure the service provision at all the health balance of equity and integration in the resource- facilities in the four provinces (Champasak, Salavan, limited setting. Since the integration strategy might Xekong and Attapeu). The target facilities are 4 pro- widen the gap between rich and poor, urban and vincial hospitals, 26 district hospitals and 159 health rural areas. centers. Results: Fifty-seven percent of all health

─ 171 ─ 国際保健医療第 29 巻第 3 号 2014

Or-As-D03 Experience of Providing a Seminar on Mass Casualty Incident in Lao PDR

RIKI SATO1, YUSUKE WATANABE1, TAKETO YAMAUCHI1, KEN KUBOMURA1, SHOTA FUKAI1, MIYUKI NISHIMAKI1, YUKI YOSHIDA1, AKIKA SAITO2, KENSUKE SUZUKI3, YUTAKA IGARASHI4, YUZURU KAWASHIMA5, MASAMUNE KUNO3, HISAYOSHI KONDO6, YUICHI KOIDO6, HIROYUKI YOKOTA4

Background: In Lao People’s Democratic Republic pharmacists, 24 other health care providers, and 5 (Laos), the morbidity and mortality from traffic medical students. The response rate was 100%. accidents is increasing as a result of worsening Results: 82% of the participants strongly agreed and transportation conditions that comes with its rapid 18% agreed with the usefulness of the lecture on economic growth. The level of medical care is still disaster medicine. 23% strongly agreed and 52% low in Laos, especially in the case of mass casualty agreed with the usefulness of the lecture on MCI. incident (MCI) and the medical education on MCI is 62% strongly agreed and 27% agreed with the insufficient. usefulness of the whole seminar. 73% strongly agreed Objectives: To educate healthcare providers, including and 16%agreed that it is worth continuing this semi- medical students, about MCI by holding a seminar nar in Laos. and to evaluate its effectiveness by aquestionnaire . Conclusion: A majority of the responders believed Methods: The seminar on MCI was held for 78 health that a seminar on MCI is useful for health care care providers, including medical students, and a providers in Laos and that there is value in continu- questionnaire survey was conducted to 56 of those ing this in the future. who attended. They consist of 14 doctors, 5 nurses, 4

Or-As-E01 Model development of community-based DOTS and health system strengthening in Myanmar-Successful outcome of the JICA Major Infectious Disease Control Project

NOBUKATSU ISHIKAWA1, HIROYUKI NISHIYAMA1, Lwin Thandar2, Kyi Hla Hla3, AKIRA SHIMOUCHI1, KOSUKE OKADA1

1Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan, 2Program Manager, National TB Program, Ministry of Health, Myanmar, 3Pyinmana Township Hospital, Pyinmana, Nay Pyi Taw, Myanmar,

TB is a major health problem in Myanmar. (CHVs) were selected by the local leaders or basic Though the country expanded DOTS widely, TB health units. They were given the training for case detection rate has been as low as 60%.National providing health education to the community, referral TB Program needed to promote case-finding more at of the symptomatic patients to the health unit, and community level. A pilot trial as a model for support for the regular treatment. Every 6 month, a community-based DOTS was explored under the workshop was organized with the review of the JICA infectious disease control project. (Method) activities and discussions on the problems and solu- Pyinmana Township was selected because of the tions. All level of people including top manager of location and leadership of the top management of health, hospital TB unit, midwives of the basic health health services, and 29 community health volunteers unit, community administrators, CHVs participated in

─ 172 ─ Journal of International Health Vol.29 No.3 2014

the workshop. As the rewards to the CHVs, non- TB patients increased 10-20%.The activities and monetary incentives such as training, certificate, processes were analyzed for wider expansion. Partici- badge, umbrella, and teaching material were given pants concluded that this approach is feasible and for the CHVs. (Results) After 2 years of the pilot can be expanded to other areas. Thus Pyinmana activities, the number of the symptomatic patients model has been adopted in the national guidelines. referred by the CHVs increased and the diagnosed

Or-As-E02 The activities for strengthening the capacity of Basic Health Staff (BHS) in Myanmar-Through the introduction of systematic training management-

CHIYOKO HASHIMOTO1, 2, SHIGEKI HANAFUSA1, 2, HITOSHI MURAKAMI1, TOSHIO AKIBA3, HIROKO BABA1, CHIAKI MIYOSHI1

1Expert Service Division, Bureau of International medical Cooperation, National Center for Global Health and Medicine. Tokyo, Japan, 2The Project for Strengthening Capacity of Training Teams for Basic Health Staff, 3Kyusyu University of Health and Welfare, Miyazaki, Japan

(Background) In Myanmar, the health workers, so management and teaching methodologies with the called [Basic Health Staff (BHS)], play a key role for formats for the training plan and reports. Monitoring providing public health and disease control services. activities were conducted through the supervision The capacity building for BHS is the essential part of from the state and regional level to the township health policy. In-service training conducted, which is level. (Findings and Discussion) The beginning stage held on the pay day at the end of each month, as the of the project, a few townships conducted the important occasion for the BHS. Since 2009, Ministry trainings with written plan and objectives. While in of Health, Myanmar with support from Japan 2013 all the pilot townships conducted the trainings International Cooperation Agency (JICA) launched in line with written plan and objectives. The decision the project which aimed to improve the training making process for training topics shifted to be taken quality for BHS through the introduction of system- by the training teams. In addition, almost all the atic training management. (Materials and Method) training records were submitted to the state and Targeted area roughly covered an half of the whole region level. It is suggested that the regular end of country. The project trained the township training month occasions became recognized as effective in- team leaders and the focal persons of the training service trainings with more systematic training activities. The training topics contained training management.

Or-As-E03 South-South cooperation on HIV/AIDS program -A case study of the support from Thailand to Uganda-

WATANABE TOMOKO1, 2, NAKAMURA YASUHIDE1

1Graduate School of Human Sciences, Osaka University, Osaka, Japan., 2Japan Society for the Promotion of Science, Research Fellowship for Young Scientists.

Background: “Okinawa infectious disease initiative” ation Agency (TICA) supported by Japan Interna- was launched in Kyushu-Okinawa Summit in 2000, tional Cooperation Agency (JICA) for African and South-South Cooperation (SSC) was addressed. countries, especially Uganda. The objective is to see Objectives: This study focused on the third country how participants applied their experiences to their training program of “International Training Course countries. on STIs Case Management Skills” (2008-2010) organ- Methodology: Semi-structured interviews were ized by Thailand International Development Cooper- conducted in Thailand in August 2012 and January

─ 173 ─ 国際保健医療第 29 巻第 3 号 2014

2013, and in Uganda from February to March 2013. revised and promoted since the Aetiological approach Result: Nine participants of the program, one officer used in Thailand was not suitable to Uganda. from NGO, three officers from JICA and 100 people Discussion: Economic gap and unpreparedness of the from the community were interviewed in Uganda receiver are problems in SSC. In HIV/AIDS, religious and five officers from TICA in Thailand. The results beliefs on the condom use and the government policy showed that the training how to approach Commer- on CSW also need to be considered. Participants cial Sex Worker (CSW) was well accepted by partici- modified what they learnt acceptable to their eco- pants. The clinic for CSW was newly built learned nomic situation. Possible factors that made this case from the public health center in Thailand, although successful to Uganda were every participant was the sex industry was unacceptable in Uganda. The colleagues, and other participating countries had guidelines for the Syndromic management was similar socio-cultural background.

Or-As-E04 Cluster Randomized Controlled Trial on Salt Reduction Intervention in Chiang Rai, Thailand

Motoyuki Yuasa1, Supalert Nedsuwan2, Saiyud Moolphate3, Hidehiro Yokokawa4, Yoshihisa Shirayama1, Eiji Marui1

1Department of Public Health, Juntendo University School of Medicine, Tokyo, Japan, 2Department of Social and Preventive Medicine, Chiang Rai Regional Hospital, Chiang Rai, Thailand, 3School of Public Health, Chiang Mai Rajabhat University, Chiang Mai, Thailand, 4Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan

Objective the participants; (3) a dietitian assisted small group The objective was to compare the effectiveness health education classes in cooking meals with less of health education via visualization of salt content in salt. food, soup and urine, with routine health education Results among high-CVD-risk diabetic and hypertension At baseline, the sodium amount had no differ- patients. ence between the intervention group (n ＝ 402) Methods 10.1+-2.7g and the control group (n ＝ 393) 10.0+-3.1g. A cluster randomized trial was conducted with a After the first health education, the intervention total of 800 high-CVD-risk patients attending diabetes group (n ＝ 389) had less sodium 8.9+-2.6g than the and hypertension clinics at health centers in Muang control group (n ＝ 394) 9.4+-2.9g (p ＜ 0.01, t-test). District, Chiang Rai province, Thailand. Patients with After the second health education, the intervention a Framingham score higher than 15% were studied group (n ＝ 374) had less sodium 9.0+-2.6g than the with informed consent. Ethical approval for this control group (n ＝ 379) 9.5+-2.9g (p ＜ 0.05, t-test).The study was obtained from Juntendo University and health education via visualization of salt content Chiang Rai Regional Hospital. showed a better salt-reduction result, compared with Within the intervention group, (1) salt content in the routine health education. the daily diet was measured using a ATAGO hand- This study was conducted with the help of held pocket salt meter; (2) 24-hour salt intake was grant-in-aid from the Japanese Ministry of Health, estimated in overnight-collected urine (using a KME- Labour, and Welfare. 03 intake salinity checker) and the results shown to

─ 174 ─ Journal of International Health Vol.29 No.3 2014

Or-As-F01 The recognition of medical coordinators participated in disaster relief operations

RIKA MINAMIJIMA1, AYUMI YAMAMOTO2, YOKO HANADA2, KOICHI SHINCHI2

1Department of Nursing, Saga University Hospital, 2Division of International Health and Nursing, Faculty of Medicine, Saga University

Background: The system of medical relief activity in of the interview. And three related factors were large scale disasters have been improved and identified from the analysis. The factors were “The established since the Great Hanshin Earthquake in factors influenced the role recognition”, “The ability 1995. The medical teams have coordinator for effec- used for the mission”, “and Negative feelings in the tive medical activities including logistics. activity period”. Method: Subjects were 4 medical coordinators who Discussion: The merit of having several coordinators participated in the disaster relief operations. The from different background is following: Effective author distributed a self-administered questionnaire medical relief operation with various skills and ability, to them, and we conducted interview about the role Mental health care and management, and Logistic recognition as a medical coordinator. This study functions. It is necessary for coordinators to have a period was from July 1 to October 30, 2012, chance of education and discussion after the medical Results: Eight categories of the role recognition of relief operations for the future effective disaster relief medical coordinators were clarified from the analysis activity.

Or-As-F02 On Humanitarian Medical Assistanceʼs (HuMAʼs) 2012-13 Philippine Typhoon Bopha disaster victim medical support activities: Making a significant contribution even in short-term medical support

MASAMUNE KUNO1, 2, Takayuki Irahara1, 2, Norifumi Ninomiya1, 2, Tomoteru Natsukawa1, Kimiko Yamashita1, Soichiro Kai1, Taichi Takeda1

1Humanitarian Medical Assistance: HuMA, Tokyo, Japan, 2department of emergency & Critical care medicine, Nippon Medical School Tamanagayama hospital, Tokyo, Japan

Background After Typhoon Bopha struck the Oriental Province, on Mindanao Island. Medical con- island of Mindanao in the southern Philippines on sultations were held on a total of 23 days and there December 4, 2012, over 6.2 million people were re- were a total of 3692 visits. Chief complaints were ported to be affected, over 1,800 people were report- acute respiratory infection (60.3%), musculoskeletal ed dead or missing, and approximately 0.8 million system symptoms (16.6%), headache (13.5%), and people were evacuated. Initially. WHO survey report- diarrhea (7.0%). In addition, we provided education on ed that over half of more than 200 medical institu- hygiene. At the completion of the activities, we tions could not function sufficiently. Due to this, donated drugs and submitted a report. HuMA dispatched medical teams from January 1 to Discussion & Conclusion For support activities to 31, 2013. be meaningful, it is necessary to at least not lose Results of activities The primary investigation sight of the fact that they are being carried out for evaluated whether there were unmet medical needs, disaster victims, and it is also necessary to prior selected sites, and secured logistics. Due to this, investigation and submit a report about results of the rotating medical consultations were performed in the support activities. north of Compostela Valley Province and Davao

─ 175 ─ 国際保健医療第 29 巻第 3 号 2014

Or-As-F03 Role of Rehabilitation Specialists in Reconstructing Period after Disaster- Through Experiences from the Great East Japan Earthquake-

MAKOTO KONO1, NOZOMI CHIWAKI2, RUMI SUNOHARA3, KAORU ISHIMOTO4, NODOKA MIURA5, NORIKO MORISHITA6, ATSUKO NISHIMOTO7, MASAKANE KUDO8, MAMIKO KIKUCHI9, CHIHIRO TOMITA10, RIARI TABATA11, AYAKA HOSHIYA12, AYAKO MATSUO13, HIROYUKI ISHII1

1Faculty of Health Sciences, Kyorin University, Tokyo, Japan, 2Teikyo Heisei University, Tokyo, Japan, 3Nagano Rehabilitation College, Nagano, Japan, 4Asian Research Centre for Social Well-being and Development, Nihon Fukushi University, Nagoya, Japan, 5International University of Health & Welfare, Odawara, Japan, 6Nippon Medical School Hospital, Tokyo, Japan, 7Keio University, Tokyo, Japan, 8Graduate School of Nihon Fukushi University, Nagoya, Japan, 9Japan Overseas Cooperation Volunteer, 10Tokyo Medical University Hachioji Medical Center, Tokyo, Japan, 11Koshi Rehabilitation Hospital, Toyama, Japan, 12Kyorin University Hospital, Tokyo, Japan, 13Kitahara Rehabilitation Hospital, Tokyo, Japan

Authors have provided supports for refugees : Since July 9th, 2011 till now due to the Great East Japan Earthquake for more : 177 therapists involved in 94 times of activities than 2years.Purpose of this report is to make recom- totally mendation to use rehabilitation specialists for disaster 2. Support for refugees from the nuclear plant acci- response in reconstructing period. Authors have dent in Fukushima provided supports for refugees due to the Great East : Since September 11th, 2011 till now Japan Earthquake for more than 2years. Purpose of : 149 therapists involved in 42 times of activities this report is to make recommendation to use reha- totally bilitation specialists for disaster response in recon- As conclusion, authors are recommending 2 structing period. types of activities as support by rehabilitation spe- As support activities in the reconstructing peri- cialists in reconstructing period. The first are activi- od after the disaster, the followings have been ties to have diversion and health for refugees. The implemented; others are activities to make community active and 1. Collaboration Activity with AAR Japan to facilitate mutual supports among refugees.

Or-As-F04 The social vulnerabilities of older people after the Great Eastern Earthquake

OKAMOTO NAHOKO1, 2, GRAINER Chieko1, SOBU Ayaka 3, FUJIMURA Shihoko3, Hashi Hidenori4

1International Nursing Sciences and Disaster Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan, 2National Institute of Public Health, Japan, 3Iwate Prefecture University, 4Non Profit Organization Yuaikai

[Background]: There have been numerous studies have indirect effects on the mortality of the Japanese conducted in Japan on the mortality of older people elders through their linkages with chronic diseases, and its links to social relationships. Social participa- functional status, and self-rated health. tion is shown to have a strong impact on mortality, [Objective]: The overall objective of the research is and this effect remains statistically significant when to gain a detailed understanding of the social other factors are considered. Social participation, vulnerabilities on older people a year on they faced social support, and feelings of loneliness are found to and continue to face as a result of their displacement

─ 176 ─ Journal of International Health Vol.29 No.3 2014

or their continued residency in affected. area M, men under 75 and females, and in area I [Methods]; Cross-sectional survey by anonymous females tended to reply that the amount of interac- questionnaire was conducted with 216 older people tion with others increased after the earthquake. Men who are living in temporary houses or continuing over 75 tended to reply that the amount of interac- residency in affected area from January through tion with other decreased after the earthquake. March 2013 to identify the social vulnerabilities they [Conclusion]; Older people faced common social faced. challenges between male and female, but they have [Results]; Man tended to reply that the amount of gender differences. Consideration of Gender culture interaction with others increased after disaster in and each evacuate condition.

Or-As-G01 International Town Health Care Room in Hyogo: health promotion for foreign residents

Nasu Junko1 Lee Kumsun2 Kurotaki Akiko3 Kinkawa Mari4 Nakata Ryoko5 Inoue Kiyomi5 Kanbara Sakiko6 Yamamoto Aiko3 Wu Xiaoyu3

1Graduate School of Nursing, Toho University, 2College of Nursing Art and Science, University of Hyogo, 3Research Institute of Nursing Care for People and Community, University of Hyogo, 4Department of Nursing, Ube Frontier University, 5Faculty of Health Sciences, Kobe Tokiwa University, 6Faculty of Nursing, University of Kochi

In 2011 the population of foreign residents was and this is its international version registered as one over 2 million, 2 % of total population in Japan. Hyogo of the groups that offer free health consultation. The is one of the prefectures with a large number of for- main purpose of the international room is to provide eign residents and ranks top 7 out of 47. Over 97,000 opportunities for all the foreign residents of all ages foreigners reside in Hyogo in 2012 and live various to feel free to come and have health check-ups, and lifestyles. We organized the town health care room to talk about anything. Nursing faculty members for foreigners at the Research Institute of Nursing from a several universities are assigned to the Care for People and Community, University of Hyogo, consultation. in September 2012. The room is called 'The Among 70 visitors 67 people provided their International Town Health Care Room' which has information. 43 were Chinese, and the rest were been held 5 times every month from September 2012 Hong Kong, Thailand, and the USA et al. The num- to January 2013. This presentation reports the over- ber of the cases of consultation was 373, and the most view of our practice and discuss about the future frequent issues were about their results of health perspectives. check-ups on that day, and their previous or current The Town Health Care Room is a new system health issues including mental problems. originally organized by Hyogo Nursing Association,

Or-As-G02 Medical Interpreter Services in Japan; For Residents with Limited Japanese Proficiency vs. For Medical Tourists from Foreign Countries

RIE OGASAWARA, YASUHIDE NAKAMURA

Graduate School of Human Sciences, Osaka University, Osaka, Japan.

Over the past few decades, the number and di- long-term residents, travelers, and medical tourists versity of patients with limited Japanese proficiency who come to Japan with the purpose of receiving has been increasing in Japan. These patients include some kind of medical care. The medical interpreter

─ 177 ─ 国際保健医療第 29 巻第 3 号 2014

services to support residents have been provided medical interpreters for it may be expected to act mainly by areal NPOs/NGOs using registered volun- like a concierge to attend the patient as a guest. teers with the spirit of humanitarian assistance to Although the current expectation to medical inter- protect minoritiesʼ human rights. In this case, medical preters is different, the core mission of the medical interpreters play a role of a social worker as needed. interpreters must be the same. The most important On the other hand, the medical interpreter service thing for the future is to be recognized as a profes- for the medical tourism seems to be different. The sional and to work as a member of the team with medical tourism is officially expected to make an eco- physicians, nurses, pharmacists and any other staffs nomically significant contribution to Japan, and in the clinical settings.

Or-As-G03 The relationships between stress of living in Japan and premenstrual syndrome (PMS) among international female graduate students

CHIZURU HIGASHI1, SHIGEMI IRIYAMA2

1Meijyou Hospital, Department of Nursing, Nagoya, Japan., 2Department of Nursing, Graduate of Health Sciences, Nagoya University, Nagoya, Japan.

Objective: This study was conducted in order to had been in Japan less than 12 months (56.3%). 17 examine the relationships between life stresses in students (23.9%) answered “Moderate PMS” symp- Japan and premenstrual syndrome (PMS) among toms. 54 students (76.1%) answered “No or mild PMS international female graduate students. “symptoms. The ILS score of students with “moder- Methods: 71 female graduate students with informed ate PMS” (70.59 ± SD10.17) was significantly higher consent completed a self-administered questionnaire than the ILS score of the students with “no or mild in Japanese and English from May to June 2012. The PMS” (62.24 ± SD14.89). In addition, there was a items of the questionnaire consisted of socio- positive correlation between social symptoms related demographic characteristics, the length of time living to PMS and the ILS scores. in Japan, PMS symptoms, Japanese and English Conclusion: This study suggests that international language ability, menstrual cycle, and ILS score for female students who feel strong stress in their daily daily stress. This study was approved by the Ethics life are likely to have a high level of PMS symptoms. Committee of the Nagoya University. The study also suggests that daily life stress influ- Results: The mean age of the subjects was 25.7 years ences in social symptoms related to PMS in regard to (SD 4.2). About 50% of students were from China. relationships with college friends, family member, Regarding their length of stay in Japan, 40 students and social activities.

Or-As-G04 Current situation of health care in prisons in Japan

KEIKO YANAI

The Japanese Red Cross Kyushu International College of Nursing, Fukuoka, Japan

This article discusses the necessity and possibili- Japan, the legal system is based on the principle of ties of introducing correctional nursing in Japan. The liability; treatment given to an individual varies court decision on a lawsuit over a suicide committed greatly depending on the ability to be held criminally inside a Japanese prison is analyzed from the responsible. A person judged as able to take respon- grounds of health care delivery in Japan and com- sibility for his own actions will be confined in prison pared to other suicide cases. In addition, a compara- while a person judged as unable to take such tive analysis based on recent American correctional responsibility, will not be penalized, moreover, will be nursing research is conducted to explain the expect- referred to a designated psychiatric hospital and ed roles of nurses working in prisons in Japan. In receive treatment if necessary. No more than 1% of

─ 178 ─ Journal of International Health Vol.29 No.3 2014

cases accused of penal code offenses are judged in must deliver nursing care to prisoner patients; the latter group. However, it is not uncommon to find considering the execution of their sentences, their prisoners with psychiatric conditions. Many of the mental health condition and their human rights to prisoners subjected to isolation and strict watch over, prevent illness, suicide attempts and related develop serious mental illness. Medical prisons are problems. Other countries experiences may be useful located inside prisons in fulfillment of the Japanese to evaluate the role of nurse. Medical Law. Nurses working in these institutions

Or-As-H01 Delivery mechanisms of antenatal care: a multinational comparative study in Japan, Lao PDR and Vietnam.

YUMIKO TANAKA, HITOSHI MURAKAMI, CHIEKO MATHUBARA, TOMOMI MIZUNO, YASUKO SATOU, KIMIKO INAOKA

Bureau of International Medical Cooperation, National Center for Global Health and Medicine

Objective This study aimed to extract success fac- tions. In Lao PDR and Vietnam, community organiza- tors and issues in ensuring antenatal care (ANC) at tions and collaborators (e.g. women’s union and community level both in Japan and in developing village health workers) notified people of the ANC. countries. Comparing service contents, Japan put emphasis on Method The study used semi-structured interviews mental and social supports whereas Lao and Vietnam of health officers in charge of maternal and child placed more emphasis on public health interventions health (MCH) in 7 municipalities in Japan and 4 such as inoculating tetanus toxoid and supplementing districts each in Lao PDR and Vietnam. iron, folic acid and vitamin A. Results For locations of ANC, hospitals and clinics Conclusions The pregnancy registration is consid- played a central role in Japan whereas community ered feasible in Lao PDR and Vietnam given existed health centres did in Lao and Vietnam. For service health education for newly married couples and providers, obstetricians and registered midwives pregnancy tracking in these countries. Conversely, provided ANC almost exclusively in Japan whereas the public health approach adopted in these countries assistant doctors and midwives with a short training may have potential advantages in Japan if applied to did in Lao and Vietnam. For the notification of the relevant issues such as smoking cessation during ANC opportunities, Japan issued an MCH handbook pregnancy. and ANC coupons at the time of pregnancy registra-

Or-As-H02 The role of maternal and child health handbook in Central Java in the effort to ensure equity in health services

Keiko Osaki1, Anung Sugihantono2, Wahyu Setianingsih2, Soewarta Kosen3, Endang Indriasih3

1Japan International Cooperation Agency, Tokyo, Japan , 2Central Java Provincial Health Office, Semarang, Indonesia, 3Central Java Provincial Health Office, Semarang, Indonesia, 4National Research Center for Health Development, Ministry of Health, Jakarta, Indonesia, 5National Research Center for Health Development, Ministry of Health, Jakarta, Indonesia

Objectives To ensure equity in maternal and child has potential to facilitate service uptake by remind- health (MCH) services still remains as a challenge in ing clients and health personnel. This analysis aims: 1) Indonesia. Central Java province has an integrated to explore prevalence of the MCHHB in Central Java; form of home-based records, called BUKU KIA (the 2) to examine roles of the MCHHB in terms of service MCH handbook: MCHHB) since 1990s. The MCHHB uptake; and 3) to draw out lessons for further utiliza-

─ 179 ─ 国際保健医療第 29 巻第 3 号 2014

tion of the MCHHB in Central Java. Results 1) Prevalence of the handbook in the Method With cross sectional data of Indonesian Basic province were higher than national in 2007 (63.0% vs. Health Survey (RISKESDAS) 2007 and 2010, chi- 39.1%), and 2010 (77.0% vs.56.7%). 2) 2010 provincial square statistic analysis was conducted to obtain data suggests that MCHHB ownership is associated odds ratio (OR) with 95% of confidence interval (CI), with i) attended birth and continuity of care for stratified by mother’s educational background. mothers who did not complete primary school (0-5 Independent variable is ownership of the MCHHB. years), and ii) child immunisation completeness for Dependent variables are: 1) assisted delivery by mothers who completed primary school (6-8, 9-11, health personnel; 2) facility delivery; 3) continuity of 12+). care from pregnancy, delivery to newborn); 4) Conclusion Associations between the MCHHB and completeness of child immunization; and 5) continuity multiple service uptake were observed, and were of immunization before and after birth. differently observed according to mother’s education.

Or-As-H03 Preliminary study on visualization of attained performance of timely and complete reporting in the routine health information system: A case study of Field Health Services Information System in the Philippines

SHINSUKE MURAI1, YUMI ISHII1, RAY JC. VENTURA2, JULITA T. GAITE2

1Division of International Health, Graduate School of Medicine, Tohoku University, Japan, 2Provincial Health Office of Palawan, Puerto Princesa, Philippines

Background Results Delayed reporting in routine health information Overall proportion of report submissions was systems (RHIS) has hindered organizational learning 98.3% (1125/1144). The date of submission was availa- in health systems. RHIS has been repeatedly updat- ble for 92.8% (1044/1125) of the submitted reports. ed. Nevertheless its performance is rarely tracked The implementation year showed lower perfor- over the operation. The present study aimed to visu- mance from third to 20th week (p ＜ 0.01). For the alize the attained performance of timely and subsequent 12 years, randomness of annual reporting complete reporting in RHIS by taking a case of Field rate was not rejected (p ≥ 0.05), excepting for Health Services Information System (FHSIS 1996) in negative trend at second week, and positive trend at the Philippines. ninth and 10th week. Overall cumulative reporting Methods rate reached 1.00 at 21st week (141st day). The Dates of submission of quarterly reports from all largest difference between 99% upper and lower 22 health centers (RHUs) in Province of Palawan limits was 0.50 at third week (17th day). were reviewed for 13 years operation of FHSIS 1996. Conclusions Annual cumulative reporting rates were computed Attained performance of RHIS widens an im- daily until they reached 1.00. Randomness was exam- provement opportunity by introducing a gauge of ined across year. A beta distribution was applied to usual and unusual performance. It is expected to estimate 99 percent upper and lower limits of annual allow RHIS managers to set more realistic goal ac- reporting rates. cording to their responsibility and available resource.

─ 180 ─ Journal of International Health Vol.29 No.3 2014

MAKOTO SEKIHARA1, MASAHIRO KIHARA2, MASAKO KIHARA2, TAKAHIRO TSUKAHARA1, HIROYOSHI ENDO1

1Tokyo Women’s Medical University, Tokyo, Japan, 2Kyoto University, Kyoto, Japan

Malaria is one of the most important cause of workers) who had an interview. Twenty-two codes death of children under five years old in Papua New and six categories emerged from the mothers, and Guinea (PNG). Strengthening malaria control in PNG nine codes and two categories from the healthcare is therefore urgently needed. This study aims identi- workers. We found a perception gap between fy social factors that constrain treatment-seeking mothers and healthcare workers, which had a behavior of mothers living in urban area in PNG from negative impact on treatment-seeking behavior. To the mothersʼ and the healthcare workersʼ perspec- ease the gap between them, we urge to reduce the tives. This is mixed method study using a structured discriminating consciousness of healthcare workers, interview questionnaire, semi-structured interviews and a change of medical-examination wording and and a complementary participantʼs observation, and attitude toward mothers of the slums working at the targeting mothers of children under five years old market. Finally, we recommend that the Health and and healthcare workers at three health facilities from Education Department may create a manual with a East Sepik Province, in Wewak, PNG. In total, we representative model of treatment-seeking behavior recruited 128 (85.3%) out of 150 who answered a and implement systematic educational opportunities questionnaire and 43 (25 mothers and 18 healthcare such as school and community awareness programs.

Or-Af-A01 Implementation of Pilot Project for Electronic Medical Record on Basic Health Care Services in Kenya

KAORI SAITO1, TOMOHIKO SUGISHITA1, 2, Haskew John3, Odhiambo George4

1Project for Strengthening Management for Health in Nyanza, Kenya, 2Japan International Cooperation Agency, 3Oxford University, England, 4Kisumu West District Health Management Team

[Objective] The pilot project of MCH EMR was every day and can be seen in the website. implemented from April to June 2013. The target [Result] 937 ANC clients, 200 deliveries and 301 was 5 health facilities in Kisumu West district, Nyan- children were enrolled into MCH EMR from 2nd za Province. The objective was to know the feasibili- April to 21st June. Even though implementation ty of MCH EMR at primary health facility and the period was 3 months only, it showed all 5 health possibility of improving data quality and service facilities were able to operate MCH EMR. The quality through MCH EMR. reduction of missing data by using verification [Method] In the pilot project, the target clients were function was observed.[Conclusion]The implementa- ANC clients, delivery and newborn babies. Their tion period was too short to observe the improve- information written in MCH Booklet after they were ment of the quality of MCH services. However, MCH seen by nurses was entered into MCH EMR by data EMR has a potential of contributing to improving the entry assistant who was employed by JICA project. quality of MCH services. It is important to improve The individual information entered into the MCH basic health care services through expanding the EMR is protected safely in the cloud-based server pilot of the EMR with employment of data entry and anonymized version of the database is updated assistants.

─ 181 ─ 国際保健医療第 29 巻第 3 号 2014

Or-Af-A02 Health Systems Management towards achieving Universal Health Coverage in Kenya

TOMOHIKO SUGISHITA1, 2, Naoko Ishii2, Mikihiro Toda2, Kaori Saito2, Yoshito Kawakatsu2

1Senior Advisor (Health), Japan International Cooperation Agency, 2JICA SEMAH Project, Kisumu, Kenya

JICA SEMAH Project (Project for Strengthening leadership, strategic management, health promotion, Management for Health in Nyanza Province, July interactive dialogue and whole systems approach to 2009-June 2013) aimed at fostering managerial articulate mindset change and organizational devel- capacities in provincial and district health manage- opment in the health sector. After four years implement teams (37 teams, 400 health mangers) in mentation, essential health service deliveries in Nyanza Province (population: 6 million), Kenya. The Nyanza increased 28% in average and some pilot Project packaged health systems management with districts recorded more than 50% increase. Kenya leadership and management training, managerial initiated Kenya Institute for Health Systems Manage- working groups, mentoring support and horizontal ment as a backbone of managerial capacities in the learning and institutional arrangement. The evolution devolved health systems towards achieving universal of health systems management induced servant health coverage.

Or-Af-A03 The role of birth attendants in rural area in Sierra Leone

CHIEMI FUJII, YASUHIDE NAKAMURA

Dept of International Collaboration, Graduate School of Human Sciences, Osaka University, Osaka, Japan

＜Background＞ Recently in Sierra Leone, delivery made for 21 SBAs, 60 TBAs, and 300 mothers. at home by Traditional Birth Attendants (TBAs) is ＜Findings＞ 62.0% of mothers delivered at home by no longer encouraged by government in terms of TBAs and 51.0% among them chose TBAs for trust. hygiene and risk managements. Therefore, the role of In the case of delivering in the health facility, 60.8% TBAs is confined to conduct delivery with Skilled of mothers stayed within 1Km and 21.2% did more Birth Attendants (SBAs) in the health facility. than 1Km from the health facility. However, 70% of pregnant women deliver at home ＜Discussion＞ In rural area in Sierra Leone, access by TBAs. When the situations in rural area are to the health facility is very difficult due to lack of considered, is it really possible to conduct all deliver- infrastructure and the condition of the road especially ies in the health facilities? The objective is to investi- at night and in the rainy season. Moreover, pregnant gate the role of birth attendants in rural area from women and community people deeply trust in TBAs. the viewpoint of both birth attendants and pregnant Under this circumstance, strengthening the govern- women. ment’s policy was thought to be difficult. Further ＜Methods＞ The study was conducted at Kambia discussion about how TBAs will be positioned in the District in Sierra Leone in March 2013.The semi- health system is required from now on. structured interview and the questionnaire were

─ 182 ─ Journal of International Health Vol.29 No.3 2014

Or-Af-A04 Health system revue in Republic of Burundi

Kayo KANEKO

Expert, Burundi, JICA

＜Purpose＞ To understand the current situation of delivery rate (64.4%) is improved. But, early antenatal health system, and to make recommendations. care coverage (12.9%) and postpartum care coverage ＜Method＞ Secondary literatures revue and non- after 24 hours from delivery (4.9%) are extremely structured interview to stakeholders based on WHO low. This was considered as the indirect factors of health system monitoring framework. postpartum hemorrhage and uterus rupture. HRS: ＜Results＞ Governance: Free health care for Midwife shortage is significant. There are only 16 mother/child, and Performance Based Financing midwives in regard to 5957 nurses. Furthermore, (PBF) made a positive impact, but its sustainability is 64% nurses are A3, and 30 % nurses are A2. HMIS: still challenging. As numerous small interventions are Credibility of the HMIS data is low because of available in MCH sector, coordination capacity rein- improper use of registers and others reasons. There- forcement is ambitiously needed. Finance: Proportion fore, PBF system has been individually established. of Health sector budget (7.7%) for governmental Two information systems increased Health workers’ budget is increasing, although proportion of partner’s reporting times. Pharmaceutical: 90% of health budget is still high (40%). Service delivery: Referral facilities keep necessary drug for emergency system is vulnerable. The number of patients of obstetric care. Blood transfusion center is functioning tertiary health facility is high, because of the absence at six locations across the country and blood donation of regulation which can limit patient acceptance, and center is functioning in 49 locations nationwide. dysfunction of secondary health facility. Facility

Or-Af-B01 Linkages of HIV care process and factors of Lost to follow up at primary health facility in Zambia.

MIKI UTSUSHIKAWA1, VINCENT CHIPETA2, SHINSUKE MIYANO3

1Japan Overseas Cooperation Volunteers, 2Kalomo District Medical Office, Kalomo, Zambia, 3National Center for Global Health and Medicine (NCGM), Tokyo, Japan

Background Results HIV care has been decentralized in Zambia. One hundred sixty-four patients enrolled into There are many challenges such as: shortage of staff, HIV care (Median age32years, Female65.9%). Pre- poor linkages in HIV diagnosis, treatment and low ART patients were less likely to remain in the care retention. This study aimed to investigate poor (Pre-ART6.0VS ART46.0months p ＜ 0.01). Patients linkage between HIV diagnosis and care and analyze who did not disclose their HIV status to anyone were the factor and barrier to be lost to follow up. more likely to be LTFU (adjusted HR: 5.4, p ＜ 0.03). Methods Other variables were not associated with increased The study site was conducted in a primary risk. Barriers of LTFU were lack of information, health center, 400km away from the capital city. The confidentiality and logistics management. Many records of adult patients enrolled into HIV care patients dropped out after diagnosis and after CD4 between June 2007 and October 2011 at this center test at other hospital. were reviewed retrospectively. The retention and Conclusion factors associated with LTFU were analyzed by There are poor linkages between diagnosis and Kaplan-Meier method and Cox’s proportional hazard care, and delayed initiation HIV care despite free model. Barriers were explored through the inter- services. Retention is low because of self-stigma and views conducted for LTFU patients who could be lack of knowledge for treatment. Human resource found by the active trace. training for HIV cares and strengthens cross-

─ 183 ─ 国際保健医療第 29 巻第 3 号 2014

sectional linkage, patient supports include adherence counseling is the keys to improve care.

Or-Af-B02 Assessment of diet and nutritional intake of rural children living in the semi-arid regions of Zambia, sub-Saharan Africa

ARIMI MITSUNAGA1, Hana Kozai2, Taro Yamauchi2

1Graduate School of Health Science, Hokkaido University, Sapporo, Japan, 2Faculty of Health Science, Hokkaido University, Sapporo, Japan

Zambia is located in sub-Saharan Africa and a carbohydrate) intake at the individual level using a large part of its land is semi-arid. Repeated droughts published Zambian food composition table. The and water shortages hamper food production, and dietary survey consisted of the following 3 compo- thereby confer a negative impact on the nutritional nents: 1. Dietary survey (direct weighing method) 2. and health status of the local population. In fact, our Development of a food frequency questionnaire (FFQ) previous study revealed that rural children in South- for the local population3. Dietary survey (FFQ ern Province were considerably lighter and shorter, method) We assessed dietary patterns and energy when assessed according to international growth and macronutrient intake of rural children using standards (United States Center for Disease Control direct weighing and the FFQ. In addition, we exam- reference), and this tendency was more prominent in ined the prevalence of poor nutritional status and boys. These findings prompted us to conduct dietary growth retardation among children and also discuss surveys to assess the energy and nutrient intake of gender differences in nutrient intake. We hope to rural children living in Southern Province, Zambia. accumulate the basic information necessary to Dietary surveys were conducted at the household establish adequate dietary patterns and favorable level between August and September in 2013, which nutrient intake for children in Zambia and other sub- assessed energy and macronutrient (protein, fat, and Saharan countries.

Or-Af-B03 Malaria prevention strategy through the capacity development of community health volunteers in urban communities in Ndola, Zambia

SATOSHI OTANI1, AYA KAYEBETA1, SATOSHI SASAKI3, SHUNSUKE SUZUKI2, YUKO MURAKAMI1, HISAYUKI INABA1, Kakungu Simpungwe4, Luck Silengo4, Rosemary Bwenbya4, Busimbwa Tambatamba4

1AMDA Multisectoral & Integrated Development Services, Okayama, Japan, 2Asuka World Consultant, Okayama, Japan, 3Soka University, Hachioji, Japan, 4Ministry of Community Development Mother and Child Health, Lusaka, Zambia

Background: Objectives: Malaria is a major cause of morbidity occupying To verify if PHAST is an effective methodology 40% of health conditions presented at health institu- applicable to malaria prevention or not. tions. Especially, the incidence rate in Ndola is worse Methods: than the nationwide average and it is deteriorating 20 community health volunteers trained by the year by year regardless of the nationwide improve- Ministry and project at Chipulukusu health centre in ment. In JICA Primary Health Care Project from Ndola conducted community sensitization on malaria 1997 to 2007, PHAST improved environmental health prevention as their one of daily activities. They also issues such as diarrhea in Lusaka. PHAST is a conducted the environmental health management methodology to improve environmental health issues like cutting tall grasses and burial of stagnant water through community empowerment using visual tools where mosquitoes breed. In addition, the project and participatory techniques. conducted cohort survey targeting all infants born

─ 184 ─ Journal of International Health Vol.29 No.3 2014

during a certain period and KAP survey targeting 97.5% on people taking malaria patients to health 300 people at each community in the beginning and facilities, from 60.8% to 83.0% on household having end of project at intervention and control sites. mosquito nets, and from 56.6% to 63.6% on household Results: using mosquito nets for children. The knowledge and behavior about malaria Considerations: improved from 83.6% to 95.9% on people knowing one PHAST is an effective methodology applicable to prevention method, from 50.2% to 68.9% on people malaria prevention. knowing two prevention methods, from 92.2% to

Or-Af-B04 Local health surveillance assistantsʼ awareness of people with disabilities in Malawi

JUNKO HASEGAWA1, 2, TARO YAMAUCHI2

1School of Rehabilitation Sciences, Health Sciences University of Hokkaido, Tobetsu, Japan, 2Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan

[Introduction] In Malawi, only 14 of 28 districts have people with disabilities provided in the catchment support programs for people with disabilities. Health area, and (4) needs of people with disabilities. surveillance assistants (HSAs), employed by the [Results] Valid responses were obtained from 75 Ministry of Health, span the whole country and HSAs whose catchment areas covered 96,607 people; support residents of catchment areas. the prevalence of people with disabilities was [Purpose] To clarify HSAs’ awareness of the living estimated at 0.07-6.29%. Respondents reported, such conditions and needs of people with disabilities in as medicine (23/75) and outreach clinics (20/75). Self- Malawi, and by comparing our results with those of a help devices were mentioned as a high-priority need previous study sampling people with disabilities, for people with disabilities. reveal the disparity in awareness between these two [Discussion] HSAs mentioned fewer social resources groups. and needs than did people with disabilities them- [Methods] A structured questionnaire by placement selves in the previous study. This suggests that while method was given to 125 HSAs from four health HSAs might know of the living conditions in their centers in the Lilongwe district between May and catchment areas, they might not be aware of the real June 2012. The questionnaire consisted of four items: situations of people with disabilities. Further research (1) HSA characteristics, (2) population size and is needed on the present conditions of support for proportion of people with disabilities, (3) services for people with disabilities.

Or-Af-C01 Rabies Situation in Amhara Region, Ethiopia

NOBUYUKI MATSUBAYASHI1, Sintayehu Girma2

1Shima Prefectural Hospital, Mie, Japan, 2Amhara Regional Infectious Diseases Surveillance Project, Bahir Dar, Amhara, Ethiopia

Background: Although rabies is supposed to be saliva of rabid dog were interviewed in 6 villages in prevalent in Ethiopia, cases and treatment have not Mecha wareda, Amhara region, Ethiopia. The been reported. Vaccine is available in the country, questionnaire includes part of body bitten, dog condi- however the actual vaccine usage has not been tion, treatment, post-exposed vaccination status, date known. Objectives: Number of cases, treatment, of vaccination, clinical findings and outcome.Result22 vaccine availability, knowledge attitude and practice bitten-cases were analyzed out of 47 cases excluding (KAP) on rabies will be revealed.Methodology:47 25 non-bitten cases. Out of 22, 7 cases (31.8%) were cases exposed from 1st Jan 2010 to 15 Mar 2012 by vaccinated while 15 cases (68.2%) were not.4 fatal

─ 185 ─ 国際保健医療第 29 巻第 3 号 2014

cases were diagnosed as rabies because of its clinical vaccination seems to be effective. It was revealed findings. 3 cases out of 4 were not vaccinated. After that people prefer traditional treatment, resulting in the bites, 8 cases (36.4%) accessed clinic / traditional the delayed modern treatment and the low vaccina- healers on day 0 or 1, 7 cases (31.8 %) visited there 2 tion rate. Shortage of vaccine and insufficient delivery days or more after the bites. Another 7 cases (31.8 %) system are major reasons for that. As a result, it is did not visit any services. Discussion Post exposed difficult for people to rely on modern medicine.

Or-Af-C02 Does it need Doctor Cars in Sudan?

NORIFUMI NINOMIYA1, Suharunan Sibasuntaran2, Rina Uchima2, Hiroyuki Onishi3, Takuya Ogushi4, Naoyuki Kawahara5, Mohamed Khalid Gaffer6, Ahmed ElSayed Ahmed Sayed7

1Emergency and Critical Care Medicine, Tamanagayama Hospital, Nippon Medical School, Tokyo, Japan, 2Axio Helix K.K. Okinawa, Japan, 3Tecnorogy seed incuvation K.K. Okinawa, Japan, 4Smart Energyr K.K., 5NPO Rocinantes, Kitakyushu-shi, Japan, 6University of Gazira, Gazira, Sudan, 7Alshaab Teaching Hospital, Gazira, Sudan

Purpose: We evaluate the need of Doctor Car in between 171 and 364. The lank of diagnosis of Sudan. consultation are Hypertension, Diabetes, Antenatal Method: We investigated the need of Doctor Car in care, common cold, chest pain, malaria. It is difficult Sudan at June 2013. We send one doctor car to Sudan to deliver the drug for these patients continuously. in 2012. Gezira Family Medicine Project used this Car But it is useful to educate for the patients. The in Gezira country site a one month. We evaluated the doctor car from Japan at 2012 was not run long results of their rounds. We also evaluated the use of distance. The reason of this car was not appropriate this doctor car. for desert run. Result: Gezira Family Medicine Project used this Consideration: It is useful the doctor car in desert doctor car from 4th February 2013 to 28th February area as health promotion car. It is better the doctor 2013. Number of consultations during this period car to be able to run as the desert running car in was 6160 consultations. The active days were 21 Sudan. days.. Number of consultations per day ranged

Or-Af-C03 MCH service by Village midwife in Sudan

Fumi Sakurai, Mohamed Intessar, Kazumi Yano, suliman Hussein, Naoyuki Kawahara

NGO Rocinantes, Fukuoka, Japan

NGO Rocinantes had carried out Maternal/Child area system' which consists of the allocation of Health (MCH) service activities in Shelif Hasabara geographical areas of MCH service responsibility to zone, Gadaref state in Sudan since 2010 and complet- each VMW and a 'monthly meeting'. To sustain MCH ed project in June 2013.IntroductionAt last yearʼs service, we introduced' donkey cart' for new income conference, we reported our activities regarding generation and hosted a commendation ceremony. MCH, especially the training of Health Visitor/Village Result Donkey cart were used for 1) Income genera- Midwife (HV/VMW). We now report regarding the tion for VMW2) Transportation for the daily home other new activities to complete the MCH project. visit3) Local Ambulance Commendation ceremony Activities We aimed to improve skills of VMWs and was held in a girlʼs school. It contributed not only to to activate their motivation by introducing 'in charge introduce girls to the job of village midwife and but

─ 186 ─ Journal of International Health Vol.29 No.3 2014

also to provide positive influence for their future. solution for VMWs financial issues and the improve- Suggestion For exit strategy of medical assistance, ment of their jobs. Although all projects were there are some essential issues to solve such as self- performed with the cooperation of Ministry Of Health sustaining system for the health center, financial (MOH) and villagers, the extent and form of MOH stabilization of each staff and continuance of motiva- involvement will be key points in the sustainability of tion for their jobs. Donkey cart was an effective MCH services after Rocinantes withdrawal.

Or-Af-C04 Antimalarial drug use of health workers at the time of negative malaria testing: a qualitative study in Madagascar

TAKAHIRO TSUKAHARA1, 2, David H Rakotonandrasana3, Makoto Sekihara1, Hiroyoshi Endo1, Noriko Yamamoto4

1Dept of Intl Affairs & Trop Med, Tokyo Women’s Med University, Tokyo, Japan., 2Graduate School of Economics, Hosei University, Tokyo, Japan., 3Centre Hospitalier Universitaire Antananarivo Hopital Mere-Enfant Ambohimiandra, Antananarivo, Madagascar., 4School of Integrated Health Sciences, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.

Although World Health Organization (WHO) and they believed that antimalarial drugs were also Madagascar National Malaria Plan (NMP) require effective for conditions other than malaria. 4) Health that malaria diagnostic test results should be the only workers did not consider conventional antimalarial determinant of antimalarial prescription, it seems medications a violation to the WHO/NMP guideline. difficult to achieve the complete adherence in Mada- 5) There were multiple guidelines for antimalarial gascarʼs primary care context. We have interviewed prescription that were inconsistent with one another. 14 health workers in Madagascar regarding their There is a basic tension between the practitioners antimalarial drug use at the time of negative malaria who believe the best benefit of individuals as first testing. 1) They considered that their main mission priority and the WHO/NMP guideline that empha- was to help clients and therefore they would not like sized society benefit. Thus, efforts to modify those to miss any one malaria case. 2) They were convinced factors should be made in order to materialize and that it was not policy makers but health care sustain the WHO/NMP guideline. Practitioners providers themselves who knew each case enough to always prioritize the patientʼs benefit, therefore the make the right decision. 3) Their experience to program should be tailored in such a way that goes prescribe antimalarial drugs safely for a long time along with the local practitionersʼ practice context was another reason for ignoring test results. Besides, and that motivates them to abide by the guideline.

Or-Af-D01 Progress of Strengthening Regional Health Administration System in Tanzania

MAKIKO KOMASAWA1, MIHO SATO2, NAOMI OKADA3, NATSUE MIYATA3, KAINA HONMA3, MOTOYUKI YUASA1, DIDACE MUTAGWABA4

1Department Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan, 2Center for International Collaborative Research, Nagasaki University, Nagasaki, Japan, 3Project for Capacity Development in Regional Health Management Phase 2, Tanzania, 4Ministry of Health and Social Welfare, Tanzania

Background support the enhancement of RHMTs, JICA is The government of Tanzania restructured the currently implementing the “Project for Capacity Regional Health Management Team (RHMT) in order Development in Regional Health Management Phase to improve the quality of health service provision. To 2 (2011- 2014).

─ 187 ─ 国際保健医療第 29 巻第 3 号 2014

Methods improved reliability. Mutual-learning within and Phase 2 focuses on the following capacity across RHMTs has been promoted. Furthermore, development (CD) areas of RHMTs: 1) Individual: various spontaneous activities have been initiated by training, provision of policy documents and their RHMTs. Moreover some CHMTs developed a new interpretation, 2) Organizational: redefining RHMT SS method toward health facilities by applying the functions, standardization of Supportive Supervision RHMT SS method. (SS), holding a national forum, 3) Developing an Discussion enabling environment: Revision of existing Guidelines Direct outcomes and their spin-off effects are and their institutionalization, collaboration with Prime seen half way through the project. For further Minister’s Office Regional Administration and Local sustainable CD of RHMTs, the project should extract Government, and advocacy. good practices from among various spontaneous Results activities, share them with all RHMTs and CHMTs RHMTs planning and reporting capacity was and encourage them to apply them in their settings. enhanced. The quality of SS to Council Health Such efforts enable the improvement in the quality of Management Teams (CHMTs) was improved. Spin-off health services through strengthening the CHMT effects of routine SS and outreach-trainings include managerial capacity. wider understanding of RHMTs responsibilities and

Or-Af-D02 Development of Versatile Antenatal Education Program for Pregnant Women and Family in Rural Tanzania

YOKO SHIMPUKU1, Frida Madeni2

1St. Luke’s College of Nursing, Women’s Health and Midwifery, Tokyo, Japan, 2St. Luke’s College of Nursing Graduate School, Graduate of Master’s Course

[Purpose] Toward the evaluation of Millennium the questions were categorized into the concepts of Development Goals, it is urgently needed to address Ajzen’s Theory of Planned Behavior. To enhance the Goal #5, improvement of maternal health. In validity, an expert was consulted, and the questions Tanzania, half of all women still give birth without were tested among 14 rural Tanzanian women. skilled birth attendants, and consequently maternal [Results] When asking the women about hours and mortality remains high: 454/100,000. We attempt to minutes from home to the nearest health center, it attack the issue by teaching danger signs and birth was difficult to obtain exact answers as their life was preparation. In this presentation, we describe the not surrounded by clocks. We made the dichotomous development process of the educational material and question to ask if it takes less than one hour or more the questionnaire to evaluate the program. to reach there. Also, when asking their income, they [Method] The highlights of the educational material were not sure about their monthly income. Hence, we are as follows: 1) Culturally appropriate evidence- revised the question as “How much do you usually based contents, 2) Family integration, and 3) high spend a day?” versatility by using picture drama. The questionnaire [Conclusion] When developing a questionnaire cross- was developed based on Madeni et al.’s study for ad- culturally, it is important to enhance validity based olescent pregnancy. The contents of Focused on expert’s opinions and participant’s population. Antenatal Care Package of WHO were added, and

─ 188 ─ Journal of International Health Vol.29 No.3 2014

Or-Af-D03 Population structure and fertility of African rainforest hunter-gatherers: Baka in southeast Cameroon

IZUMI HAGINO1, TARO YAMAUCHI2

1Graduate school of Health Sciences, Hokkaido University, Sapporo, Japan, 2Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

Introduction Demographic parameters sufficiently logical data were likewise collected from 22 adults in indicate the health status of a small population. these villages. Pygmy hunter-gatherers in African rainforests still Results Census data and estimated ages revealed a retain the traditional hunting and gathering lifestyle. clear population structure. The mean ages for each However, demographic studies that focus on their sex were 21.0 (males) and 21.8 (females) years old. unique hunter-gatherer society are limited. This The sex ratio was 107.8. The number of births during study has two aims, namely, to reveal the population one year was 25, including 1 fetal birth. Thus, crude structure and dynamics of hunter-gatherers in south- birth rate (35.1 per 1,000 individuals) was considered east Cameroon, and to estimate the fertility in the high. The mean completed parity obtained from 47 target population. women who presented their family tree in interviews Methods Census, fertility, and mortality data for was 5.26 ± 2.96, and this value slightly increased four Baka villages located in the East province of from that before the settlement policy was enacted in Cameroon were collected twice, that is, in the long the 1960s (5.16 vs. 5.36). dry season of 2011 and 2012. Personal interviews Conclusion The birth rate of Baka hunter-gatherers were conducted with all residents of these villages, is moderately high, and fertility is shown to have and their ages were estimated in one- and five-year increased. ranges for children and adults, respectively. Genea-

Or-Af-D04 The predictors to the female genital mutilation (FGM) practice and its succession to a daughter in Nigeria

JUN NISHITANI1, KAZUE TANAKA2, KAZUHIRO KAKIMOTO3

1Clinical Nutrition, Osaka Prefecture University, Osaka, Japan, 2School of Nursing, Osaka Prefecture University, Osaka, Japan, 3College of Health and Human Sciences, Osaka Prefecture University, Osaka, Japan

Background: We have been investigating the (45-49 years old: AOR ＝ 3.419, p ＜ 0.001), ethnic situation of FGM practice of African countries, and group (Igbo: AOR ＝ 2.762, p ＜ 0.001) and religion showed that the FGM prevalence was higher in the (Islam: AOR ＝ 2.059, p ＜ 0.001) as well as low educa- women of high education and living urban areas tion and living rural areas. In addition, 95.8% of specifically in Nigeria. Therefore, DHS data were mother without FGM (1,357) did not have the daugh- analyzed for the purpose of determining factors of ter with FGM. Among mothers with FGM, factors to FGM practice and the succession in more detail. FGM in their daughters were very similar to those to Method: Women data of Nigerian DHS (n ＝ 33,385, FGM in the women. FGM prevalence 25.4%) were obtained after Conclusions: The results showed that FGM was permission and analyzed to determine factors to likely to be succeeded by a daughter depending on FGM practice by a multivariate logistic regression social cultural backgrounds such as age, ethnic group analysis targeting Ekoi group (n ＝ 583, prevalence and the religion. In addition, the analysis among only 35.0%), Igbo (n ＝ 4,583, 54.8%) and Yoruba (n ＝ 4,861, the ethnic groups with high FGM prevalence 60.7%), which have high prevalence in FGM. In indicated that low education and living rural areas addition, background of mothers (n ＝ 4,562) who had are factors to the FGM practice similarly to other the daughter receiving FGM was investigated. countries. Results: The main factors to FGM practice are age

─ 189 ─ 国際保健医療第 29 巻第 3 号 2014

Or-Oth-A01 Community Care in the United Kingdom

HARUNA TANAKA1, YUMIKO MOMOSE2, AKIRA MIZOO3

1Department of Nursing, School of Health Sciences, Gifu University of Medical Science, Seki, Japan., 2School of Nursing & Health, Aichi Prefectural University, Nagoya, Japan, 3Tokyo Kosei Nenkin Hospital, Tokyo, Japan

Purpose event, to launch a specialized home hospice service. This study focused on investigating the actual It was also discovered that nursing homes estab- situations and problems of home care and care which lished a 24-hour hot line, in which advice by special- is provided by medical and nursing institutions in the ists may be sought for palliative care. And with United Kingdom. home-care, equipment such as an electric lift can also Study methods be rented free of charge, providing mobility assis- Observations and staff member interviews from tance for older persons. It was also observed that 4 institutions, including a nursing home, residential home-visit carers receive low wages and therefore home, hospice and hospital, were conducted. In have to hold a number of different jobs. addition, one older person’s home which uses a home- Discussion care service, was visited. Observations of this home- Unlike Japan, the UK 24-hour specialist support care were conducted and 4 home-visit carers were system can be received in nursing institutions and in also interviewed. Consent was received after verbal the home, which enables older people to face death in explanations about the content of this study and a familiar environment. Employment conditions of approval was also obtained to take and use photos, care givers also need improvement, in order to when presenting this study. improve the quality of community care. This study Results was part of a research project subsidized by the The observed hospice in the UK held a charity grant-in-aid for scientific research (C).

Or-Oth-A02 The Role of Community Hospitals in the United Kingdom

HARUNA TANAKA

Department of Nursing, School of Health Sciences, Gifu University of Medical Science, Seki, Japan

Purpose physiotherapist or occupational therapist, with the The role of community hospitals in the UK was aim of returning patients to their own home. Fur- examined, based on observations of medical institu- thermore, in nurse-led units (wards managed by a tions and nursing homes for older people, including nurse) in hospitals without a permanently stationed personal experiences of working as a nurse in the physician, examinations of hospitalized patients is UK. generally conducted by a visiting GP. The rapid Research methods response teams, which have offices in community The role of community hospitals in the UK was hospitals, visit patients who have just been dis- examined through observations taken from personal charged from a hospital to their home, to verify living experiences of working as a nurse in a community patient’s living conditions and provide any care, hospital of the NHS, in the UK, personal experiences which is needed. of training with a rapid response team in the UK, and Discussion observations conducted 3 times in private nursing Community hospitals provide medical care and homes and medical institutions between September rehabilitation. And the transition to home-care is also of 2010 and November of 2012. believed to improve the sickbed availability ratio in Results acute care hospitals, as well as play an important role Community hospitals in the UK receive patients in reducing financial costs to the NHS. Therefore, from acute care hospitals, conduct medical examina- support for community hospitals is needed, as they tions by a podiatrist and provide rehabilitation by a carry out several important roles.

─ 190 ─ Journal of International Health Vol.29 No.3 2014

Or-Oth-A03 Reclaiming the Contextual Analysis of the Spanish Flu Pandemic

RISAKO KURONO

School of Nursing, Dept. of Public Health Science, Kobe Tokiwa University, Kobe, Japan

WHO, CDC and the Japanese Infection Control the bigger picture, the history of infection and human bureau have been promoting the discourse: With society, we soon realize in high income countries, the another New Super-virulent & infectious Flu like steady and remarkable decline in the mortality of Spanish Flu, the whole society goes panic, which has infectious diseases has been observed in the mid19th been transmitted & multiplied in various media century when there was no concept of pathological means i.e. TV, paper, entertainment and internet, as micro-organism let alone the chemical treatment to excuse high-priced, medicalized approach, utilizing available, therefore the advance in medical knowl- forever-changing vaccinations and antivirals. Swim- edge or technology had very limited influence in ming in the seas of highly professional and technolog- bringing down infection related mortality rate in ical information: the history of genetic development modern history. In this panicky scare of biomedical- of Flu viruses or how virus acquires lethal virulence ized discourse and cry for more intense monitoring in mutating avian to human to swine flu? something and medicalized interventions, there be another voice over our head or thus total scam, we might be misled addressed to reclaim our primary health approach in to depending on our human medical/technological infection control, hopefully this presentation might be advances to win a battle with terrible mutant invisi- the one. ble enemy. However, taking one step back to look at

Or-Oth-A04 Mental health research for Japanese living in overseas countries (Interim report)

TAKESHI YODA1, TAKUMA KATO2, MARIKA NOMURA3, ASAKO MIYASHITA4, AKIRA YOSHIOKA1, TOMOHIRO HIRAO1

1Department of Public Health, Faculty of Medicine, Kagawa University, Miki, Japan, 2Faculty of Public Health, Mahidol University, Bangkok, Thailand, 3Department of Global Health and Population, Harvard School of Public Health, Boston, USA, 4Nihon Medical Healthcare, New York, USA

Objective both paper based and Web based questionnaires. The It is considered that Japanese who live in over- questionnaire was consisted of following items; 1) seas countries have some difficulties because of the Socioeconomic status, 2) Depression scale by Kessler different culture, language, and environments. Our 6 questionnaire (K6) and Hamilton Rating Scale for object is to clear the mental health status in Japanese Depression (extracted only insomnia score), 3) Resil- who live in overseas. ience evaluation by Koshio’s scale. And we added Methods additional special questions for oversea residences Study areas were selected by the Statistics for such as residential place’s language skill, the length Japanese who live in overseas from Ministry of of stay and so on. foreign affairs of Japan. We chose 2 largest Japanese Results and Discussion population areas (New York, USA and Bangkok, This research is now on going. So this is an Thailand). And also chose some small Japanese popu- interim report. Interim results will be presented at lation areas (some African countries, etc). We used the conference.

─ 191 ─ 国際保健医療第 29 巻第 3 号 2014

Or-Oth-B01 Epidemiological study of reproductive health in Haiti after the earthquake in 2010

MAKI MATSUCHIKA, KEN INOUE, YASUYUKI FUJITA

Department of Public Health, Faculty of Medicine, Shimane University, Izumo, Japan.

[Objective] The International Federation of Red tion camps in Leogane in Haiti in June 2010. The Chi- Cross and Red Crescent Societies (IFRC) is a humani- square test and the logistic regression were used for tarian organization focusing on disaster response, the analysis. recovery, and development. More than 200,000 people [Results] Among 263 women the average age was were killed by the earthquake in Haiti in 2010. The 35.1 years. 78% had some symptoms of virginities, IFRC has responded immediately and is continuing and 72% took antimicrobials after the menstruation its activities until now. Haiti is the poorest country every month.[Conclusion]Taking antimicrobials has a in the western hemisphere, two thirds of its inhabit- statistical significance regarding the virginities. Some ants being poor. Therefore, the country has extreme antimicrobials kill the Lactobacilli, which helps to difficulties to recover on its own. Many displaced preserve vaginal health. Many antimicrobials are sold persons couldn’t leave the camps for a long time, on the street, which makes it easy for many women which created health problems for women, especially to buy them. Misusing antimicrobials can cause virginities. This study aims to show the relationship resistant bacteria and other problems. Adequate between the virginities and the behavior and knowl- instruction of the women can reduce maternal mor- edge of the women in the camps. tality and the mortality rate of infants. The results [Methods] A questionnaire survey of women in show the importance to improve the women’s knowl- their reproductive age was conducted in ten evacua- edge continuously.

Or-Oth-B02 Medicines sans Frontiersʼ challenges in Syria

Isaac Tonderai CHIKWANHA1, Nobuko KUROSAKI1, Tomoaki ATSUMI1, 3, Kohei ANDO1, 2, Yasushi TANABE1, Yuko SHIRAKAWA1

1Non Profit Organization Medecines Sans Frontieres Japon, Operations, Tokyo Desk, 2Kyouryoukai Ichinomiyanishi Hospital, ER, Aichi, 3Sankoukai Miyazaki Hospital, Surgery/ER, Nagasaki

Background Syria had been stated “lower middle health problems, such as physical and mental trauma, income country” by the World Bank, and the medical disturbed the treatment of chronic diseases, difficult capacity was well advanced enough for its population; to access to Maternal and Child Health (MCH); fur- however, since the onset of the crisis in March 2011, thermore, deteriorating sanitation and lack of water, the country has been deteriorating desperately. and stopping provision of routine immunization will According to the OCHA’s humanitarian data (July lead high risk of infectious diseases /epidemic. 2013), more than 93,000 people have been killed since Activities of MSF in Syria Medicines sans Fron- the onset of the crisis, with an average of more than tiers (MSF) have been assisting Syrian population 5,000 killed per month since July 2012. Moreover, an since the onset of the crisis. MSF runs six hospitals, estimated 6.8 million people are in need of humanitar- four health centers and several mobile clinic pro- ian assistance, including 4.25 million internally grams inside Syria. While these medical programs displaced persons (IDPs). People have increasingly are undoubtedly saving dozens of lives every day, limited access to basic commodities and services the extremely high insecurity means that MSF’s including health care; deteriorating infrastructures reach is limited. In this presentation, we will report therefore insufficient water and sanitation. Under the reality, MSF’s activities, health problems and such circumstance, population have faced tremendous challenges we have been facing in Syria.

─ 192 ─ Journal of International Health Vol.29 No.3 2014

Or-Oth-B03 A trial of distance education to support education of co-medical professionals in developing countries

YOSHIE MORI1, HIROMI TSUJIMURA1, SACHIYO MIYAKOSHI2, JAY RAJASEKERA3, DEEPANIE PATHIRANAGE4, RATHNAYAKE SARATH4, ZENEYDA QUIROZ5, SANDRA REYES5, MARLENE GAITAN5, KHULAN GAALAN6, MASAAKI SAKAMOTO1, RIE NAKAZAWA1

1Graduate School of Health Sciences, Gunma Univ. Maebashi, Japan, 2Nagano College of Nursing, Komagane, Japan, 3International Univ. of Japan, Minami Uonuma, Japan, 4University of Peradeniya, Peradeniya, Sri Lanka, 5National Autonomous Univ. of Nicaragua - Managua, Managua, Nicaragua, 6Health Science Univ. of Mongolia, Ulaanbaatar, Mongolia

[Purpose] Distance education, focused on delivering order to avoid Internet congestions. Techniques of lectures via Internet has become quite popular, postural change and bedsore care were requested by worldwide. However, in medical staff training, not three universities. In both sides, the similar equip- only lectures, but also technique learning are essen- ment was used in all cases. Japan side evaluated the tial. This research explores possibility of training practices and instructed students’ performance via nursing techniques through a live stream delivery. Skype. A survey revealed that student satisfaction [Method] Live streaming of advanced nursing was good. technique demonstrations about daily life assistance [Discussion] In developing countries, even if IT was delivered via Internet from Japan to three infrastructure is not advanced, it turned out that universities in Mongolia, Nicaragua, and Sri Lanka training in a nursing lab is possible to some extent as that train local nursing students. The delivery and distance education. More studies on which techniques training qualities were evaluated through a question- can be taught by distance education, how to use new naire. IT technologies, and how they should be demonstrat- [Results] It was found that video conference systems ed needs further exploration, which our research common in developed countries cannot be used in team is doing now. the three countries as their IT infrastructures could *This work was supported by Grant-in-Aid for not accommodate such. Thus, delivery was tested 16 Scientific Research (B) (No.23390486). times using Skype by picking early morning hours in

Or-Oth-B04 The ripple effect from school-based interventions to the broader community: a multi-agent-based simulation.

Susumu Tanimura, Masayuki Shima

Dept of Public Health, Hyogo College of Medicine, Hyogo, Japan.

Background: School-based interventions in develop- health information in the community members after ing countries typically expect schoolchildren to serve the school-based intervention. as health messengers to their families as well as to Methods:150 schoolchildren and 50 families were the broader community. More effective interventions observed for 100 days in an artificial community. The are commonly identified with interventional trials, in silico experiments were repeated with different which undesirably require great expense and time. values of model parameters. The intervention were As a solution of the problem, we developed a multi- conducted once or repeated at intervals of 10, 30, and agent simulator so that we can evaluate various 50 days. interventions with little expense and time. Results: If the probability of transmitting health Objectives: The objective of the study was to information among the family members is greater measure dynamics in pervading and disappearing the than 0.05, the impact of school-based intervention

─ 193 ─ 国際保健医療第 29 巻第 3 号 2014

pervaded at a certain level in the community; howev- ventions at 10-day intervals have prevented the er, if the probability is less than 0.01, the impact dis- impact from disappearing even with the probability appeared from the community. Yet repeated inter- of less than 0.01.

Or-Oth-C01 JICAʼs efforts and directions in introducing impact evaluation to health sector cooperation

YUSUKE KAMIYA1, KEITARO AOYAGI2, HISAKAZU HIRAOKA3

1Osaka School of International Public Policy, Osaka University, Osaka, Japan, 2Evaluation Department, Japan International Cooperation Agency, Tokyo, Japan, 3Human Development Department, Japan International Cooperation Agency, Tokyo, Japan

This session looks back JICAʼs efforts regarding Health Sector: Present and Future” in September the introduction of impact evaluation over three 2010. Furthermore, JICA issued “Guideline for the years and then shows their achievements, challenges introduction of impact evaluation” and presented and future directions. Due to increased demand for principles and procedures of impact evaluation in transparency, accountability and effectiveness of October 2012. international development assistance, evidence-based Third, HDD actually started several impact practice (EBP) has become an important agenda in evaluations in health sector, in which RCT were put Japanʼs ODA. In particular, impact evaluation which into practice in Tanzania and Bangladesh. Forth, investigates causal effects of a particular project HDD tried to promote understanding of their work using rigorous evaluation designs such as randomized by holding two mini-symposiums at the Japan controlled trial (RCT) has been rapidly utilized in the Association for International Health Congress in 2011 global health field. and 2012. Several evaluation works were also Since 2010 JICA’s Human Development Depart- published in international peer-refereed journals. ment (HDD) has tackled the introduction and dissem- Fifth, JICA’s Evaluation Department started in- ination of impact evaluation in the following steps. service training on impact evaluation to strengthen First, HDD started discussions over the introduction capacities of JICA staff in 2011. In addition, HDD of impact evaluation with experts invited from inside launched the first training course “Capacity develop- and outside JICA. Second, HDD announced their ment for impact evaluation in health” in July 2013. stance towards EBP in their “JICA’s Operation in

Or-Oth-C02 Analyses of JICA health projects contributing to health system strengthening

MOTOYUKI YUASA1, YOSHIE YAMAGUCHI2, MIHOKO IMADA3, YOSHIHISA SHIRAYAMA1

1Dept of Public Health, Juntendo University School of Medicine, Tokyo, Japan , 2Graduate School of Medical Administration, Tokyo Medical and Dental University, 3Department of Tropical Medicine and Parasite Infection, School of Medicine, Keio University

[Objective] The study aimed to analyze the contri- the target countries and implementation periods of bution of health projects by Japan International the projects, and in which health fields the projects Cooperation Agency (JICA) to health system strength- focused. To assess the extent of the contributions of ening (HSS). JICA projects to HSS, we developed an original [Methods] We collected the data of web-based Pro- matrix, organized in six rows and columns, based on ject Design Matrix (PDM), and analyzed 105 PDMs the six building blocks of WHO’s health system implemented between 2005 and 2009. We identified framework. It has 36 cells as outputs and activities of

─ 194 ─ Journal of International Health Vol.29 No.3 2014

PDM, respectively. Through the matrix, we catego- targeted on blocks regarding workforce and service rized the types of projects, based on contributions to delivery, whereas there was very little support for HSS. Association between type and health field was financing. The correspondence analysis showed examined by a correspondence analysis. relationships between medical products and EPI, and [Results] JICA had supported health-related service delivery and infectious diseases control, ma- projects over 50 countries with periods ranging from ternal and child health, and reproductive health. 10 months to 7 years. The projects had mainly

Or-Oth-C03 Development of an integrated framework for analyzing international public-private partnership (PPP) programs

YOSHIHISA SHIRAYAMA1, Motoyuki Yuasa1, Tsutomu Kitajima2, Ryoko Nishida3

1Department of Public Health. Juntendo University School of Medicine, 2Faculty of Social Sciences, Graduate School of International Cooperation Studies, Kyorin University, Tokyo, Japan, 3Japanese Organization for International Cooperation in Family Planning, Tokyo, Japan

Background The previous studies reported the effec- Methods Reports and scientific papers regarding tiveness of public-private partnership (PPP) programs PPP experiences were collected and analyzed. The since the 1960s. The partnership, however, does not integrated framework was developed as public sec- always bring positive impacts. Some cases reported tor, private sector, and researchers exchange views wasted time and cost, due to the partnership. on a wide range of issues with the partnership. While reports and scientific papers regarding PPP Results The integrated analysis format consisted of experiences have been accumulated to some extent, several parts; program summary (to get the overall no systematic study has been conducted to analyze image of the program), introduction process (to see the keys to success, challenges, and lessons of PPP how the partnership started, and how it went), programs. impacts (to examine the effectiveness of the partner- Objectives Objectives of this study are 1) to develop ship), and partnership (keys and lessons leading to an integrated framework for analyzing PPP pro- success of the partnership). The framework and how grams, 2) to conduct systematic reviews of PPP to apply it will be presented in the conference. programs using the developed framework and test Acknowledgements This study was conducted with the fitness of the framework, and 3) to contribute to the help of the Global Health Promotion Program, the promotion of the PPP programs via visualizing grant-in-aid from the Japanese Ministry of Health, factors leading to the success of the PPP. Labour, and Welfare.

Or-Oth-C04 Promoting Global Health from The Studentsʼ Points of View in Kagawa University

KENGO HIWATASHI1, TOMOHIRO HIRAO2, TAKESHI YODA2, NATSUNO MAJIKINA3, JIRO MORINAMI1, ARISA MIURA1, KONOMI UESHIBA1, TAISUKE WATANABE1, MISAKO KATO1, YUKO IMATANI1, SAORI KURATANI1, TAKUYA OHNO1, HAJIME NAKAYA1, SATORU MESE1, TAKAYUKI YOKOTA1

13rd Grade of Faculty of Medicine, Kagawa University, 2Department of Public Health, Faculty of Medicine, Kagawa University, 3Faculty of Nursing, Kagawa University

Background We will make presentation on the way there are not so abundant professionals or informa- to promote global health from the students’ point of tion about global health, some students have a desire view in Kagawa. In Kagawa Prefecture, although to study global health. Therefore, the condition they

─ 195 ─ 国際保健医療第 29 巻第 3 号 2014

study may not be good than other parts of Japan. accepts maternity health staffs from Africa and However, they find the way to study global health makes chances to communicate with them for stu- and visit various countries including Japan to see the dents. In addition to this, we have been sharing field. information with students who have interests in Method In this situation, Kagawa University has international affairs. promoted the relationships with international cooper- Vision We will share information much more and ative organizations and we have provided the promote the interchange of personnel with interna- chances to study global health for students (especially tional exchange club to make study meetings for medical ones). some topics. On the other hand, we should tell the Present State Though we have been holding kinds of importance of the global health to every student to events on global health, they have almost no sustain- get interested in. ability. However, nowadays Kagawa University

Or-Oth-D01 Population Ageing and Family Policy in Africa

Abu G. MOGES, Miyoko Motozawa

Faculty of Humanities and Social Sciences, University of Tsukuba, Tsukuba, Japan

Population ageing is an emerging challenge in significant share of the global elderly population Africa. Africa has dynamic demographic features and without the commensurate financial, institutional and yet there are slow but steady transition taking place infrastructural resources to provide long term care across African countries. Fertility rate, life expectan- and income security for the elderly. Demographic cy, population growth rate, longevity and standard of decision, nonetheless, are made within the context of living indicators show improvements in recent dec- family and hence behavior, values, and relationships ades. One of the consequences of these developments with family members and expressed within commu- is that the ageing population is growing fast. As of nities and societies essentially define the demographic 2010, about 40.37 million Africans, or 3.9 percent of behavior of families and nations. This paper develops the total population, were 65 years old and over with a total family policy approach to assess the recent a median age of 19.7 years. Current demographic demographic dynamics in the continent and explores projections suggest that the continent may have as the policy options that could improve the capacity of much as 10 percent of its population constituting the the society, the family and governments to manage elderly by 2050. By then, Africa will be home to a emerging challenges.

Or-Oth-D02 Mental Well-being, Disability, and Development: Outcomes of the UNU - United Nations Expert Group Meeting

ATSURO TSUTSUMI1, TAKASHI IZUTSU2

1United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia, 2The World Bank, Tokyo, Japan

Globally, an estimated one in four people will the second leading cause of death: Among girls, experience a mental health condition in their lifetime. suicide is the leading cause of death. Depression is Annually, approximately one million people die due the largest single cause of disability worldwide. to suicide which is higher than the number of Economic loss due to problems related to mental maternal mortality, malaria, or death related to well-being is vast. Additionally, there are stigma and murder and wars. Among young people, suicide is discrimination against persons with mental or

─ 196 ─ Journal of International Health Vol.29 No.3 2014

intellectual disabilities. In particular in disaster long been neglected in development discourse. settings, protection of their rights is often neglected Successful and sustainable development policies and and not recognized. As emphasized by the General programmes require a renewed prioritization of Assembly, the genuine achievement of MDGs and mental well-being and disability. The UNU - United other internationally agreed development goals Nations Expert Group Meeting (EGM) in Malaysia requires inclusion of perspectives of mental well- discussed this issue, and issued recommendations for being and disability rights in development efforts at action. This presentation will discuss recommenda- all levels. Mental well-being represents a critical tions for action of the EGM for integration of mental indicator and a key determinant of well-being, quality well-being and rights of persons with mental or of life, hope, and sustainable development. However, intellectual disabilities in all the development efforts despite this close link between mental well-being and as critical indicators. disability with development, the mental aspects have

Or-Oth-D03 Antenatal nutritional interventions for preventing low birth weight: an overview of systematic reviews

ERIKA OTA1, Rintaro Mori2

1Division of Epidemiology, National Research Institute for Child Health and Development, Tokyo, Japan, 2Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan

Background Low birth weight is not only a major Main results We identified 13 Cochrane reviews indicator of perinatal mortality and morbidity, but investigating the effectiveness of various interven- also increases the risk of chronic diseases such as tions for preventing low birth weight. Five nutritional cardiovascular disease and diabetes later in life. interventions during pregnancy showed positive ef- Objectives To summarize the evidence from fects to prevent the risk of low birth weight. (1) Cochrane systematic reviews on the effects of ante- Balanced energy/protein supplementation (Risk ratio natal interventions for preventing low birth weight (RR): 0.79, 95%confidence interval (CI): 0.69-0.90) (2) during pregnancy. Vitamin A supplementation (RR: 0.64, 95%CI: 0.47-0.96) Methods We collaborated with the Trials Search (3) Magnesium supplementation (RR:0.67, 95%CI: 0.46- Co-ordinator of the Cochrane Pregnancy and Child- 0.96) (4) Multi micronutrients supplementation birth Group to identify all relevant Cochrane system- (RR:0.86, 95%CI:0.80-0.91) (5) Daily oral iron (RR:0.81, atic reviews on the effects of interventions which aim 95%CI: 0.68-0.97) to prevent low birth weight. Two review authors Authors’ conclusions A number of successful pre- independently evaluated reviews for inclusion, ex- ventive interventions for reducing low birth weight tracted data, and assessed evidence and methodologi- were carefully assessed in this overview. We identi- cal qualities using AMSTAR. fiedfive effective antenatal nutritionalinterventions .

─ 197 ─ 国際保健医療第 29 巻第 3 号 2014

Or-Oth-D04 The 1st International Conference on MCH Handbook at African continent

Akemi Bando1, 2, 3, Calvin S. de los Reyes1, 4, Miyako Shinohara1, 3, Masashi Yokota1, 3, Tomohiko Sugishita5, Yasuhide Nakamura1, 3, 4

1International Committee on MCH Handbook, 2The Support of Vietnam Children Association (SVCA), Kyoto, Japan, 3(NPO) HANDS, Tokyo, Japan, 4Osaka University Graduate School of Human Sciences Department of International Collaboration, Osaka, Japan, 5JICA, Tokyo, Japan

[Objective] The 8th International Conference on Health and Sanitation; and the unwavering support of Maternal and Child Health (MCH) Handbook was numerous agencies and NGOs. held in Kenya on October 2012. The Conference con- The four-day event included: country reports; ses- gregated about 300 participants, representing nine sions on the development of the program in specific countries from Africa and 14 countries from other settings; and, field visits at selected MCH centers in parts of the world. The theme was “Use of the MCH Nairobi. Through these activities, the role of the Handbook to Achieve Millennium Development Goals MCH Handbook was further recognized as a useful (MDGs) 4 and 5.” tool in promoting the ‘continuum of care’, with a “Call [Results] As 2015 fast approaches, there is a call for for Action” on the effective use of the handbook renewed global efforts to overcome the issues con- adopted in the conclusion of the conference. cerning MDGs 4 and 5. Africa remains seriously [Discussion] The 9th International Conference is challenged in achieving these goals. The Conference scheduled to be held on 2014 in Cameroon. The con- was staged through the initiative of Miriam Were, ference will serve as a follow-up on the efforts made the First Hideyo Noguchi Africa Prize Awardee; with from the previous conference. It will also be a venue collaborative efforts by the International Committee to discuss further development and promotion of on MCH Handbook and Kenya Ministry of Public MCH Handbook programs in the African continent.

Poster Presentations

Po-Af-A01 Changes in patientsʼ self-perception and reconciliation with the disease after receiving antiretroviral therapy (ART)-A survey conducted in the Central African Republic-

AYAKO TAKATSUKA1, SHOKO KATO2, MIZUKO TOKUNAGA3

1School of Nursing, The Jikei University, Tokyo, Japan, 2Faculty of Nursing at Higashigaoka, Tokyo Healthcare University, Tokyo, Japan, 3Department of Nursing, Faculty of Human Sciences, Sophia University, Tokyo, Japan

Background: This study has revealed changes in and less than 6 years at A Clinic in the city of patients’ self-perception and reconciliation with the Bangui, in the Central African Republic, and made disease after starting ART. In the Central African qualitative and inductive analyses of interview data. Republic, ART has enabled long-term survival in Results: Fourteen categories were extracted patients with HIV. Understanding the self-perception concerning changes in patients’ perception of the of HIV-positive patients is important in considering disease and self, and the following four stages were their quality of life (QOL). further identified: the first stage, acceptance of the Methods: We conducted semistructured interviews disease after diagnosis; the second stage, foundations with 58 HIV-positive outpatients (29 male and 29 for HIV-positive patients; the third stage, changes in female) who had been on ART for more than 1 year patients’ perception of the disease and self; and the

─ 198 ─ Journal of International Health Vol.29 No.3 2014

fourth stage, future prospects. recognized themselves and found their own values, Conclusions: In their daily lives, patients became reconciling themselves with the disease. It became aware of improvements in their physical symptoms clear that patients are living while trying to find a and have regained their self-confidence and roles. balance between themselves as HIV-positives and as Through the achievement of their roles, they have ordinary citizens.

Po-Af-A02 Health Care Check in elementary school in DRC

SHIHO MIZUTANI1, RIKA FUJIYA2, SHOKO KITAZAWA1, MASAFUMI KAMATA1, KEITARO YAJIMA1

15th Grade, School of Medicine, Keio Univ., Tokyo, Japan, 2Faculty of Nursing and Medical Care, Keio Univ., Tokyo, Japan

Objective Democratic Republic of the Congo (DRC) Result About weight and height, comparing with is one of the poorest countries in Africa. Keio Uni. WHO’s Child Growth Standard, almost all of the has Acadex Elementary School Project, which is students are plotted from -2SD to the average. But running a model school in Africa with medical, out of 57 boys, 5 has lighter, and 7 were shorter that architecture and educational faculties. In 2012, we -2SD. Out of 41 girls, 5 has lighter, and 1 was shorter have done health care check to all the students and than -2SD. Also, some students have anemia, hernia teachers at school to estimate their health status and on the stomach, abdominal dropsy, and decayed to start monitoring children’s growth. tooth. Method On Aug. 29 2012, 99 students (3 to 13 year Discussion To estimate children’s health situation, old, 57 boys and 41 girls) and 7 teachers had health monitoring their health status is important and care check, which is height, weight, body tempera- health care check at school is needed to be continued. ture, sight, and medical examination by doctor.

Po-Af-A03 Introduction of drug insurance system for children in Tambacounda district, Senegal

YUKO SUZUKI

Graduate school of International Health Development, Nagasaki University, Nagasaki, Japan

Introduction: This is a case of introduction of drug Results: The drug insurance system was launched insurance system for children in Tambacounda in September 2010. After two years, in September district, Senegal, which has high maternal and infant 2012, the drug insurance system was introduced at mortality rates. all four health huts under the dispensary spreading Objective: To facilitate access to health care widely with 370 members and 640 insured children. services for children of low income residents in rural The average number of users was 20 per month and areas. Method: The executive committee of the drug the average of each purchase was 1500F(300yen) and insurance system for children was established by the obligation fees of user was 750F(150yen). The health facility staff, health facility committee, a local drug insurance system has sustained to the present. NGO and JOCV. The drug insurance system was Discussion: Introduction of the drug insurance intended for women’s groups that were implementing system could contribute to the reduction of economic the microfinance and 2 children of each member of burden on health care cost, the early care-seeking for women’s groups were insured. Each member paid sick children and the understanding of mutual aid. 50F (10yen) as premium every week for each child. Challenges for the future include sustainability of the When the insured child became ill, members could system by only local staff with ownership and buy drugs at half price. The women’s group defrayed increase coverage of the insured. half of prescription charge.

─ 199 ─ 国際保健医療第 29 巻第 3 号 2014

Po-Af-A04 The management of a elementary school and the result of house visiting in Democratic Republic of the Congo by medical, architecture and education faculties.

MASAFUMI KAMATA1, RIKA FUZIYA2, KEITA KONDO1, KAZUHIRO AKASHI1, SHIHO MIZUTANI1, KEITARO YAZIMA1, SHOKO KITAZAWA1, NOZOMI SAKAMOTO2

15th grade, School of medicine, Keio University, Tokyo, Japan, 2Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan

Objective Democratic Republic of the Congo is one of by the nation as outreach activity, and there are the poorest countries because it is 186th country in many people who have mosquito nets and quinine for Human Development Index. We have had health preventing malaria. We can see a tendency in the activities in an elementary school in Democratic number of times of eating and its contents, and active Republic of the Congo, in which medical, architecture breast feeding. However, there are many people who and education faculties collaborates, and we visit suffer from parasite disease and diarrhea. children’s houses to investigate the situation of Discussion Some people often focus on the vaccina- sanitation in this area. tion and maternal and child health in developing Method The subject region is Kimbond area in countries, but in this area these projects are leaded Democratic Republic of the Congo. In visiting home, actively by the local people. However, there are we went to 30 children’s houses which agreed with problems about parasite disease and diarrhea, and us, and investigate the situation of vaccination, these links with situation of water or nutrition, so we infection disease, maternal and child health, water need to take account for these problems to manage supply and nutrition. school health. Result In this area, vaccination project has been done

Po-Af-A05 Teenage girlsʼ perception and significance toward pregnancy and childbirth in the Central African Republic

SHOKO KATO1, AYAKO TAKATSUKA2, MIZUKO TOKUNAGA3

1Faculty of Nursing at Higashigaoka Division of Nursing. Tokyo Healthcare University, Tokyo, Japan., 2School of Nursing, The Jikei University, Tokyo, Japan., 3Department of Nursing, Faculty of Human Sciences, Sophia University, Tokyo, Japan.

Objective: Early age pregnancy is a physical and were “surprised and confused about the unexpected social risk factor. Reportedly, about 70 percent of pregnancy. After learning from their mothers about primiparae in the Central African Republic (C.A.R.) “the value of a child” and “the acceptance of the are teenagers. This study aims to describe teenager’s unexpected,” they “realized the significance of preg- pregnancy and childbirth experiences to identify nancy.” They continued their school and domestic their perception of the event and its significance to work with a perception that “pregnancy is a natural them. process.” All the four gave birth in a hospital. They Methods: Semi-structured interviews were conducted felt “fear” when labor began but “endured” the pain, with four teenagers who had prenatal care from July thinking it is “a force to push out a baby.” “Prayers to to September, 2011 at B National Health Center. First their mothers and god” provided psychological sup- during pregnancy about 1) how they felt when they port. Their childbirth was an “experience without knew they were pregnant, and 2) how they see significance.” They felt “happy to be a mother.” pregnancy in their daily lives, and then later, two Conclusion: The teenage women in CAR saw preg- days after the birth, about their feelings when labor nancy and birth as a natural event. This experience started, during and after delivery. was considered to be a process of learning important Results: When they found themselves pregnant, they qualities as a person to be a mother.

─ 200 ─ Journal of International Health Vol.29 No.3 2014

Po-Af-A06 Establishment and challenges of the regional platform for French speaking African countries on human resources development in health

TOYOMITSU TAMURA1, NORIKO FUJITA1, MARI NAGAI1, SEIKO KOBAYASHI2, TAKAYUKI SHIMIZU1, NORIAKI IKEDA1

1Bureau of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan, 2Senegal Office, Japan International Cooperation Agency

Japanʼs Official Development Assistance started measures in the health sector. In January 2012, the the training course for overseas participants in 1955 trainees who completed the course and returned to as the first technical cooperation project, and it now their home countries established a regional platform accepts approximately 9,000 trainees each year from Human resource management network in health developing countries. This courseʼs implementing sector for French-speaking African countries (Reseau agency is Japan International Cooperation Agency Vision Tokyo 2010, in French) aimed at sharing their (JICA), and in recent years operates activities focus- experiences, technical exchange, and accumulation of ing on African region. Within this context, in 2009, knowledge. The platform continuously works on the National Center for Global Health and Medicine challenges on human resource development and its (NCGM) started the training course for human organizational strengthening, and then NCGM and resource management in the health sector for JICA have continued technical and financial supports. French-speaking African countries in commission of We introduce the processes (the training course in JICA targeted at ministries of health and relevant Japan, preparation for and establishment of the departments (human resource development depart- regional platform, organization strengthening, and its ments, personnel department, etc.). This course had activities on human resource development) and been conducted until 2011 for three years, and report lessons from that, challenges for the future, accepted 45 administrative officers from 8 French- and discussion about future potential. speaking African counties to share various issues and

Po-Af-A09 Health facilities data quality improvement study in Analamanga region, Madagascar

TOSHIHARU OKAYASU1, SUSUMU TANIMURA2, JEAN LUIS RAZAFIMAHATRATRA3, HARISOA JULIE NOROVAHANGY3, JACKY RAHAMEFY4, ANDRIAMIARIZO ANDRIANJATOVO4, KAE FURUKAWA5

1JICA Benin, Cotonou, Benin, 2Department of Public Health, Hyogo College of Medicine, Hyogo, Japan, 3Health Statistics Service, Ministry of Public Health, Antananarivo, Madagascar, 4National AIDS Program, Ministry of Public Health, Antananarivo, Madagascar, 5JICA Burundi, Bujumbura, Brundi

[Background] JICA HIV Prevention Strengthening [Methods] In this intervention study, 191 health project in Madagascar has integrated STI/HIV facilities providing HIV testing in Alanalamanga indicators in routine Monthly Activity Report (RMA) region were randomly assigned to a control group and updated RMA database software in 2010 and in and 4 interventions groups: (G1) training, (G2) super- 2011. As a result, the national coverage rate and vision, (G3) distribution with RMA with filling up completion rate have recorded the highest rates in notes, and (G4) error visualization model. For 78 2011 since 1998. However, the quality of such data indicators of STI /HIV and others indicators in RMA, has not been evaluated yet. The objectives in this the frequency of errors in each group has been study were to evaluate the quality and find better compared before (January 2012) and after interven- approach to reduce error events in HIV and other tion (January 2013). indicators. [Results and Discussion] The monthly median of

─ 201 ─ 国際保健医療第 29 巻第 3 号 2014

errors in total groups has been drastically reduced satory rivalry effects as errors graphics of G4 were from 17 in January 2012 to 2 in January 2013 (p ＜ posted in district offices. 0.001). The median reductions in G1, G2, G3, G4, and [Conclusion] The error visualization model has more the control group were 10.0, 6.0, 9.0, 15.5, and 14.0, prevented errors than other conventional costly in- respectively. The reduction in the control group terventions such as training and supervision. might be explained with the Hawthorne or compen-

Po-Af-A10 An evaluation of the significance of TB/HIV operational research in Madagascar

Shuko Nagai1, Jacky RANAIVO RAHAMEFY2, Sahondra Jeannine RANDRIAMBELOSON3, Hajarijaona RAZAFINDRAFITO4, Toshiharu OKAYASU5

1Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan, 2National HIV/STI control program, Ministry of public health, Antananarivo, Madagascar, 3National TB Control program, Ministry of public health, Antananarivo, Madagascar, 4National HIV/Aids Council, Antananarivo, Madagascar, 5Japan International Cooperation Agency Madagascar, Antananarivo, Madagascar

Background: Operational research (OR) for TB/HIV ination” got higher scores, but “Milestone 2: Publica- program in resource limited setting has a great tion” did not. Nevertheless, “Milestone 3: Changing potential to improve related policies and practices, policy and practice” had relatively high scores. All and is encouraged by many international guidelines. the evaluators noted “ Milestone 4: Effect on program Recently the reports of OR are increasing in number, performance” was too early to evaluate. but how to assess the significance of these ORs is yet Discussion and Conclusions: In this trial, we found not clear. This study aimed to evaluate the signifi- some successful outcomes of three ORs, though they cance the ORs for TB/HIV program in Madagascar. were not yet published in scientific journal. It is not- Methods: Using the proposed OR checklist for meas- ed that the impact of the OR can be strong as it is uring the successful OR (Lancet Infect Dis. 2012; 12: implemented by the program managers. There were 415-21), three ORs for TB/HIV in Madagascar were also some positive feedbacks for the evaluation pro- evaluated. These ORs were conducted by Ministry of cess. To evaluate its performance and/or impact Public Health in Madagascar during 2010-2012. The needs relatively long time span, more than one year. evaluation was made two times after 6 and 7 months As the next steps, we are planning to compare other of completion of ORs. evaluation indicators and to conduct cost analysis. Results: In all of the three ORs, “Milestone 1: Dissem-

Po-Af-B01 Primary School Teachersʼ Role on Health Education and Promotion among Semi-Traditional Maasai Students in Narok, Kenya

Calvin S de los Reyes1, Nobuhide Sawamura2

1Graduate School of Human Sciences Osaka University, 2Graduate School of Human Sciences Osaka University

Introduction Schools serve as an effective channel examine how primary school teachers perceive their for the delivery of basic health education and the role and practices on health education and promotion promotion of health-related practices among children. among semi-traditional Maasai primary school stu- Teachers remain as a key player in the success, or dents in Narok District, Kenya. failure, of health programs and activities in their Methods In this study, four public primary schools respective schools. Thus, this study was conducted to in Narok District, of close vicinity to each other, were

─ 202 ─ Journal of International Health Vol.29 No.3 2014

visited. Thirty-seven (37) primary school teachers performance, with health-related activities taking a were interviewed to describe their health education ‘backseat.’ The semi-traditional Maasai society may and promotion practices and involvement, barriers be more receptive to school health programs, but encountered, competencies, and other related topics. balancing ‘traditional’ with ‘modern’ remains a chal- Results and Discussion Teachers acknowledged lenge. Teachers’ role and practices towards health their significant role on health education and promo- education and promotion is closely linked to the local tion among their students, categorically identifying community’s traditions and views on health themselves as: (1) informants, (2) health advisors, and Conclusion Understanding primary school teachers’ (3) ‘middle-men.’ Teachers admitted that a gap perceived roles and practices are instrumental in persists between these perceived ‘ideal’ roles with strengthening student health activities and programs the pragmatic way of practicing these roles. Their in the semi-traditional Maasai setting. efforts remain focused on their students’ academic

Po-Af-B02 The Ideal Diet of High School Students in Tanzania Based Upon the Drawing Method

MEGUMI HASEGAWA1, K Ahmad Imtiaz2

1Dept of Public Health, Faculty of Health Sciences, Kyorin University, Tokyo, Japan, 2Dept. of Electrical and Computer Engineering, College of Engineering, Effat University, Jeddah, Kingdom of Saudi Arabia

Background: The Drawing Method is a tool to research participants. gather information on a person’s preferred food Objectives: The objective of this research is to iden- intake and can be extrapolated to infer assumptions tify and highlight any factors related to the Ideal about the person’s personality. Based upon the Draw- Diet of a select sample of participating high school ing Method is the Ideal Diet. Tanzania is an East students in Tanzania. African country which shares many borders includ- Methods: The participants of this research are 81 ing Kenya and Uganda to the north. Its economy is high school students. The research used the Drawing heavily dependent on agriculture, which makes up Method and was conducted by collecting illustrations over 25% of the nation’s Gross Domestic Product, of the participants’ Ideal Diets, and the statistical 85% of exports and employs 80% of the working analysis was performed using IBM SPSS Ver. 16.0. population. The major exports of Tanzania are agri- Results: The results show that there are no signifi- cultural commodities such as coffee, cotton, cashew cant differences in dietary knowledge, dietary behav- nuts and tobacco. A staple food, made from maize ior, habits and environment between male and flour, known as Ugali is eaten with broth. In light of female students. Also, it is evident that gender equal- the above, the population’s diet may well depend on ity exists between male and female students in the local agricultural resources and economic situa- Tanzania tion, and perhaps be reflected in the Ideal Diet of the

Po-Af-B03 Relationship of HIV infection, and nutritional condition between HIV positive people, their family, and HIV negative people

EICHI TAKAHASHI, KAZUO INOUE

School of Public Health, Teikyo University, Japan

[Background] Prevention for HIV infection is still successful. However, the prevalence rate has been important subject in Sub-Saharan Africa. In respect increasing recently. On the other hand, there are to Uganda, it is said that the preventive strategy was prejudices for HIV positive people still existing

─ 203 ─ 国際保健医療第 29 巻第 3 号 2014

especially in rural area. There is a possibility that Mubende HIV Clinic (Mubende District, Uganda) HIV infection affects their daily eating habit, and 2.Masafu General Hospital, Masafu HIV Clinic (Busia nutritional condition as a potent factor.[Purpose] To District, Uganda) [Target quantity] HIV infected compare the difference of eating habit, and nutritional people, Their family, HIV negative people (Each condition between HIV positive people, their family, 100people) and HIV negative people. To reveal the facts, HIV [Conclusion (Expectation)] We expect to be revealed infection affects their QOL, including eating habit, by this survey that HIV infection affects eating habit, and the nutritional condition among HIV positive and nutritional condition of HIV positive people. In people. addition, expect that this survey will be a trigger to [Method and Design] Cross sectional survey with review their nutrition education. I would feel amply using questionnaire. [Outcome measure] Frequency, rewarded for my efforts if this survey proved helpful Contents of daily meals, BMI [Period] 23rd August to to HIV region of research. 3rd September. [Venue] 1.Mbende General Hospital,

Po-Af-B04 Impact of 5S Practice on Quality of Health Services in Regional Referral Hospitals in Uganda: Results of Mid-term Assessment

NAOKI TAKE1, TORU YOSHIKAWA2, HIROSHI TASEI3, SARAH BYAKIKA4, MARTIN SSENDYONA4

1Kaihatsu Management Consulting, Inc., 2The Institute for Science of Labour, 3International Techno Center Co., Ltd., 4Ministry of Health, Republic of Uganda

Background 5S practice (Sort, Set, Shine, Standardize Results Patients’ satisfaction: Out of 7 items meas- and Sustain) is regarded as a fundamental of quality ured, only cleanness of health facilities showed the of health services in the Health Sector Quality positive and significant difference in the effect of 5S Improvement Framework of Uganda. The JICA practice on patients’ satisfaction between RRH Project on Improvement of Health Service through implementing 5S and those without intervention (p ＜ Health Infrastructure Management (2011-14) conducts 0.05). Satisfaction with staff attitudes and drug availa- the impact assessment of 5S. The following is a part bility has significant effect on general satisfaction (p of the results of mid-term assessment. ＜ 0.001). Methods Patients’ and providers’ satisfaction were Providers’ satisfaction: Staff surveyed in 5S RRH was measured as quality of services in all 13 Regional significantly more motivated than those in non-5S Referral Hospitals (RRH) in Uganda in 2012 and 2013. RRH in terms of pleasure to work, inspiration to do Those in 10 RRH currently implementing 5S practice staffs’ best, opportunity to discuss work issues and were compared with 3 RRH without intervention of morale of colleagues (p ＜ 0.01). 5S with use of double-difference estimator. 1,404 and Conclusion Emergence of the effect of 5S implemen- 1,275 samples were yielded for patients’ satisfaction tation on providers’ satisfaction and an aspect of in 2012 and 2013 respectively. As for providers’ patients’ satisfaction is good news even with a short satisfaction, 125 and 122 samples were collected. period from commencement.

─ 204 ─ Journal of International Health Vol.29 No.3 2014

Po-Af-B05 Spatial Analysis Of Cambridge Road Traffic Accidents For Injury Prevention In Sub-Sahara Africa

KAZUICHIRO HORI1, 3, ATSUMASA UCHIDA2, HIROKI HORI1, 2

1Department of Medical Education, Graduate School of Medicine, Mie University, Mie, Japan, 2Mie University, 3Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan

Introduction: According to the WHO, in 2010, more Methods: Using Arc GIS 10.1 software, we evaluate than five million people die from injuries every year. the road network planning improvements for safer And about 25 % of all injury-related deaths are due roads and mobility in Zambia. As a control, we to traffic injuries. The number of deaths from traffic- compare these results to results from Cambridge, related injuries has increased by 24% between 1990 Boston, U.S.A. and 2010. Moreover, the global burden of these types Conclusion: In Zambia, the results indicate poorly of injuries is expected to increase over the next 20 maintained roads (e.g., lack of pavement), lack of road years. In fact, the total number of deaths from traffic- safety audits, and difficult to access district hospitals. related injuries was greater than the number of The capital had intricate streets, which were difficult deaths from infection with HIV-AIDS, tuberculosis, for EMS units to navigate. To prevent traffic and malaria combined (3.8 million). Even more accidents, road engineering (to improve the planning, troubling is the fact that in low- and middle-income design, construction and operation of roads) and EMS countries (LMIC), the number of injury-related deaths systems are needed. Crash data, roadway inventory was 89% of total number of deaths. Objective: In data and traffic operations data could identify prob- Zambia, our research is to prevent injuries, focusing lem locations and, by integrating with GIS, more on Road Traffic Injuries (RTIs) using the WHO Plan effective suggestions. ‘Action for Road Safety’.

Po-Af-B06 The improvement of immunization coverage through an intervention of Growth Monitoring Program Plus (GMP+) in urban communities, Zambia

STOSHI SASAKI1, Satoshi Otani2, Aya Kayebeta2, Yuko Murakami2, Hisayuki Inaba2, Shunsuke Suzuki3

1Faculty of Nursing, Soka University, 2AMDA Multisectoral and Integrated Development Services, Okayama, Japan, 3Asuka World Consultant, Okayama, Japan

Background. Outreach health service plays an Objectives. This research is aimed at assessing the important role in delivering necessary health services impact on immunization coverage through introduc- to individuals with insufficient access to health tion of GMP plus in underprivileged urban settings facilities (Partapuri, 2012). JICA and the Ministry of and to provide scientific basis for effective implemen- Health in Zambia implemented the Lusaka District tation of the outreach health services. Methods. KAP Primary Health Care Project for 10 years from 1997. surveys were conducted in intervention and non- The project initiated the packaged outreach health intervention areas in 2011 and 2013. The frequency of service called GMP plus (Growth Monitoring Pro- GMP+ attendance and immunization history was gram plus) that was integrated with necessary health copied from Child Health. services such as growth monitoring, immunization, Results. In a comparison of full immunization cover- and Vitamin A supplementation. The GMP has age between the intervention and non-intervention proved its impact on improvement of knowledge and areas, the coverage of the intervention area increased healthy behavior among caregivers (Sasaki, 2010). significantly from 61.9% in 2011 to 74.3% in 2013.

─ 205 ─ 国際保健医療第 29 巻第 3 号 2014

Coverage of the non-intervention slightly increased immunization. Currently, the integrated outreach 70.5% in 2011 to 73.0% in 2013. health services have been paid attention as a strate- Conclusion. This research indicates outreach health gy for increasing the equity and efficiency of health services have a potential to improve coverage of interventions.

Po-Af-B07 Interventions to reduce diarrhea cases through the capacity development of community health volunteers in urban communities, Zambia

SATOSHI OTANI1, AYA KAYEBETA1, SATOSHI SASAKI3, SHUNSUKE SUZUKI2, YUKO MURAKAMI1, HISAYUKI INABA1, KAKUNGU SIMPUNGWE4, LUCK SILENGO4, ISABEL MELEKI4, ALICK CHIRWA4, BUSHIMBWA TAMBATAMBA4

1AMDA Multisectoral & Integrated Development Services, Okayama, Japan, 2ASKA World Consultant, Okayama, Japan, 3Soka University, Hachioji, Japan, 4Ministry of Community Development Mother and Child Health, Lusaka, Zambia

Background: 80% of health conditions presented at health data collection. They also formulate and health institutions in Zambia are attributed to implement other activity plans based on the analysis deteriorated sanitary conditions. Especially in urban of abovementioned data. In addition, the project communities, it is worse due to deterioration of living conducted cohort survey targeting all infants born environment, immature capacity by public institu- during a certain period and KAP survey targeting tions, and poor personal behavior. In JICA Primary 300 people at each community in the beginning and Health Care Project from 1997 to 2007, PHAST end of project at intervention and control sites. improved the incidence rate and personal hygiene Results: Continuous PHAST activities are highly behavior on diarrhea in Lusaka. PHAST is a method- appreciated by health related stakeholders and ology to improve environmental health issues activities like promotion of dry toilets are planned to through community empowerment using visual tools be extended to other areas as a successful model. and participatory techniques. Also, the behavior about diarrhea improved from Objectives: To verify if PHAST is applicable to other 31.6% to 46.0% on people washing hands appropriate- urban communities to reduce diarrhea cases or not. ly and from 53.7% to 58.0% on people disinfecting Methods: 20 community health volunteers (CHVs) water appropriately in Kabwe. are trained at 8 health centres each in 4 cities by the Considerations: PHAST is applicable to other urban Ministry and project. They conduct daily activities communities to reduce diarrhea cases. like community sensitization and environmental

Po-Af-C01 Trend of Childbirth Delivery by Skilled Birth Attendant (SBA) in African Countries and Related Factors.- Comparison in the age groups using Demographic and Health Surveys (DHS) -

KANAKO YAMADA, KAZUHIRO KAKIMOTO

Osaka Prefecture University, Osaka, Japan

＜Introduction＞ In this study, we compared the Tanzania (1999 and 2010) and Rwanda (2000 and changes of the factors and trends of delivery by SBA 2010). We investigated the changes in the factors of in the African countries with high growth rate of the hospital delivery of each country using a multi- SBA in these 10 years. variate logistic regression analysis with the depend- ＜Methods＞ With the permission to use it, we ob- ent variable “whether or not the subject had a tained female DHS data of Ethiopia (2000 and 2011), hospital delivery.”

─ 206 ─ Journal of International Health Vol.29 No.3 2014

＜Result＞ The ratio of hospital delivery and deliv- performed by an SBA” (AOR ＝ 9.175, 95%CI:1.447- ery by the SBA has increased significantly in these 58.174, p ＝ 0.019).Furthermore, Ethiopia in 2011 and countries. “Living in the countryside” and “means of Rwanda in 2010 showed similar results. transportation is not available” were significant ＜Conclusion＞ The measures for pregnant women factors in Tanzania in 1999 and in Rwanda and who had geographically poor accessibility were Ethiopia in 2000. In 2010 in Tanzania the following issues about 10 years ago. On the other hand, the responses showed significant difference: “A previous study suggested the importance of the delivery by child was delivered somewhere other than facility” SBA from first pregnancy and contact with SBA in (AOR ＝ 8.701, 95% CI: 5.029-15.057, p ＝ 0.000) and “Gy- the early stage for gynecological checkups in recent necological checkup for the last child was not years.

Po-Af-C02 Strengthening capacity of Village Midwife (VMW) in the Republic of the Sudan - Experiences from JICA Project, ‘Mother Nile Project’ -

Sachiko Miyake1, Kumiko Nakano1, Aya Yagi1, Akiko Hayashi1, Akira Saiki1, Junko Nagano1, Yasuhide Nakamura1, Dr. Sawsan Eltahir Suleiman2, Dr. Nada Gaafaer Osman3

1Nonprofit Organization HANDS (Health and Development Service), 2Director of National Reproductive Health Program, Directorate of Mother and Child Health, General Directorate of Primary Health Care, Federal Ministry of Health, 3Director of Mother and Child Health Directorate, General Directorate of Primary Health Care, Federal Ministry of Health

[Background] MCH situations are challenging in 28% in Gezira were not enrolled into formal educa- Sudan, and education/training for midwifery profes- tion. Average years after VMW school graduation sionals is urgently required. Mother Nile Project and the engaging durations were not different in the Phase II will complete 3 years of operations in two localities, respectively. Participants assisted September 2014. In order for women to receive averaged 2 deliveries each in the last 30 days. quality cares related to pregnancy and childbirth, one Percentage of correct answers was 42.0 in pre-test of activities is to support the Federal Ministry of and 67.8in post-test. Essential capacities for midwifery Health to strengthen the capacity of VMW through care were enhanced, particularly in antenatal, normal in-service training following implementation of TOT delivery and postnatal. and SOC training for supervisors in 8 of 17 States [Discussion] Training strengthens VMW’s capacity and establish a VMW supportive environment. and contributes to quality improvement of services. [Outline] The Project has conducted VMW in-service It is important to establish supportive environments training in selected localities of Gezira and North in which VMW retain and apply the knowledge and Kordfan - 2 of 8 target States. Pre/post-tests skills gained from trainings. Practical methodologies measuring knowledge/understanding was conducted with current resources are needed in the short term on 172 participants as well as interviews on back- but a long term plan tackling challenges in financial ground and service delivery information. and human resources is also required. [Result] 46% of participants in North Kordfan and

─ 207 ─ 国際保健医療第 29 巻第 3 号 2014

Po-Af-C03 The final evaluation of maternal and child health activities in the eastern villages of Sudan

KAZUMI YANO1, NAOYUKI KAWAHARA1, FUMI SAKURAI1, INTESSAR MOHAMED1, HUSSAIN SULEMAN1, ASAKO SERIZAWA2

1NPO Rocinantes, 2University of Khatoum, Faculty of Nursing Sciences, Sudan

NPO Rocinantes had carried out Maternal/ Child MCH services by VMW while understanding of the Health (MCH) service activities in Hassabara zone, importance of check-ups during pregnancy. . III. Gedarref state in Sudan since 2010 and completed Suggestions Responsible postnatal care services led project in June 2013.We report the final evaluation of women the opportunity to sustain a reliable relation- outputs of MCH activities. I. Criteria for evaluating ship and facilitated the increase of the number of activities1. Comparison of the results of a women’s antenatal care and deliver services by VMW. survey conducted between July 2010 and March 2013 Moreover, it was also very important for the im- 2. Quantitative survey for the MCH service3. provement of MCH services to have an assisted self- Comparison of the results of MCH qualitative sustaining system for the health center facilitated by surveys conducted between 2011 and December factors such as income generation by donkey cars for 2012II. Results The number of antenatal care, deliv- VMWs or change of the time of medical examination. ery and postnatal care services increased. Finally, On the other hand, the extent and form of MOH almost all of the pregnant women in these areas involvement will impact greatly on the employment became to open to receiving antenatal care. Moreo- of medical staff, and training of VMWs after ver, the quantitative survey for the MCH service Rocinantes withdraw and this will affect the presented that most of the women came to prefer sustainability of MCH services.

Po-Af-C04 South Sudan: Report of Technical Cooperation for the Development of Human Resources for Health

KASAHARA HIKARU, Shigeki TANIHO, SEIKI TATENO, KOHTA NISHIJIMA

TA Networking Corp, Tokyo, Japan

In 2011, South Sudan became the world newest partners etc. In implementing the project, the project country. However, the nationʼs major health indica- team respected JICAʼs strategy in health sector aid: tors such as maternal mortality rate 2,054/100,000 strengthening of health governing and capacity live births (2006) and under-five mortality rate development of developing countries. The issue of 106/1,000 show the severe status of health sector of HRH has gained attention in global health since the this post-conflict nation. The Project on Human WHOʼs World Health Report 2006. The project Resources Development for Health in South Sudan addressed to this global trend such as health work- (Japan International Cooperation Agency, from force policy and management capacity building and March 2009 to July 2013) which was implemented by development of HRIS for the evidence-based HRH TA Networking in collaboration with University of management in the Kampala Declaration, while the Ryukyus aimed to improve health service valued locality by collaborating with the Ryukyu provision through the capacity building of Ministry of University which is rooted in Okinawa. In this Health and all 10 State Ministries of Health. The fieldwork session, the project activity in the post- project contributed to develop national health human conflict and fragile nation will be shared, and the resources (HRH) policy and strategic papers, develop challenges and how to address to them for the better and rolled out of health human resources information HRH development in South Sudan will be examined. system (HRIS), and coordination of development

─ 208 ─ Journal of International Health Vol.29 No.3 2014

Po-Af-C05 A study on factors affecting the impact of midwifery in-service training in South Sudan

MIKI HIRATA1, FUJIKO OMINE1, YUMIKO ENDO1, YOKO TAMASHIRO1, KEIKO KAWAMITSU2, SHIGE KAKINOHANA1, KUMIKO TSUJINO1, YASUKO KOJYA1, TSUGIKO GIMA1, TOMOMI TAKAYAMA1, RIKA TAKEMOTO1, SHIGEKI TANIHO3

1School of Health Sciences, Faculty of Medicine, University of Ryukyus, Okinawa, Japan, 2Shiozaki Jyodsanin, Okinawa, Japan, 3ta Net Working, Tokyo, Japan

The MMR in South Sudan with population of of these training to discover attitude and behavioral 10,838,000 is 2,054 per 100,000 live births according to changes as well as the implementation of learning. the 2006 Sudan Household Health Survey. The Based on findings, we will investigate the factors number of obstetricians is less than 10 in the entire affecting the impact of training, and hope to country with approximately 100 midwives. In the contribute to the planning of future in-service train- midst of severe shortage of obstetricians, only 10% of ing in South Sudan. Methods and subjects: Qualita- women give births under professional care of obste- tive research. We conducted semi structured inter- tricians or skilled midwives, 30% by under-trained views on six practicing midwives and five South village midwives or traditional birth attendants, 30% Sudan Ministry of Health staff between 26 April and by husband or family member, and 30% by herself. 12 May, 2013. Questionnaire included attribute such This is said to be causing the high MMR. For as age, educational background, number of years development of skilled midwives and improvement of practicing midwifery, and questions on their skills and knowledge of practicing midwives are implementation progress, challenges, thoughts on critical in promotion of deliveries by skilled midwives, midwifery as a profession, and the impact of JICA JICA provided three in-service training in 2010 and training on their career. 2011. In this study, we interviewed the participants

Po-Af-C06 Medical Operation of United Nations Peacekeeping Operations in South Sudan -A report from a Japan Ground Self-Defense Force nurse-

NORIHITO NOGUCHI1, 2, KOICHI SHINCHI3

1Graduate school of Medical Science, Saga University, Saga, Japan, 2Japan Ground Self-Defense Force Fukuoka Hospital, Fukuoka, Japan, 3Division of International Health & Nursing Saga Medical School Faculty of Medicine, Saga University, Saga, Japan

Medical Operation of United Nations peacekeep- Result, Nursing activities are as follows: medical ing operations in South Sudan-A report from a Japan assistance of doctors, bed side nursing care, medical Ground Self-Defense Force nurse-Norihito NOGU- staff guidance in nursing skills, writing and manage- CHI1)2), Koichi SHINCHI3) Introduction, The author ment of medical records, setting up the medical participated the United Nations Mission in South equipment in medical facility, schedule management Sudan (UNMISS) as a nurse of Japan Ground Self- of medical staff, assist of writing medical referral Defense Force (JGSDF) Medical Team between letters, environmental management in the camp, and February 1 and June 30 in 2012. Purpose, The pur- patients transportation Conclusion, Promotion of pose of this report is to clarify the required nursing practical nursing skills and ability of nurses, standard activities for nurses who dispatch for United Nations manual of setting up medical facility, flexible change peacekeeping operations in the future. Method, This of the form of medical records depending on local report is based on the first authorʼs experience. It is situations, and out-reach type of nursing activities based on the description for making a retrospective were considered very important.1) Graduate school of review of nursing activities reports in South Sudan. Medical Science, Saga University, Saga, Japan2) Japan

─ 209 ─ 国際保健医療第 29 巻第 3 号 2014

Ground Self-Defense Force Fukuoka Hospital, Fukuo- Nursing Saga Medical School Faculty of Medicine, ka, Japan3) Division of International Health & Saga University, Saga, Japan

Po-Af-C07 Ethnographic Approach to Medically Pluralistic Environment: Cases of Medico-Anthropological Researches at the School of International Health Development, Nagasaki University.

KEN MASUDA1, SHIHO HIRANO2, NAOMI WADA1, CHIHARU KAMIMURA3, FUMIKA HASHIBA4

1Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan, 2HANDS, Tokyo, Japan, 3Center for International Collaborative Research, Nagasaki University, Nagasaki, Japan, 4Japan Overseas Cooperation Volunteers, Tokyo, Japan

Introduction tion is prevalent and patterns of treatment seeking Ethnography is a basic method of socio-cultural vary. anthropology and aims at describing socio-cultural Kamimura and Hashiba carried out their re- particularity among each society. As a part of searches on the relationship between health behavior qualitative research methods, ethnography contrib- and community health in Amhara Region of Ethiopia. utes to global health in discovery of particular Kamimura focuses on the role of CHWs in the variables and contextualization of health behavior. ongoing process from local treatment to modern- This study attempts to figure out the possibility and medical one against a folk illness “milk teeth aporia of ethnography through introducing four diarrhea”. Hashiba points out the risk of home research cases conducted at the Graduate School of delivery by detailed ethnographic description. International Health Development, Nagasaki Univer- Global Health Ethnography: Aporia sity. Ethnography makes it possible to interpret Cases of Ethnographic Research medically pluralistic environment on cultural context Hirano, in Palawan Island of the Philippines, and of each society. However it is not proper to attribute Wada, in Burkina Faso, were engaged in ethnograph- all health behavior to culture. Dilemmas between ic researches on local recognition and treatment cultural relativism and validity of health intervention seeking patterns against malaria. Those studies would awake the arguments on the potentials and discover that the “right” knowledge on malaria predicaments of ethnographic approach to the global infection prevails in two countries while folk recogni- health.

Po-Oth-A01 A Report of international health activity in Pacific Partnership 2013 in Papua New Guinea

AYUMI YAMAMOTO, YOKO HANADA, KOICHI SHINCHI

Division of International Health and Nursing, University of Saga, Saga, Japan

Introduction: Pacific Partnership 2013(PP) is a In this PP operation, 6 doctors and 4 nurses partici- practical Civilian-Military cooperation operation and pated. We had health promotion education (lectures also practical exercise of intentional health in the of washing hands and brushing teeth for school Asia Pacific region. The first and second authors children), and we also had dental examination. We participated in this PP as a nurse of the NGO teams. also examined many patients in the local hospitals. We report the activity in Papua New Guinea. Result: We used a picture-story show for health Method: The authors report the activity of PP in promotion education in the elementary schools. We Papua New Guinea between June 20 and July 5, 2013. also noticed many problems in Papua New Guinea

─ 210 ─ Journal of International Health Vol.29 No.3 2014

through the communication with the residents. response in the international disaster relief opera- Poverty from low income, increasing numbers of tions. STD patients, very little support for handicapped Conclusion: PP was very effective activity and children, and domestic violence against female are exercise for international disaster relief operations. In problems. What kind of support we can do as NGO this PP, we cooperated with United States, Australia, members is the big problem from now on. In this and Japan military medical staffs. We learned that activity, transportation, logistics, and security were mutual understanding and trust of other organiza- very smooth, because it was civilian-military tions is very important for future smooth inter- operation. We also learned the need of flexible national disaster relief operations.

Po-Oth-A02 Nutritional status from the aspect of the bone density in residents living at Asia-Pacific area

JUN HAGIHARA1, MINATO NAKAZAWA2, TARO YAMAUCHI3, DAICHI ISHIMORI4, YUKO NAKAYAMA5, TOSHIO KAWABE6

1School of Nursing, Miyagi University, Sendai, Japan, 2Graduate School of Health Sciences, Kobe University, Kobe, Japan, 3Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan., 4Department of Sociology, Faculty of Sociology, Musashi University, Tokyo, Japan, 5School of Nutrition, Kiryu University, Japan., 6Graduate School of Regional Policy, Takasaki City University of Economics, Takasaki, Japan.

By means of changes in lifestyle by moderniza- We measured 115 subjects (60 males, 55 females) at tion, the nutritional status of residents can also Honiara, which is capital of Solomon Islands. Collected change. In Asia-Pacific area, the process of moderni- items were as follows; personal information (age, sex, zation progress more rapidly, so that it is more lifestyle such as habitat of food consumption, and so important to evaluate the nutritional status. Changes on), anthropometric measurements (height, weight, of medical care system will affect the longevity. As a skinfold thickness, and so on), blood pressure, and result, it can change the health problem in such bone density estimated with an ultrasound bone countries. For example, osteoporosis is the major densitometer (SENSA-MARK8800). The result of health problem for elderly people, but there is more measurements in this study compared with the result serious problem in Asia-Pacific area because the from the other country we investigated, and we number of elderly people is relatively small. The pro- discuss the difference between countries. The result gress of modernization can affects the population of regression analysis showed that there was structure, which elderly people will increase, so that significant negative correlation between bone density the lifestyle-related disease will become more and age for males, but not for females. This result important at such area. In this study, we investigated was consistent for the results of the investigation at the nutritional status, focused on the bone density, Laos. and estimated the factors that affect bone density.

─ 211 ─ 国際保健医療第 29 巻第 3 号 2014

Po-Oth-A03 A Study on Lifestyles among Upper Graders of Primary Schools in Urban and Rural Areas of Vanuatu

EMI NAKASEKO1, NOBUKO MATSUDA2

1Department of Human Nursing Faculty of Human Health, Sonoda Women’s University, Amagasaki, Japan, 2Department of Community Health Sciences, Graduate School of Health Science, Kobe University, Kobe, Japan

Objective: To identify the lifestyles of upper graders comparison between urban and rural groups, the of primary schools in urban and rural areas of intake of rice, bread, and processed food and drinking Vanuatu, with a view to obtaining basic data for the rates were significantly higher in the urban group, development of health education programs to pre- while the intake of root crops, fresh fish, and fruits vent non-communicable diseases (NCDs). were significantly higher in the rural group. Howev- Methods: The target participants were 6th, 7th, and er, the current situation of knowledge related to 8th grade students of primary schools from both NCDs and attitude of health practice, and those in urban and rural areas in Vanuatu. We performed a whom guardians’ parenting attitudes were better in questionnaire regarding food consumption, exercise, the urban group than in the rural group. smoking and drinking experience, health knowledge, Conclusion: Considering that lifestyle behaviors, attitude of health practice, guardians’ parenting knowledge and attitudes, as well as guardians’ attitudes related to health. Urban and rural groups parenting attitudes, varied among areas, it may be were compared regarding each item by performing necessary to support primary school students’ univariate analysis (chi-square and Mann-Whitney U behavioral changes toward healthier lifestyles by tests) using statistical analysis software SPSS for providing them with health education programs in Windows ver. 18.0. The significance level was set at consideration of the environmental conditions and p ＜ 0.05.Results: A total of 415 students, (urban :194; regional characteristics. and rural: 221) participated in the survey. On

Po-Oth-A04 The research of maternal death and newborns death in Majuro hospital, The Marshall Islands

RIE YAMASAKI, Chiyuki Hamano, Hiroka Kondo

JICA Japan

The statistics for two yearsʼ worth of delivery to say that the medical system and environment are numbers and cases in the Republic of the Marshall adequate enough, as evidenced by the neonatal mor- Islands Majuro hospital in 2011-2013. tality death rate and infant mortality death rate. There are 29 atolls and five islands in the The Republic of the Marshall Islands is an island Republic of the Marshall Islands, but there are only nation, and as such, deliveries of offspring produced two hospitals. Majuro hospital is located in the capital by blood relatives and other problems characteristic city of Majuro, and it’s the largest general hospital in of an island nation are common. Moreover, Marshall the Republic of the Marshall Islands. In the maternity has the Bikini Atoll, which is also said to have its ward, there are more than 1000 deliveries in year. own characteristic features in connection with However, it is a still developing country, so it is hard deliveries.

─ 212 ─ Journal of International Health Vol.29 No.3 2014

Po-Oth-A05 Integration of Medic, trained health/medical volunteer in conflict area, to the government health system. ”Kaiho Seido”, “Medical Service Man system” of Okinawa of Post World War Ⅱ, and Challenge & Practice in Myanmar-Thai Border.

KENTARO HAYASHI

Barefoot Doctors OKINAWA / Representative, “Nippon Foundation”-“Myanmar Medical Association” Affiliate Primary Health Care Project at Myanmar-Thai Boarder / Advisor, National Institute of Public Health Japan, Health Crisis department / Visiting Researcher.

Medic is primary health care provider of the also concern with the general problem which we Myanmar-Thai Border jungle area where notorious observed in remote area of the globe including Japan. for continuous conflict between Myanmar Military It is extremely difficult to find the qualified medical Junta and independent ethnic groups. Medics have human resources for remote, jungle harsh living been serving as “combat medical orderly” trained by condition area. Addition to it, we have to prepare for Humanitarian NGOs arise in 1970th. coming back 500,000 refugees, which will surely come From 2010, after the general election and after the peace treaty will be concluded, from Thai- establishment of constitution, transition to democracy border. has been observed in Myanmar. In parallel, armistice In such environment, one of the effective and agreements have been arranged between each hopeful solutions would be a application of “Kaiho groups and Government. Following this trend, neces- Seido”, “Medical Service Man System” of Okinawa sity to apply/establishment of legal health system & after World War II to compensate the lack of Human services become clear and furthermore, implication of Resources in the region. Utilization of idea & experi- heath system & services agreed by both party will ence of “Medical Service Man System” of OKINAWA be a big contribution in concluding peace treaty. to the Region where Medics already exists would be Problem concern about health system of this a key for constructing health system & Peace. post war region is not only the security matter but

Po-Oth-A06 The Health Issues of the Brazilian in Japan

SATOMI SUZUKI, KUNIE MATSUMOTO, KAZUKO YOICHI

Gifu College of Nursing, Gifu, Japan.

Objectives The purpose of this study is to classify the results were problem of nutrition balance. The the result concerning the health of the Brazilian in health issues of the adults Findings revealed were Japan and to utilize the outcome as a source to future obesity, lifestyle, mental manifestation and stress. investigation. The rate of obesity was higher. Their diet was much Methods The Japan Medical Abstracts Society Web meat, fat and sweet juice, and less fish and vegetable. version was the resource to conduct this research by The causes of stress were lack of sleep associated the keywords of “Brazilian student” and “health”. We with night shift work and less time together with collected fourteen literatures. Health issues of family etc. Brazilian students and adults in Japan were analyzed Conclusion Brazilian students have health issues in this study. caused by accepting Japanese lifestyle in school and Results The health issues of the students Findings their parent’s work shift. The obesity of the students revealed were mental health, obesity, dental caries and adults was resulted from their diet. Therefore, and lifestyle etc. Risk factors were language barrier, the grasp of the lifestyle characteristic to Brazilian is relationship with Japanese student and acceptance of needed. The research task is to grasp, through the lifestyle in school etc. The stress level and the lesser analysis of their lifestyle, the causes that prevent the time with family members were mutually students’ health. interrelated. About obesity, dental caries and lifestyle,

─ 213 ─ 国際保健医療第 29 巻第 3 号 2014

Po-Oth-A07 AIDS policy in Brazil and the movement by people with HIV

SAYAKA ARAI1, SATOMI SHIMOGO2, CHIZURU MISAGO3

1Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan, 2Freelance journalist, 3International and Cultural Studies, Tsuda College, Tokyo, Japan.

Background: The Brazilian AIDS policy is consid- geographical disparity in health care services. But ered to be a model for the world because the the NGO supports people living with HIV/AIDS, and government guarantees AIDS drugs to all domestic it performs prevention activities for young people. people for free since 1996. This policy has enabled Moreover, activists were never satisfied with the the government to reduce the number of HIV- present conditions and constantly appealed to the infected persons and the death toll due to AIDS. The society. purpose of this study was to show the problems of Discussion: The AIDS policy success in Brazil is due the policy and to consider the influence of the to the civic voices of activists. Considering Brazilian movement by people with HIV on the society. history, people oppressed in the military regime were Methodology: In September 2012, I conducted conscious of the social change under democratization. fieldwork in Sao Paulo, where I visited some NGOs This movement can correspond to Conscientization. and specialized agencies that support people living It is Paulo Freire’s concept and that means the with HIV/AIDS, observed their preventive enlighten- process of developing a critical awareness of one’s ment activities, and carried out a half-structure social reality through reflection and action. Further- interview. more, the construction of cooperative relations Results: The study revealed that problems included between citizens and society in Brazil is the fruit of the lack of specialists in poverty-stricken areas and the social activists’ efforts.

Po-Oth-A08 Assessment of a Skype-based international distance-learning program in Nicaragua on nursing techniques for postural change

SACHIYO MIYAKOSHI1, YOSHIE MORI2, HIROMI TSUJIMURA2, RAJASEKERA JAY3, QUIROZ ZENEIDA4, REYES SANDRA4, GAITAN MARLENE4, RIE NAKAZAWA2, MASAAKI SAKAMOTO2

1Nagano College of Nursing, Komagane, Japan., 2Graduate School of Health Sciences, Gunma University, Maebashi, Japan, 3Graduate School of International Management, International University of Japan, Minamiuonuma, Japan, 4National Autonomous University of Nicaragua-Managua, Managua, Nicaragua

[Objectives] We examined the future perspectives was more than four on a five-point scale, and the and issues associated with conducting an internation- domains acquisition of new insights, contentment, and al distance-learning program on nursing techniques applicability to own practice and life showed using post-class assessment and self-evaluation significantly high scores, whereas the domains sound reports. quality, realistic sensation, and hearing comfort, [Method] We connected the classrooms of B School of showed low scores. Nursing techniques for assisting A University in Nicaragua with C University in a patient to sit up and assisting a patient to move in Japan through the Skype and implemented three sets a wheel chair were introduced for the first time to of postural-change practice program for each nursing students and their self-evaluation showed low scores. technology. Post-class assessments and self-evaluation Nursing techniques to treat wounds, promote mater- reports were collected from the student recipients to nal health, and provide an intensive care were recog- develop nursing skills. nized as the courses that required continuous [Results] In particular, 28 sheets of post-class enhancement. assessments and 28 self-evaluation reports were [Discussion] The results revealed that the Skype- collected. The average post-class assessment score based international distance-learning program can

─ 214 ─ Journal of International Health Vol.29 No.3 2014

promote interests on innovative techniques and Future programs should critically consider language effectively enhance student’s satisfaction with the barriers associated with interactive-learning pro- classes. However, it is necessary to provide the grams and explore useful demonstration methods for classes with more stable sound and video quality. improvements in skill and technique.

Po-Oth-B01 The relation between perceived social support on depression of carers of community-dwelling elderly people from a nationwide survey in the Republic of Chile

FELIPE SANDOVAL1, NANAKO TAMIYA2

1Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan, 2Department of Health Services Research, Faculty of Medicine, University of Tsukuba

Objective: We aim to clarify the relation of social 0.220~0.600) compared to low support; age of the support and depression among informal carers of carer (OR:0.980, 95%CI:0.962~0.999); years of education community-dwelling elderly people in the Republic of (OR:0.924, 95%CI:0.870~0.980); national health Chile. insurance (OR:0.207, 95%CI:0.090~0.477), and other Methods: This is an inferential study, using logistic health insurance (OR:0.179, 95%CI:0.038~0.836) regression on secondary data from 445 community- compared to those uninsured. Significant harmful dwelling caregivers of elderly from all over Chile. factors that increase the likelihood of being depressed The Duke-UNC FSSQ was used to measure per- are: female sex of the caregiver (OR:2.148, 95% CI: ceived social support as exposure and CES-D for 1.175~3.928), hours of care (OR:1.026, 95%CI: depression of caregivers as outcome. Gender, age, 1.004~1.049), and being the partner of the recipient, education, urbanization, health insurance status of the as opposed to other carers (OR:2.679, 95%CI: carers and their relation with the recipient were 1.307~5.491). used as covariates, along the dependency of the re- Conclusion: Higher levels of perceived social support cipient. were associated with lower prevalence of depression Results: 77.5% of the carers perceived a normal level in community-dwelling caregivers. Interventions to of social support; 47.4% of the caregivers present enhance perceived social support might be helpful for depression. Logistic regression shows significant improving mental health among informal caregivers, beneficial factors that decrease likelihood of being in addition to support female carers, uninsured, and depressed are: a normal level of social support (Odds who care for longer hours. Ratio, OR: 0.363, 95% Confidence Interval, CI:

Po-Oth-B03 Possible determinants to acquire a career pass in the field of nutrition for international medical cooperation

MIKI MIYOSHI1, Midori Ishikawa2, Kaoru Kusama3, Kaori Mizumoto4, Miho Nozue1

1Center for International Collaboration and Partnership, National Institute o f Health and Nutrition, Tokyo, Japan, 2National Institute of Public Health, Saitama, Japan, 3Aomori University of Health and Welfare, Aomori, Japan, 4Fukuoka Women’s University, Fukuoka, Japan

Whilst highly qualified human resources capable this circumstance, we have been working on the of working out the global health and nutrition issues research to establish the system of continuous career have been required, the system to develop and development for those working in the field of nutri- recruit the manpower in the field of international tion for international medical cooperation. Of which, nutrition has not been well established yet. Under the results of a survey conducted with the aim to

─ 215 ─ 国際保健医療第 29 巻第 3 号 2014

grasp the career path of these with experience of they were more likely to pursue higher education (e.g. international nutrition cooperation activities will be postgraduate school) or research career, rather than presented here. A self-recorded questionnaire survey returning to the former workplaces (e.g. hospital). It was conducted for the participants of small work- is reported that the skills acquired through experi- shops on international nutrition organized at the ence of international cooperation are useful to the Annual Meeting of the Japan Association for Interna- current job, but in fact, they used to face with a lack tional Health and the Annual Academic Meeting of of information how they could utilize these skills after the Japanese Society of Nutrition and Dietetics. Total returning to Japan. Further investigation is in 64 participants, of which 40 had experience of progress to investigate the possible determinants to international cooperation, returned the completed acquire a career path in the field of international questionnaires. One of the interesting characteristics nutrition. of career selected after the first dispatch was that

Po-Oth-B04 Study of diagnosis and treatment of BODY PACKER (drug body packing patient) in the Emergency Shock and Trauma center closest to the Narita International Airport

DAISUKE KAMEYAMA, Kunihiro Mashiko, Hisasi Matsumoto, Yoshiaki Hara, Takanori Yagi, Nobuyuki Saito

Nippon Medical School, Chiba Hokusoh Hospital, Shock and Trauma Center, Chiba, Japan

[Background] Our Hospital is close to Narita Interna- discharge all packets in the conservative. There was tional Airport, have cooperated in the diagnosis and 1 case of an emergency abdominal surgery to remove treatment of Body Packers (drug body packing packet admitted acute stimulant intoxication symp- patient; BP) at the request of Customs. Illicit drugs toms of packet corruption, 1 case elective abdominal seized 122cases was decreased (81%), but the amount surgery to remove packet developed ileus by past of drug seized was a record up to 281 kg in 2012 surgery. [Conclusion] The 2 cases was negative in the year. Stimulants accounted still high for 71cases X-ray, but has led to positive add a CT because it (58.2%), 8 BP (13%). showed excretion of drug or vomiting packet after [Purpose] To consider the sensitive diagnostic meth- X-ray. Sensitivity of X-ray are 90-93% in solid, and 45- ods and treatment, for BP. [Target and methods] 104 64% in liquid in the study of the past. BP was cases of that suspected BP came for five years 2008- believed to be the enforcement of abdominal CT 2012. We summarized results of diagnostic abdominal actively for reliable. Drug addiction symptoms of X-ray, abdominal CT, and treatment of patients who packet corruption is a sudden and fatal, We must let were BP positive. the excretion of them in the hospital that can be [RESULTS] 54 cases (51.9%) were positive for drug abdominal surgery immediately. Standardization of concealment (Solid 53, liquid 1). 52 cases were able to diagnosis and treatment of body packers is needed.

─ 216 ─ Journal of International Health Vol.29 No.3 2014

Po-Oth-B05 The activities of Saku Central Hospital Global Health Committee - Strategies for the human resource development on global health in a rural hospital

TOMOYUKI HIRATA1, MASAHIRO ZAKOJI2, YUJI NAKAMURA3, MAYA FUJII2, TOMO KARIYA4, TOMOYO TSUCHIYA5, AKIHIRO KITAZAWA6

1Division of Obstetrics and Gynaecology, Saku Central Hospital, Nagano, Japan, 2Division of General Medicine, 3Emergency and Critical Care Center, 4Junior resident, 5Division of Secretary and Public Relations, 6Division of Community Care

Introduction: Saku Central Hospital have provided In August, we hosted the Saku Global Health Semi- more than 1600 foreign trainees with the opportunity nar, focusing on what should be introduced to the to learn the core concepts of primary health care in world from our experiences of primary health care in Saku, declaring our mission “to contribute to the rural communities in Japan. Prof. Nakamura Yasu- international health”. In 2013, 25 staff from various hide (JAIH) and Dr. Sumana Barua (WHO) took the fields across the hospital have gathered and newly lead of the discussion among 60 young medical pro- set up the Global Health Committee to further fessionals and students from all over Japan. strengthen our contribution. Future prospects: We have developed a senior resi- Activities: In June 2013, 20 governmental officials dency program on international health in partnership from Indonesia visited our hospital as part of “Project with NPO GLOW. We are determined to further for Improvement of District Health Management strengthen our network in the hospital to serve to Capacity in South Sulawesi Province” by JICA. We the young professionals dedicated to the global tried to fit to their individual expectations and health, and contribute to the human resource devel- provided them with the opportunity to expose them opment. to the frontline of the community care in rural Japan.

Po-Oth-B06 Ten years experience of training to control health care associated infections in developing countries and observed problems

Yumiko Haneishi, Kenichi Komada, Shinsaku Sakurada, Masahiko Hachiya

Expert Setvice Division Bureau of International Medical Cooperation, Tokyo, Japan

Background and Objective Healthcare-associated who participated in the training held in 2010. Ques- Infection (HAI) Control in developing countries is an tion items were as follows; content of action plan, urgent need for global spread of multidrug-resistant achievement, support from administrator(s) and bacteria by medical tourism. NCGM has conducted colleagues, promotional and inhibitory factor(s). training for HAI Control in developing countries at Results Response rate to the questionnaire and request from JICA. The number of total participants achievement report were 100% (11/11) and 63.6% and entry countries reached to 94 and 30 respective- (7/11) respectively. “Five S-Kaizen-TQM “in the ly. All participants formulated an action plan to HAI curriculum was highly rated for implementation of Control in their facilities and were requested to action plans. Support from administrators and report “achievement “ around 6 months after leaving colleagues have been shown to be one of key factors for their homes. The response rate was below 30% to achieve the action plans. every year despite demand. Thus, we conducted a Discussion One practitioner and one administrator small survey to assess achievement and detect from the same facility have been requested to promotional and inhibitory factor(s) for feedback. participate in the training since 2011. However, Methods A questionnaire was sent to 11 subjects selection of participants was not always satisfactory

─ 217 ─ 国際保健医療第 29 巻第 3 号 2014

due to local factors. We have a plan to visit selected questionnaire and environmental rounds with a facilities for assessment by interviews based on a checklist.

Po-Oth-B07 Introduction of phase for evaluation of vector control trials

ATARU TSUZUKI

Dpt of Vector Ecology & Environment, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan

Vector borne diseases such as malaria and that is defined as rational decision-making process for dengue are serious public health problems especially the optimal use of resources for vector control was in tropical and sub-tropical regions. Vector control is developed and introduced by World Health Organiza- only an option for control of these diseases since tion (WHO) to improve the efficacy, cost-effectiveness, there is no available vaccine for public health use. ecological soundness and sustainability of disease- Many of chemical controls (e.g., insecticide), biological vector control. However, it does not mention how to controls (e.g., natural enemy), environmental controls interpret the outcomes of various types of vector (e.g., elimination of larval breeding sites), and other control trials. It is necessary to evaluate the quality controls are able to obtain expected outcomes such of data and interpret it in terms of efficacy and as reducing vector density and disease incidence effectiveness for rational application of each vector under appropriate conditions for each control tool; control tool. Categorization (i.e., phase) based on the however, few routine vector control programs ended study design and types of control tools is useful for in the success. Integrated Vector Management (IVM) application of rational vector control.

Po-As-A01 Systematic review on care burden of family caring for the elderly in Asia

YUMIKO MIYASHITA, NANAKO TAMIYA

Dept. of Health Service Research, Faculty of Medicine, University of Tsukuba, Japan.

BACKGROUND: In most of Asian countries, the the country or region, focusing on care burden of main provider of the elderly care is a family member. family carers as outcome, and on care of the elderly, However, due to the current social change, such as patients with dementia or stroke survivors. rapid population aging, declining birth rate and ur- RESULTS: Sixty two articles met the criteria. The banization, the capacity of family carers is expected number of articles on care of the elderly, dementia to decline and the way of caregiving is to be recon- patients and stroke survivors were 31, 35 and 12 sidered. respectively. By country, Taiwan (18), Hong Kong (11), OBJECTIVE: To grasp the current situation of the Korea (11), China (10), Singapore (6), Thailand (3), long-term care of the elderly by family, focusing on Malaysia (3) and Philippines (1) analyzed these care their care burden and its factors. burdens. The most common scale of care burden was METHODS: A systematic review of empirical Zarit Burden Interview. studies conducted in East and Southeast Asia was CONCLUSION: The result indicates that care undertaken. PubMed was searched for articles in burden on elderly care is recognized as a social English with abstract published after Jan. 2000 by problem in East Asian countries and Singapore. the search terms: caregivers and burden. Inclusion Further cross-national research will give us a key to criteria were: original article, quantitative research in consider how to support family carers.

─ 218 ─ Journal of International Health Vol.29 No.3 2014

Po-As-A02 Barriers to Disaster Medical Information Dissemination in Multicultural Society

SAKIKO KANBARA1, Kimiko Nagasawa1, syogyoku Go2

1DIsaster Nursing Global Leadership program, University of Kochi, 2University of Hyogo, Research Institute of Nursing Care fore People and Community

Introduction This study explores the barriers to ences in living conditions while traveling around disaster relief information dissemination in public Japan. Most of them collected information from places and transportation areas in times of emergen- internet or members of the foreign communities they cy. belong to. It has also been found that should signs be Methods The current information contents and coded in easy Japanese, it would raise the level of methods for dissemination about disaster and understanding the contents. In addition, signs in easy emergency relief information around major stations English would be helpful for deciphering the contents for public transportation, tourist attractions, and/or by non-English speakers including Japanese educational institutions are enumerated in a work- residents. sheet. To conduct group discussion and focus group Conclusion What needs to be dome is to identify the interviews to obtain basic information on communica- initial points of receiving information for foreign tion methods, skills, knowledge, culture, language residents and travelers and to visualize emergency choices, and level of understanding about various evacuation routes and other vital information by communication channels to verify information obtain- adding easily identifiable illustration and easy English ing abilities of e foreign residents. that anyone can understand. In addition, uploading Results These signs do contain English translation, disaster related information and other helpful infor- yet it has been shown that access to these signs is mation for everyday life to channels that foreign weak. The recipients of information expressed differ- residents normally access.

Po-As-A03 Foreign single-female-parent household is the highest in those getting public assistance among registered foreigners in Japan (except for south and north Korea nationalities)

EIKO KOBORI1, YUKO MAEDA2

1Faculty of Nursing, Setsunan University, 2Human Health Science, Graduate School of Medicine, Kyoto University

We identify proportions of householdsʼ categories respectively. For registered foreigners with south of registered-foreigners who are getting public and north Korean nationalities, 28 thousand house- support (Seikatsu hogo) in Japan and compare the holds got public assistance, those proportions were proportions to those of Japanese. Using government- 51.9%, 6.5%, 10.0%, 18.5%, 13.1%, and for the other statistics about households getting public support, we nationalities, 14 thousand households got public compared proportions of the aged household, single- assistance, the proportions were 7.8%, 41.4%, 5.0%, female-parent household, household with the sick and 18.6%, 27.2%. Although time trend of proportions of wounded, and household with disabled persons the aged household between 2006 and 2011 were between Japanese and registered-foreigners with continuing at a high level of 40ʼ to 50ʼ% among Japa- requirements. In 2011 more than 1.49 million Japa- nese and south and north Korean nationalities, the nese households got public assistance. The propor- proportions of single-female-parent household were tions of the aged household, single-female-parent more than 40% in the other nationalities. More than household, household with the sick and wounded, half of households with public assistance among household with disabled persons, and the other south and north Korean nationalities were the aged households were 42.6%, 7.6%, 21.4%, 11.4%, and 17.0% households, similar to those of Japanese; more than

─ 219 ─ 国際保健医療第 29 巻第 3 号 2014

40% were single-female-parent households in the parent households, especially non-Japanese and non- other nationalities. Support for foreign single-female- Korean nationalities, is suggested to be significant.

Po-As-A04 Current situation and challenges regarding legal frameworks and qualification systems in nursing

TOYOMITSU TAMURA, CHIYOKO HASHIMOTO

Bureau of International Medical Cooperation, National Center for Global Health and Medicine

Background: With the Millennium Development country’s current situation of qualification system for Goals, ensuring the quality and quantity of nursing nursing personnel. In addition, FDG revealed that personnel involved in measures for infectious diseas- there is an urgent need to codify regulations and es, maternal and child health, etc. is considered to be qualification systems based on the ASEAN Mutual important. We conducted a survey to reveal the Recognition Agreement (MRA). current situation of legal frameworks and qualifica- Discussion: The four countries have legal frame- tion systems for nursing in four countries: Cambodia, works to ensure the quality of nursing. These frame- Lao People’s Democratic Republic (PDR), Myanmar, works only work effectively if they are disseminated and Vietnam. and complied with nationwide: however, they have Method: We conducted a semi-structured interview some problems on this point. These frameworks are and focus group discussion (FGD) with nursing considered more or less effective as regards ensuring administrative officials of the above countries. the quality of nursing personnel. Results: Cambodia has a royal decree which defines Conclusion: We compared the four countries’ legal nursing service, and a nursing regulation. Lao PDR frameworks, and found that further tasks are has a nursing and midwifery regulation and a dissemination and compliance of their regulations and nursing practice guideline. Myanmar enacted the guidelines. ASEAN MRA serves as an important Nurse and Midwife Law. Vietnam enacted a nursing driving force for them. service guideline. Our survey revealed the each

Po-As-A05 Values of young Korean living in Japan in relation to family and marriage, and opinions of premarital sex

CHIE TSUBAKI

School of Nursing, Osaka Prefecture University, Osaka, Japan

[Background] Approximately 390,000 Koreans have of which 77 (89.5%) were valid. When asked the special rights to permanent residency in Japan. nationality of the person they hoped they would Young Korean living in Japan were born and raised marry (multiple answers), the majority of respond- in Japan, and who have been strongly influenced by ents stated that ‘Nationality is irrelevant’ (59.7%), with Japanese society. It is thought that they may, the next most common answer being ‘Korean living however, also be influenced by their grandparents, in Japan’ (45.5%). When asked about traditional their parents and the community. values, a significantly higher proportion of women [Objectives] This study aimed to clarify the values of than men affirmed that ‘It is not right to marry young Korean living in Japan, in relation to family against the wishes of my parents’ (p ＜ 0.05). In terms and marriage. [Method] Between June and October of opinions about premarital sex, 95.0% of men and 2012, an anonymous questionnaire survey was 86.5% of women stated that it was permissible. distributed to 86 young Korean living in Japan aged [Conclusions] Over the past few years mixed-race between 18 and 35. marriages have become more common, and increas- [Results] Eighty-five (98.8%) responses were obtained, ing numbers of young people believe that the

─ 220 ─ Journal of International Health Vol.29 No.3 2014

nationality of their proposed spouse is ‘irrelevant’, but as young Japanese, but they also have their own many still hope to marry Korean living in Japan. identity as a special resident. Young Korean living in Japan have the same values

Po-As-A06 Collaboration work of Non-Profit Organization (NPO) and a governmental office of Rikuzentakata-city post Tsunami disaster

SHIHO HIRANO1, KAORU YAMANAKA1, HITOMI NUMATA1, SAEKO HATTA1, MASASHI YOKOTA1, YASUHIDE NAKAMURA2

1Health and Development Service, Japan, 2Graduate School of Human Science, Osaka University

Background: The objective of this report is to share symposium with a council, residence and NPO as a the experience of collaborating work between NPO facilitator to discuss how to build a child and family and governmental office after the Great East Japan friendly city together. Also, HANDS has been Earthquake. The city lost 1,700 residents and also, involved in Miraizu-kaigi which model a health clus- most of the core public facilities such as a council hall ter meeting. Continuous advocate of the importance or a hospital. Health and Development Service of a child and family-centred care during the (HANDS) has been working towards developing child reconstruction period has presented. and family friendly city in Rikuzentakata since April Results: Interviews from the government officials 2011. Intervention: The program contains the three showed the proposal-based approach which HANDS components; child health promotion, child care made lead them to think us as their partner. Also, support work, and supporting child carer. In March the benefits in cooperating with an international 2011, the city council set up their priority towards development organization seen. reconstructing Mother and Child Health (MCH) Conclusion: Collaboration work with NPO and Service such as an immunization program and MCH governmental office showing a benefit in each stage clinic. In response of this, HANDS has restarted of the reconstruction steps. The continuous feedback these activities (with UNICEF Japan) using poster of MCH needs should be presented in Miraizu-kaigi notifications. After summer 2011, HANDS hold a for the sustainability of the activities.

Po-As-A07 The State of Domestic Violence and Support among Filipinas Residing in Japan

HIROKO SAKAI

School of Nursing, Faculty of Health Sciences Morinomiya University of Medical Sciences, Japan

[Background/Objective] Recently there have been [Activities] We provided consulting services to 20 many foreign women residing in Japan who face women (among these 17 were Filipinas) residing in various issues, including being unable to divorce due Japan. At the seminar held and sponsored by the to their inability to renew their residence qualifica- Philippine Consulate General, we also held a lecture tion, or lacking residence status due to overstay or targeting Filipinas residing in Japan with a focus on divorce. Furthermore, foreign women residing in the definition of domestic violence, the state of Japan are placed at a disadvantage in relation to domestic violence among Filipinas, and the laws and their husbands and/or their husbands’ families due to social support that are available for the victims. cultural, economic, and social power relationships. As Moreover, we supervised a program which was a result of which there are presently many cases in broadcast through the Philippine portion of the which these women have become victims of domestic Fmcocoro Radio Station about the state of domestic violence. violence among Filipinas in Japan and the difficulties

─ 221 ─ 国際保健医療第 29 巻第 3 号 2014

arising from the marriage of Filipinas and Japanese were unable to seek legal support and were socially men. isolated. It is required to support these domestic [Results/Conclusion] Many female victims of do- violence victims while educating people of the cur- mestic violence were foreign women who had rent actual state of Filipinas residing in Japan. overstayed their visas. Because of this, these women

Po-As-A08 Factors Related to Desire to Work Abroad Among Filipino Nurses

MIWA TAKAHASHI

Department of Nursing, Faculty of Health and Welfare Science, Nayoro City University, Hokkaido, Japan

Objective: In an effort to earn foreign currency and (16 men, 36 women) expressed an interest in working build the economy, The Philippines have seen an abroad. This group had a professional identity score outflow of workers overseas. As for nurses, roughly of 74.3±5.9, while those with no interest in 160,000 are currently working abroad. The purpose working abroad had a score of 74.3±6.0. There of this study is to clarify the factors that affect the was a significant difference (p ＝ .008) between self- desire to work abroad among Filipino nurses. esteem scores for the first group (31.7±3.5) Method: An anonymous, self-administered question- and the latter group (33.2±1.4). No significant naire was given in February 2011 to nurses working relevance was found between interest in working at a hospital in Manila. It consisted of items to abroad and professional identity. Additionally, a measure social attributes, salary and professional significant relevance was found between interest in satisfaction, desire to work abroad, Rosenberg’s self- working abroad and salary satisfaction (p ＝ .029), but esteem scale, and 20 five-point Likert scale items not with professional satisfaction (p ＝ .216). from the scale of professional identity created by Conclusion: Filipino nurses’ interest in working Sasaki et al (1993). abroad was found to correlate significantly with self- Results: A total of 103 people responded to the esteem and salary satisfaction. survey, a collection rate of 56.9%. Of these, 52 people

Po-As-A09 Factors Related to Desire to Work In Japan Among Filipino Nurses

MIWA TAKAHASHI

Department of Nursing, Faculty of Health and Welfare Science, Nayoro City University, Hokkaido, Japan

Objective: Under terms of the Japan-Philippines Results: Respondents totaled 103, a collection rate of Economic Partnership Agreement (EPA) signed in 56.9%. Forty-eight respondents (16 male, 32 female) 2006, it became possible for Filipino nurses to work indicated desire to work in Japan. For this group, in Japan. The purpose of the present study is to professional identity and self-esteem scores were clarify factors that influence the desire of Filipino 74.1±6.4 and 31.8±3.5 respectively. nurses to seek employment in Japan. Scores for respondents without a desire to work in Method: An anonymous, self-administered question- Japan were 72.4±4.8 and 32.8±1.8, with naire was given in February 2011 to nurses working no significant difference between the two groups for at a hospital in Manila. It consisted of items to both factors (p ＝ .205, .055). One item of professional measure social attributes, salary and professional identity “I feel that I always give patients the nursing satisfaction, desire to work in Japan, Rosenberg’s self- care that represents my professional values“ had the esteem scale, and 20 five-point Likert scale items strongest correlation to a desire to work in Japan (rs from the scale of professional identity created by ＝ .394,p ＝ .001), while another 6 items in this group Sasaki et al (1993). also showed a significant correlation.

─ 222 ─ Journal of International Health Vol.29 No.3 2014

Conclusion: Filipino nurses’ desire to work in Japan esteem, but there was a significant correlation with did not correlate to gender, salary, professional seven items of professional identity. satisfaction, professional identity nor professional self-

Po-As-A10 ASSESSMENT OF THE EXTENT OF COUNTERFEIT MEDICINES IN CERTAIN AREAS IN BATANGAS, PHILIPPINES

TOMOYO ITOH1, YOKO GOCHO1, YUMI SANAMI1, AYANO KOSUGI1, Wilfredo Torres1, NAOKO YOSHIDA1, HIROHITO TSUBOI1, TSUYOSHI TANIMOTO2, KAZUKO KIMURA1

1Drug Management and Policy, Kanazawa University, Ishikawa, Japan, 2Faculty of Pharmaceutical Sciences, Doshisha Women’s University, Kyoto, Japan

[Background] Asia may account for the biggest sample was imported or domestic (Fisher’s exact test, share of the trade in counterfeit medicines. The p ＜ 0.05), and whether outer packaging was provided Philippines was one of the most active countries for (Fisher’s exact test, p ＜ 0.001). Loose medicine was combating counterfeit medicines. However, their sold only at pharmacies without a pharmacist. precise figures and the actual extent are unknown. Samples sold at pharmacies without a pharmacist Counterfeiters are also applying their newer tricks were more likely to be substandard (Fisher’s exact and logistics. test, p ＜ 0.05). Pharmacies without a pharmacist [Methods] Target medicines were amoxicillin, were also less likely to have air conditioning (Fisher’s amlodipine, metformin, glibenclamide and cilostazol. exact test, p ＜ 0.001). The samples were collected in certain areas in [Discussion] The quality of most medicines examined Batangas province at pharmacies which were ran- was satisfactory. However, a few collected samples domly selected. Quality test (quantity, uniformity of appeared to require improvement to reach acceptable dosage units, dissolution), observation investigation, quality. Our findings suggest that good pharmacy authenticity investigation and data analysis were practice is important as well as good manufacturing performed. process. [Results] A total of 277 samples was examined. No [Acknowledgements] This study was supported by counterfeit medicine has been detected so far. A few Japan Pharmaceutical Manufacturers Association. We samples of glibenclamide failed in quality test. The are very grateful to the Food and Drug Administra- results of quality test were related to whether the tion of the Philippines.

Po-As-A11 Self-Rated Health and Social Environment for Elderly in the Philippines

SHIHO KASHIWAGI, NANAKO TAMIYA

Faculty of Medicine, University of Tsukuba, Japan

Background: We found out that the factors associat- not been fully developed yet. ed with self-rated health (SRH) were gender, age, Objective: We aim to clarify the factors associated education, marriage, family, spouse, obesity, illness, with SRH for the elderly in the Philippines. depression, job, income, smoking, exercise, social Methods: A total of 300 individuals aged 60 and over capital, social activity and happiness by reviewing participated in a survey in Metro Manila, Quezon case studies focusing on East Asian countries. The City, from November 2012 to January 2013. The number of studies focusing on South East Asian number of effective answers was 300. We ranked countries is smaller than those of East Asian coun- their SRH according to 5 levels (from 0: “very bad” to tries. Also, in the total number of studies regarding 4 : very good). The median was 2. Therefore, we set SRH, the cases focusing on elderly were fewer. 3 to 4 as “low SRH group” and 0 to 2 as “High SRH Therefore, research related to SHR for elderly has group”. Dependent variable was SRH, and independ-

─ 223 ─ 国際保健医療第 29 巻第 3 号 2014

ent variables were factors pointed out by reviews SRH for elderly in the Philippines were years of above. We selected variable (p ＜ 0.2). Logistic education, smoking experience and contact with regression models were used for this analysis after friends. On the other hand, the factors related testing for “multicollinearity”. negatively to SRH were illness, exercise habits, and Conclusion: The factors related positively to high friends.

Po-As-A12 Social Determinants of Maternal and Child Health among Indigenous Peoples in the Philippines: Case of Tagbanua Mothers and Children of Coron, Palawan

Calvin S de los Reyes

Graduate School of Human Sciences Osaka University

Objective Indigenous mothers and their children their low income (personal) to poor access to health- continue to suffer disproportionately on several care facilities (institutional). However, the Tagbanuas’ health issues and rarely enjoy the same standard of perception of health is not individual, but one that health as the majority of Filipinos. The study sought encompasses the whole community, with a very to explore the social determinants determining the strong link to their ‘lupaing ninuno’ or ancestral maternal and child health among the indigenous domain. How these determinants interact with each Tagbanua mothers and children in Coron, Palawan, other, with respect to their ancestral domain, defines Philippines. their health. Methods Fifty mothers were interviewed, which Discussion It is necessary to address these deter- aimed to determine the current knowledge and minants, with deeper understanding of the socio- practices of Tagbanua mothers on maternal and child cultural context, in order to ensure better health health and to understand further the social determi- among indigenous communities, such as the Tag- nants influencing their health. banua of Coron. This serves as a good opportunity to Results The maternal and child health of the Tag- raise awareness about the numerous factors that banua was found to be closely linked to their across affect health and the need to act across sectors to the board socioeconomic characteristics: ranging from improve the health of every Filipino.

Po-As-B01 A qualitative interview study exploring HʼMong ethnic group womenʼs lifestyle during pregnancy and birth custom in the mountainous area of Vietnam

TAMAMI SHIMOKOSHI1, SUMIE SHIRAISHI2

1Gerontological Nursing and Health Care System, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan, 2Graduate school of Nursing, Chiba University, Chiba, Japan

[Objective] To explore the lifestyle of reproductive serious cases of anaemia or pregnancy hypertension age women of H’Mong ethnic minority group living were found among the pregnant women living in the in Dien Bien Province in Northwest Vietnam so as to area. VHWs provide counseling services to pregnant draw recommendations for the implementation of a women, however, since most of the VHWs are men, Safe Motherhood Project. many women are reluctant to access such health [Subjects and Methods] We conducted group inter- services. As per H’Mong custom, majority of views using a semi-structured questionnaire to deliveries take place at home, with assistance from village health workers (VHW), village women’s union, mother in laws and husbands. Women living near the community midwives (CM), and mothers in two commune health centres (CHC) gave birth at home communes. with CHC midwife’s assistance. A few CMs trained [Results] From the interviews, it was discovered that on safe motherhood for 6months were posted in the

─ 224 ─ Journal of International Health Vol.29 No.3 2014

communes. CMs give recommendation to pregnant CHC midwife assisted-delivery are intensively carried women and their families to give birth at CHC, out. Thus, improvement of communication skills of nevertheless, many villagers prefer delivery at home. VHWs, village women’s union and CMs, establish- [Discussion] In order to improve the health of ment of referral system and strengthening the pregnant women in the area, it is essential that IEC/ function of CHCs to provide primary health care BCC for safe motherhood and advocacy to promote should be the priority of the support in the area.

Po-As-B02 A profile of hospitalized patients of acute diarrhea in Nam Dinh province, Vietnam

Asako Tokizawa1, Dinh Thiem Vu2, Conh Khanh Nguyen2, Duc Tho Pham2, Van Chuyen Vu3, Duc Luu Do4, Taichiro Takemura1, Tetsu Yamashiro1

1Vietnam Research Station, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan, 2National Institute of Hygiene and Epidemiology, Hanoi, Vietnam, 3Nam Dinh Children’s Hospital, Vietnam, Nam Dinh, Vietnam, 4Nam Dinh Preventive Medical Center, Nam Dinh, Vietnam

A Hospital based study to determine a broad More than half of the enrolled patients visited the range of etiological agents of childhood diarrhea is hospital in 2-4 days after onset of diarrhea. Approxi- carried out at Nam Dinh Childrenʼs Hospital in Nam mately 70% of the patients excreted stools more than Dinh Province, northern Vietnam. A pair of diarrheal 6 times per day, and vomiting were observed in 60% stool samples and questionnaires was collected from of the patients. Watery diarrhea was shown in 65% of 386 patients hospitalized for the treatment of the patients, followed by muddy stools and dysenteric diarrhea from 10 Dec 2012 to 27 Jun 2013. In order to stools in 31%, and 2%, respectively. Approximately estimate a profile of childhood diarrhea in the 30% of the patients used over-counter antibiotics community, several features of the enrolled patients before admission. As a source of drinking water, a and their families were outlined by questionnaire majority (79%) of the patients used tap water rather based analysis. than using bottled water or water from well (closed The analysis revealed that the mean age of the style or open style). The analysis indicated that more enrolled patients was 10 months, and 65% of those than 95% of the patients boiled tap or well water were boys. The number of household members was before drinking. 3-5 persons (90%) in total, with 1-3 (99.5%) children.

Po-As-B03 The support of children in the south of Vietnam

MIHO KOIKE1, 2, Akemi Bando1, Toru Shibata1, 3, Yoshiyuki Ako1, 4, Yoko Nishimura1, 5

1The support of Vietnam Children Association, Kyoto, Japan, 2Nishieigashima hospital, 3Morinomiya hospital, 4Aijinkai rehabilitation hospital, 5House visiting nurse station Hotaru

The Support of Vietnam Children Association program was carried out once a year for a week. The (SVCA) was organized in 1990. SVCA has been team consisted of medical personal, educator and supporting people around Ben Tre province in the volunteer people. The theme of workshops in Ben south of Vietnam from a standpoint of health, Tre Handicapped Children School were "the relation- childcare, education and welfare. Community Based ship of play and education and rehabilitation", many Rehabilitation is one of the activities of SVCA. This CBR workers in the region participated. Not only

─ 225 ─ 国際保健医療第 29 巻第 3 号 2014

Japanese, but also Vietnamese experts lectured. "The for a healthy social life of children to be considered party to play and exchange" was held on the family inclusively also welfare and education as well as and children with disabilities. Purpose of that was medical services. Conceptually, it is difficult to be exchange of each other and understanding the understood immediately. There are 2 important relation of rehabilitation and play. We visited children points for the life of children, the first, itʼs a sugges- with disabilities together with CBR workers and staff tion to government and educator, second is the of local clinics. We made various suggestions for approach to children and family through the home them at their home and discussed plans of them with visit and the party. CBR workers and staff of local clinics. It is important

Po-As-B04 Nursing care provided by the family and the roles of the nursing in developing countries -Analysis on reports of Japan Overseas Cooperation Volunteers in Vietnam -

KEIKO SAITO1, HIROMI TSUJIMURA2, MOYO RI3, KYOKO YAMADA2, KAZUKO TANAKA2, YOSHIE MORI2

1Department of Nursing, Faculty of Health Sciences, Saitama Prefectural University, Koshigaya, Japan., 2Graduate School of Health Sciences, Gunma University, Maebashi, Japan., 3Department of Nursing, Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki, Japan.

Background According to the previous works, it then categorized them referencing Targets for became clear that there exist nursing skills and Nursing Skills/Midwifery Skills(Ministry of Health, nursing care which are different from those in Japan Labour and Welfare, 2004). in developing countries. Meanwhile, it was also Results We have analyzed 69 reports made by 14 revealed that the families of patients are playing volunteers: 2 public health nurses, 9 midwives, and 3 important roles in the daily life assistance in many nurses. The descriptions about the nursing care countries. provided by the family included meal support skills, Objectives This work concentrates on the roles of elimination support skills, cleanliness and clothing the family and the nurses in developing countries in skills, activity and rest support skills, and the order to clarify the nursing cares allotted to each of observation of newborn infants. Many descriptions them. about the practices by nurses (midwives) were on Methods The analysis was done on the available vital function management skills and medication publicized activity reports written by JOCV nurses skills. who had been dispatched to Vietnam by JICA from Conclusion It can be assumed that the nurses 2002 through 2005. We extracted the descriptions mainly provide the skills regarding the assistance for about the nursing care provided by the family and medical treatment, while the family plays an impor- that by the nurses, and what nurses do not practice, tant role in daily life assistance.

Po-As-B05 Knowing the challenges regarding health for children in Pakse, Lao P.D.R. through the project of free healthcare service for children under 5.

AYANO SUZUKI

Independent

Introduction: The Maternal and Children Under 5 (MdM) is implementing a project named Pilot safe (CU5) Mortality Rate in Lao P.D.R is still very high motherhood and childhood programme in Champasak compared to neighbouring countries. In order to province, Lao PDR. General outline: This project improve the current situation, Medecins du Monde contains three main components; 1. Providing a free

─ 226 ─ Journal of International Health Vol.29 No.3 2014

healthcare service to CU5 in Moonlapamok and work efficiently and effectively, and also improving Sukuma districts in Champasak province.2. Providing two district hospitals. Moreover, IMCI (Integrated health education and informing commencement of Management of Childhood Illness) has been imple- new service at villages3. Improving the knowledge mented to provide equal treatment to any patients. and skills of staff in health centres and district Nevertheless, the focus of provision of information hospitals Activity: MdM employs two Laotian nurses regarding the concept of prevention has been mainly in each district; one nurse visits two villages per day to villages. Conclusion: The number of patients of and gives a health education session at a temple of CU5 has risen in comparison to before the project the village. The other will attend at a health centre began, up to 4 to 5 times higher in Sukuma district to supervise staff to improve knowledge and skills hospital. While some villagers are dissatisfied by the following guidelines. Expatriate nurses have two service at the health centre due to lack of medicine, roles; supervising MdM nursing staff in ability to human resources and poor staff attitude.

Po-As-B06 Effects of Inter-Professional Education in the Laos Study Tour

TOMOKO KOIKE1, Rika Fujiya1, Masato Yasui2, Keiko Kishimoto3, Shinzo Kato1

1Faculty of Nursing and Medical Care, Keio University, 2School of Medicine, Keio University, 3Faculty of Pharmacy, Keio University

OBJECTIVE Keio University implements a study dents at the elementary school of the village. tour in Laos as a joint inter-professional education RESULTS Compared to the needs/assets map (IPE) program by School of Medicine, Nursing and prepared by the participants beforehand, the map Pharmacy. This paper is to report our examination of created after the study tour more clearly indicated the effects of this IPE program. challenges of local health disparities attributable to METHODS 1. Participants: 15 ungraded students. factors such as medical staffing and geographical 2. Program Details: (1) Prior Preparation - Students barriers. In addition, there were increased proposals from different schools formed three ungraded teams for sustainable systems at the village level including and carried out group work. They examined the those to improve activities of the health center and needs and assets of Laotian healthcare and planned health education at the elementary school. Moreover, health education at the elementary school. (2) Outline health education at the elementary school further of the Study Tour - (i) They stayed in Vientiane and facilitated cooperation in the team activities of visited medical institutions and other facilities. (ii) students from three school and faculties. Thy stayed with families at the Village in Sekong CONCLUSION Addition of homestay at a village to Province (for one night) and interviewed the resi- the program facilitated students’ understanding of dents. They provided health education (hand-wash, local health problems, further invigorated their team tooth-brushing and height/weight check) to all stu- activities and enhanced the effects as IPE.

─ 227 ─ 国際保健医療第 29 巻第 3 号 2014

Po-As-B07 Comparative case study on supportive supervision in Laos and Kenya

SHINICHIRO NODA1, 2, 3, KAORI SAITO5, TOMOHIKO SUGISHITA4, 5, SHIGEKI HANAFUSA1

11st Expert Service Division, Bureau of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan, 2Ministry of Health, Vientiane, Lao People Democratic Republic, 3JICA -Laos Technical Cooperation Capacity Development for Sector-wide Coordination in Health Phase II, 4Japan International Cooperation Agency, Tokyo, Japan, 5JICA-Kenya Naynza Health Management Project

Background: Although supportive supervision (SS) in ment, while in Kenya by donors. Training methods health has been introduced in developing countries to and contents were similar. Before visiting health sustain health staff capacities for more than 10 years, facilities, the supervision teams reviewed the results there is still lack of lessons learnt in practice. of previous visits in both cases but in Kenya they Methods: Two cases of SS in Laos and Kenya, which reviewed monthly health reports as well in order to were implemented by the ministry of health or the identify problems of target health facilities in provincial health office in collaboration with the advance. The SS procedures at the health facilities in Japan International Cooperation Agency, were re- both cases were almost same. They confronted same viewed using a framework with 6 components: policy challenges such as irregular supervision visits due to context, setting-up, planning, supervision visit, delayed budget disbursement, insufficient quantita- following-up and monitoring & evaluation. Relevant tive assessment of problems and limited follow-ups of data were collected by semi-structured interviews, the agreed action plans. group discussions, document reviews and direct Conclusions: Although continuous improvement by observations of SS practices during field visits. problem solving is one of key features of SS, such Results: In both cases, SS systems have not been functions in both cases seemed to be limited. Further established yet under national health quality assur- study on problem-solving practice in SS need to be ance policies. SS in Laos was funded by the govern- carried out.

Po-As-B08 Relationship between information exchange and Quality of Life (QOL) of women in community, Lao PDR

KAZUE SONE1, Hideki YAMAMOTO1, LAMANINGAO Pheophet2, Yasuo SUGIURA3, Mutsuhiro NAKAO1

1Teikyo School of Public Health, Teikyo University, Tokyo, Japan., 2Department of Public Health, Kansai Medical University, 3National Center for Global Health and Medicine

Background It is known that social bond and housewife or equivalent in each household was asked network promote local resident’s health recently. for both interview and self-administered question- Information exchange is prosperous among local naire. The WHOQOL-BREF was used to measure women in Laos, where the infrastructure is insuffi- health-related QOL, which was translated into Lao. cient and health interventions often use such existing Result In the past 4 weeks, those consulting HV local network or information exchange. This study (Health Volunteer) or leader of LWU (Lao Women’s aims at clarifying the relationship between the Union) had significantly higher QOL scores, com- information exchange and QOL for local women in pared with those having no health consultation (3.61 Laos. ± 0.48 vs. 3.39 ± 0.36, P ＜ 0.001). Significantly higher Methods Data were obtained from 660 local women QOL scores were observed in those who had “asking in 4 villages in Vientiane city. In each of 4 villages, neighbors their health” or “getting health advice from 165 households were randomly selected and the neighbors”, compared with those who did not.

─ 228 ─ Journal of International Health Vol.29 No.3 2014

Discussion and conclusion It is suggested that the role in a community as well as by active informa- individual health of local woman could be contributed tion exchange with neighbors. by the information exchange with a person having

Po-As-B09 The present situation of intestinal parasite infection in a small village in Lao PDR and exam the further methods to control the parasites

HIROAKI YAMAZAKI1, KIYOMI HANDO2, SHUJI FUKUYAMA2, TOMOKO SAITO2, JUNKO ISHIHARA2, TOITIRO ISO2, TAKAO SUGIMOTO1, DAISAKU URABE1, XAYPANGNA Thonelakhanh3, TAKATOSHI KOBAYAKAWA2

1International Cooperation Department, 2ISAPH,Minato ward, Tokyo, JAPAN, 3Health Department, Khammouane province, LaoPDR

[Purpose] New parasite control project has been 46 year old was 31 cases (25.0%). Hook worm was started in a small village and conducted a survey to most found in the school age children and Opisthor- grasp the situation of intestinal parasite infection and chis viverrini was found most over 15 years old. exam the future methods to control the parasites. Women whose aged from 15 to 45 was confirmed 24 [Method] 190 peoples who are living in the village in cases (19.4%). Drug administration rate for Mebenda- Lao PDR were involved in the project. Stool was zol was 92.6% and for Praziquantel was 81.1%. submitted by 15 hours daily for 5 days. The examina- [Conclusion] Intestinal parasite infection rate was tion and drug administration were done at health 69.3%. This rate shows that the area is high burden volunteer house in the village. The examination was of parasites. It is difficult to control using drug done soon after stool was submitted. The method of administration only following national policy. It is stool examination was Kato-Katz. Drug administra- suggested that easy access to examination and drug tion was done face to face. administration should be consider to village peoples [Result] Stool submission rate was 94.7%. Intestinal and reexamination should implement after drug parasites were found 124 cases(69.3%).By age, under administration. Also health education on how to 5 years old was 3 (2.4%), School age children was 37 prevent the parasites is necessary. (29.8%), 15 years to 45 years was 53 (42.7%) and over

Po-As-B10 Factors affecting childhood immunisation in Lao Peopleʼs Democratic Republic: case-control study from nationwide, population-based, multistage cluster sampling

Tomomi Kitamura1, Masahiko Hachiya1, Kenichi Komada1, Anonh Xeuatvongsa2

1National Center for Global Health and Medicine, Bureau of International Medical Cooperation, Japan, 2Ministry of Health, Lao People’s Democratic Republic

Vaccines are one of the most important achieve- average. This study aims to evaluate risk factors ments in public health and the major contributor to affecting underutilization of immunisation among this success is the Expanded Program on Immuniza- children with five to nine years of age. It is a case- tion (EPI). The success of EPI does not only depend control study from nationwide, population-based, on effective vaccination series, but also on achieving multistage cluster sampling. The cases are the optimal use by the target population. Various factors children who have received "standard six" antigens influence the uptake of the EPI vaccination series. In and the controls are those partially immunized. In Lao Peopleʼs Demographic Republic (Lao PDR), bivariate analysis, household occupation, maternal immunisation coverage was lower than regional age, means of transportation, time to the nearest

─ 229 ─ 国際保健医療第 29 巻第 3 号 2014

health facilities, birth place of the children, birth decreased odds. The appropriate notification of the attended by medical staff, notification of vaccination vaccination service is needed. Further detailed date by medical staff, village authority or megaphone qualitative research may be needed to discover how were associated with the vaccination status. The final maternal sociodemographic factor influences the multivariate logistic regression model revealed that utilization of the services. Future research needs to maternal age and notification of vaccination date by target the younger children and also has to include the village authority had increased odds and health care provider factors related to the vaccination notification of vaccination date by megaphone had services.

Po-As-B11 Descriptive study on people with mental disorder and care Descriptive study on situation and care for the people with mental disorder in Songkhone District, Savannakhet Province, Lao PDR

TOMOKO KOMAGATA-ABE1, Bounheung Bangon2, Sihalat Bunnoum2, Duangchantha Sisaveuy2, Keomoungkhoun Khamsavang2, Kounnavong Sengchanh3, Phrommala Souraxay3, Masue Inoue1, Futoshi Nishimoto4, kazuhiko Moji4

1Graduate School of Nursing, Chiba University, Japan, 2Division of Health, Songkhone District, Savannakhet Province, Lao PDR, 3National Institute of Public Health, Lao PDR, 4Research Institute of Humanity and Nature, Japan

Mental health is one of the essential factors of recognized as "Mental disorder" except feelings of well-being. However, unfortunately in most part of worthlessness. Among 23 people, 7 were mentally the world, mental health and disorders are not handicapped because of perinatal trouble. Sixteen accorded anywhere the same importance as physical psychiatric disordered persons have some causes; health. Rather, they have been largely neglected and real psychiatric disease, after-effect of drugs mainly surrounded by stigma. In Lao PDR also, mental amphetamine, and organic mental disorder by injury. health is still new issue. Number of physicians and Mentally handicapped persons did not have any mental health facilities are quite limited and condition treatment, but psychiatric disordered people were of patients are not clear. This study aims to describe mostly treated by modern medicine in Thailand. In the perception of medical staffs towards mental case the patient does not recover, they choose tradi- disorder and general condition and care/medical tional medicine than modern medicine in another treatment of people with mental disorders by hospital. In spite of familyʼs vigorous support, appro- interview with Songkhone district, Savannakhet priate treatment was difficult due to less compliance province, Lao PDR. Data were collected from the of patients and financial problem. More support is medical staff of all 13 health centers in Songkhone required for continuous medical treatment for district and 23 people with mental disorder and their mentally-disordered and mentally handicapped families. Mental symptoms which specified by DSM-4 people in Lao. such as hallucination, delusions were clearly

─ 230 ─ Journal of International Health Vol.29 No.3 2014

Po-As-B12 Efficacy of a single-dose administration of Mebendazole against intestinal parasitic infection in rural areas, Lao P.D.R.

KIYOMI HANDO1, HIROAKI YAMAZAKI2, SHUJI FUKUYAMA1, JUNKO ISHIHARA1, TOMOKO SAITO1, TOICHIRO ISO1, TAKAO SUGIMOTO2, DAISAKU URABE2, THONELAKHANH XAYPANGNA3, TAKATOSHI KOBAYAKAWA1

1Nonprofit Organization, International Support and Partnership for Health, Tokyo, Japan, 2International Cooperation Department, St Mary’s Hospital, Kurume, Japan, 3Khammouane Provincial Heath Office, Thakhek, Lao P.D.R.

Introduction: A single-dose administration of 500mg tion. of Mebendazole (MBZ) or 400mg of Albendazole is Results: STH infections were found in 54.2% of the common treatment for soil-transmitted helminth test subjects (97/179). 83 of 97 test subjects who were (STH) infections in Lao P.D.R. However, there have confirmed to have STH infection were assigned a been some reports which suggest that administering single-dose administration of MBZ and received a such doses is not effective enough for the treatment second stool examination after the drug administra- of STH infections. We therefore assessed the efficacy tion. 15 of 83 test subjects (18.1%) remained STH egg of a single-dose repeat oral administration of MBZ positive and received a third stool examination after (500mg) for the treatment of STH infections. the second treatment. Hookworm infection was found Methods: A total of 179 stool samples were collected in 7 of 11 test subjects. and the stool samples were examined using the Kato- Conclusion: Our study also confirms the low efficacy Katz technique. 90 people infected with STH were of a single-dose administration of MBZ against STH. assigned the treatment with a single-dose oral admin- Test subjects who remained hookworm-egg positive istration of MBZ, and received a second stool were re-assigned MBZ. However, the administration examination after the drug administration. Test of MBZ showed low cure rates for hookworm. subjects who still tested positive for STH eggs were Therefore, the single-dose administration of MBZ then re-treated and received a third stool examina- against hookworm in Lao P. D. R should be reviewed.

Po-As-C01 Situations of HIV care prior to TB diagnosis of HIV co-infected TB patients and its influence on prognosis in a province of northern Thailand:

NORIO YAMADA1, Supalert Nedsuwan2, Pacharee Kantipong2, Worrarat Imsa-nguan2, Saiyud Moolphate5, Narin Suriyont3, Chamnan Hansudhivejchakul3, Kuniko Murakami1, Shinsuke Miyano4

1Centre for International Cooperation and Global Tuberculosis Information, 2Chaing Rai Provincial Hospital, Chiang Rai, Thailand, 3Chiang Rai Provincial Health Office, Chiang Rai, Thailand, 4Bureau of International Medical Cooperation, National Center for Global Health and Medicine, Tokyo, Japan, 5Department of Public health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Thailand

Background: Chiang Rai province of Thailand is one surveillance system and medical records. The study of areas where HIV was epidemic previously and subjects are new TB patients with HIV infection about 20% of new TB patients are HIV co-infected. known who are registered in 2011. The patients are Death rate of HIV/ TB patients is high (about 20%). categorized into 3 groups; Group A: those with HIV This study aims at investigating whether strengthen- diagnosis at the same time as or later than TB ing of HIV care before TB disease may improve diagnosis, Group B: those with HIV diagnosis made prognosis of HIV co-infected TB patients (hereinafter within 1 year before TB diagnosis, Group C: those HIV/TB patients). with HIV diagnosis made 1 year or longer before TB Methods: Information is extracted from the TB diagnosis. Records of CD4 examination in medical

─ 231 ─ 国際保健医療第 29 巻第 3 号 2014

records are used as indicators of history of HIV care. record and D with follow-up CD4 records respective- Results: 136, 47 and 52 HIV/TB patients are catego- ly. rized into Group A, B and C respectively. Among Conclusion: The findings may indicate strengthening Group C, 19 have record of CD4 examination between early HIV diagnosis and regular HIV care after HIV 1 month and 1 year prior to TB diagnosis. Success diagnosis may contribute to improving prognosis of rate of TB treatment was 63.2%, 63.8%, 78.9% and HIV co-infected TB patients. 84.2% for Group A, B, C without follow-up CD4

Po-As-C02 Healthcare service utilization among rural elderly in North Thailand

Watcharakorn Riabroi1, Nanako Tamiya2, Yukiko Wagatsuma1

1Department of Epidemiology, University of Tsukuba, Japan., 2Department of Health Services Research, University of Tsukuba, Japan

Objective: This study aimed to describe sub-district of Public Health, Thailand. The study was approved Health Promoting Hospital (HPH) healthcare service by the Ethical Review Committee of University of utilization among rural elderly in North Thailand. Tsukuba. Methods: Study subjects were people aged 60 years Results: The two-day training course was organized and above, both males and females, and live in the for nurses working in Maechai District. There were rural area in Maechai district, Phayao province, 17 nurses attended from nine sub-district HPHs. The Thailand. There were 5,414 elderlies in 2013 in this coverage was 80-95% for each sub-district HPH area. 800 study subjects were randomly selected catchment area, and the study covered both sexes based on a sample size calculation. Data was collected adequately. We present the preliminary data results through home interviews by trained nurses using a from this survey and discuss on main characteristics structural questionnaire. The questionnaire consists of healthcare service utilization among elderly in of two parts: part I; socio-demographic and health North Thailand. information and part II; information on health care Key words: elderly, aged, health services, rural service utilization. The study had an official approval health services from Maechai District Public Health Office, Ministry

Po-As-C03 The current situation and problems facing the school lunch system in Myanmar temple schools

SAKI SHIMAHARA, MIKIKO ARAKI, HIDEKI YAMAMOTO, MARIKO INOUE

Teikyo University, Graduate School of Public Health

Background and purpose Myanmar has a lot of kitchen and interviewed priests and kitchen staff. temple schools. The quality and management of Furthermore, performed contents of the lunch, a education in these temple schools are entrusted to marketing research and performed a nutritive value each monastery. Regarding school meals, the calculation (based on the Standard Tables of Food provision of stable school lunches is difficult as the Composition in Japan) school lunches at temple schools rely on donations. Results The school lunch usually offered in this This study aimed as understanding the current temple school consisted simply of “rice and bean system regarding school lunches and how it may be soup”. The energy 390kcal, calcium 16 mg, vitamin A improved with regard to the health of the children. 1μgRE, vitamin B1 0.13 mg, and the cost was ap- Method We visited a temple school with an enroll- proximately 60 yen per student. From our observa- ment of 526 children, aged between 4-17 years, in tions, it was revealed that the menu planning, record Yangon city in January, 2013. We inspected the management, accounts of school lunch and well water

─ 232 ─ Journal of International Health Vol.29 No.3 2014

management for the purchased ingredients were gested that intelligence was more necessary because inadequate. it did not investigate the home environment of the Discussion Nutritive value was low for lunch, and child, this time only in one school. improvement was necessary. However, it was sug-

Po-As-C04 The Problem of Former Leprosy Patients in Republic of the Union of Myanmar: Consideration by Semi-Structured Interview Methods

Yuto Naka1, Takahiro Iwagaki2, Atsushi Saito3, Atsushi Ogihara4

1Department of Health Sciences and Social Welfare, School of Human Sciences, Waseda University, Tokyo, Japan, 2Graduate School of Human Sciences, Waseda University, 3Faculty of Oriental Studies, Al-farabi Kazakh National University, 4Faculty of Human Sicences, Waseda University

[Background] In Republic of the Union of Myanmar, was 1385. Number of former patients was 356. 120 there are many villages where former leprosy pa- former patients had made their living by the beggar. tients live. Because of those diseases, they are Patients with serious handicaps had to beg, and most discriminated. Most of previous researches stressed of them would like to resign it. Patients claimed the collecting medical and statistical data. To accomplish necessity for new industries which can obtain a symbiosis between former patients and society, steady income. Former patients with mild handicaps studies about their social-economic situation are were engaged in mainly agriculture. They seldom felt necessary. In this study, we aimed to understand the discriminations because they had few opportunities status and needs of former leprosy patients for policy to come out of a village. However, those who begged recommendation. experienced discriminations in urban area and felt [Subject and Method] We conducted field survey at uneasy. Strategies against leprosy were mainly disa- Nanther Myaing village in Mandalay precinct from bility prevention. There was little support to people August 25th to 28th 2012, we collected statistical data who already had a handicap. The household that from the medical institution and conducted semi- could not work only depended on a beggar or sup- structured interview to 60 former leprosy patients port. In order to improve that situation, the govern- about socio-economic conditions. ment needs to make supports according to degree of [Results and Discussion] Population of the village handicaps.

Po-As-C05 Introduction of case study to develop capacity of midwives in Cambodia

KANAKO FUKUSHIMA1, YASUYO MATSUMOTO1, 2, YURIKO EGAMI1, SVENG CHEEATH CHHAY3

1Bureau of International Medical Cooperation, National Center for Global Health and Medicine, 2Ohmori Ladies Clinic, 3National Maternal and Child Health Center

OBJECTIVES Project for Improving Maternal and writing record and assessment. Newborn Care through Midwifery Capacity Develop- METHOD The case study targeted the midwives in ment was launched in 2010 at National Maternal and NMCHC and started from January 2013. Team Child Health Center (MCHC), tertiary hospital, and in leaders and chief of each ward selected the case. In Kampon Cham region in Cambodia. Midwifery case case study, all midwives can participate to and follow study was introduced in order to utilize the lesson one midwifery process. learned from the workshops aiming evidence-based RESULTS Thirteen case studies were conducted quality midwifery care and enhance the ability of from January to July 2013. In each time 5-19 people

─ 233 ─ 国際保健医療第 29 巻第 3 号 2014

and in total 45 people participated Cases were CONCLUSIONS This case study began with the selected from ANC, first stage of labor, third stage of classification of information and main interest of labor, PIH etc. Observation and explanation to the participants was method of writing record. In order client was focused on planning the midwifery care. In to enhance midwifery capacity, it is essential to 108 answers from questionnaire, 35.2% mentioned record the care actually provided and evaluate care about elements on midwifery process, 15.7 % men- itself. To review their own care using record remains tioned about midwifery care, 13.0% mentioned about challenging. observation.

Po-As-C06 The survey on the complementary food intake of inpatients at the National Pediatric Hospital in Cambodia and their eating habit at home

SHINO SAITO1, AKEMI TAKAHASHI1, Molyka Nhean1, KAORU KUSAMA2

1Foundation for International Development/Relief, Phnom Penh, Cambodia, 2Aomori University of Health and Welfare, Aomori, Japan

Cambodia has had a considerably high percent- practice. Firstly, the structured interview was con- age of the stunted under 5 (UNICEF, 2013), and for ducted to 164 caretakers. Then secondly, the follow improving this situation, the Ministry of Health has up interview was carried out to 21 caretakers who promoted a nutritious complementary food for babies were randomly selected for exploring more in depth. who are 6 to 24 months old since 2011. In Cambodia, The results of the first interview indicated that the a watery porridge has traditionally been cooked as a knowledge of the mixed porridge has been dissemi- complementary food; yet it does not satisfy babyʼs nated widely; 64% of caretakers have learnt about it. nutritional requirement. In contrast, the new is a However, 42% of them have never practiced it. The thick porridge made with vegetables, oil and protein second interview revealed that mothers stopped rich food (hereinafter mixed porridge).Since 2012, the cooking due to babyʼs rejection, or relativeʼs prohibi- National Pediatric Hospital has served the mixed tion. It also revealed that mothers have been porridge for babies with the assistance of the motivated to cook when their babies liked to eat it. In Foundation for International Development/Relief sum, this research shows the necessity of not only (FIDR). With the introduction of this porridge, the the information dissemination, but also support and FIDR carried out the interview to caretakers of baby encouragement to motivate mothers to cook the patients to monitor the knowledge dissemination and nutritious complementary foods.

Po-As-C07 A new challenge of building up a sustainable clinical support system using Tele-conference at the Neonatal Care Unit of National Maternal and Child Health Center, Phnom Penh, Cambodia

CHIE IITAKE1, 2, AZUSA IWAMOTO1, SHINICHI HOSOKAWA2, NAO MORIMOTO2, SATOSHI TAKASAGO2, TOMOKO MORI2, NAOYUKI KASHIWA2, KOUTARO NOMURA2, KAZUHIRO SHOYA2, TAKEJI MATSUSHITA2, YURIKO EGAMI1, TAMOTSU NAKASA1

1Bureau of International Medical Cooperation, National Center for Global health and Medicine, Tokyo, Japan, 2Department of pediatrics, National Center for Global health and Medicine, Tokyo, Japan

Introduction In Cambodia, it’s difficult to have an staff continuously, which is difficult. Therefore, we’ve every-day doctor’s meeting and a morning round due decided to hold a Tele-conference to motivate, en- to many reasons. Also, doctors and nurses have rare courage and skill-up the staff in Cambodia, which was opportunity to gain new knowledge. Under these also a great chance for the Japanese doctors to learn circumstances, we’re asked for support sending our in different environments.

─ 234 ─ Journal of International Health Vol.29 No.3 2014

Background National Maternal and Child Health balance and glucose infusion speed were started to Center became the top referral hospital in Cambodia, be calculated and the volume of the record rise up to during the support from JICA in this 15 years. Re- 25%. Number of participants of the conference cently, the neonatal care unit has also been asked to became triple. 2 new test and exam, and new infor- be progressed and skilled. mation from nurses and midwives became available. Contents The first conference was held on May, 2012 Discussion After 1 year of trial, good results came just by a simple style. After that, one by one, we little by little, without sending Japanese doctors on tried new styles and ways to improve. That’s a big bed sides. Tele-conference seems to be effective in challenge to the Cambodian doctors, too. We held 21 some way and also is a golden opportunity to recon- conferences by now. sider both of our daily practice. Results Some good improvements were found. Water

Po-As-C08 Self-evaluation of simulation-based continuing education nursing workshop participants in urban area of Bangladesh

OSHIDA YUMI

Nursing Dept of Soka University, Tokyo, Japan

Background and Purpose According to World Bank to 16 nurses. They are all of participants of the (2010), one third of the population is living under the workshop. Transcribed interview data was coded poverty line in Bangladesh. An increase of wealth and analyzed. gap and the demand management for hospital pa- Result Fourteen out of sixteen participants’ overall tients in response to a rise of non-communicable impression were positive. Based on the codes: 1) diseases in urban areas of Bangladesh causes nursing SimMan is like a man, 2) not harmful to patients, and care more complicated. Continuing education is vital 3) possible to practice again, the benefits of to Bangladeshi nurses in order for nurses to keep simulation-based learning method categorized as their practices safe and current. However, in Bangla- practical tool. Also, the nurses commented that it desh there is no continuing education requirement or teaches well to students; the view was categorized as regulation to make sure nurses’ knowledge updated. a good teaching method. The purpose of this research is to describe the Discussion The workshop participants nurses evalu- experiences and evaluations of nurses who participat- ated that the simulation-based learning was effective. ed in a simulation-based nursing continuing education The study confirmed the importance of conducting a workshop in urban areas of Bangladesh and learn pre-assessment of learners’ level and choosing teach- what to improve with their continuing educations. ing methods based on the expected learning out- Methods One year after the workshop held in Octo- comes for Bangladeshi nurses. ber, 2011, semi-structured interviews were conducted

Po-As-C09 Health System Assessment Targeting Preventable Noncommunicable Diseases and Health Promotion in Indonesia

MAYUMI MIZUTANI1, JUNKO TASHIRO2, MAFTUHAH3

1Doctoral Program, St. Luke’s College of Nursing, Tokyo, Japan, 2St. Luke’s College of Nursing, Tokyo, Japan, 3Syarif Hidayatullah State Islamic University, Jakarta, Indonesia

[Purpose] In Indonesia, noncommunicable diseases en prevention of NCDs and health promotion. (NCDs) are a significant health issue. This health- [Methods] Information on health system key compo- system assessment targeted areas that could strength- nents (World Health Organization, 2010) including

─ 235 ─ 国際保健医療第 29 巻第 3 号 2014

leadership and governance, health information However, in 2011 only 92 districts in one-third of the systems, health financing, service delivery, essential provinces had implemented blood glucose measure- medical products and technologies, and human ment. The majority (54%) of health human resources resources for health for NCDs were collected through are nursing personnel. The ratio of nurses per website of Indonesian Ministry of Health, Ministry of 100,000 population differed among provinces ranging Education, and Nursing Association and assessed. from 64 to 348. Bachelor’s programs in nursing [Results] One of the eight priorities in national health increased from one in 1985 to 318 in 2011 and nation- plan was controlling diseases including NCDs using al competency examinations at graduation will start early detection and risk factor control. Health strate- in 2013. gies were developed and managed at national, pro- [Conclusion] The national health plan for the preven- vincial, and district levels. Financial resources of local tion of NCDs and health promotion were variously governments were lacking. Community health posts implemented among provinces and districts. There- conduct health services such as measurement of fore, it is essential to secure local budgets and body mass index, blood pressure, and blood glucose, strengthen nursing personnel for consistent imple- and health education on smoking, exercise, and diet. mentation.

Po-As-C10 Current situation of school health at South Sulawesi Province in Indonesia -Preparation status of the school health rooms and actual condition of utilization of them-

SAEKO HATTA, YASUKO KINJO, SEIKO MATSUSHITA

Dept of Nursing, Faculty of Human Health Sciences, Meio University, Okinawa, Japan

This survey on the status of school health at the school health rooms and also had a shortage or South Sulawesi Province in Indonesia was conducted lack of health-related goods. The School health from 2007 to 2010. The survey consisted of installa- activities in Indonesia were designated as a minimum tion status of the school health rooms, arrangement basic service to be provided by local governments on status of goods and medical products at the school the order of Minister of Health in 2003. However, it health rooms, availability of teachers in charge of became obvious that the actual preparation status of school health, usage status of the school health rooms, the school health rooms and health-related goods and implementation status of each schoolʼs health varied a great deal depending on provinces, districts training about the junior secondary schools at three and schools. In addition, each schoolʼs health training districts in South Sulawesi Province. The survey was found to be conducted jointly with regional found that over half of the concerned schools had no health-related parties.

Po-As-C11 Research on Value of Children in the Province of West Nusa Tengara, Area of West Timor

KANAKO SHINKAWA, MIWA TUNETA

Faculty of nursing, Sapporo university of health sciences.

'Value of children' is a concept which is applied prioritizing method in 2011. We can find several in order to explain the varying fertility levels within results among each group by analysis of variance. different cultural settings. The focus of the research Group means that the item has to be priority number is the question which conditions determine the value one. There are follows:1) Son preference group is of children and desire for children preferences. The linked with the grope of family continuation group survey conducted for 99 Indonesians who live in East significantly. It is natural result, because most of male Nusa Tenggara province, area of West Timor using a children in Indonesia are still socialized to adopt the

─ 236 ─ Journal of International Health Vol.29 No.3 2014

norms and expectation of family, to foster continuity group is linked with a determinant of family continu- of the family. 2) No preference group is linked with ation for child value significantly. And also elderly the adult status group significantly. Women prefer to group prefer to son than another group Determinant the adult status for having a child than men. Having of economic value for children has not so strong a child as well as marriage is still a necessary prereq- factor than that of a family continuation. Although uisite for their successful and stability socialization in there is a tendency of son preference, it is not an Indonesia.) Compared with three age groups, elderly overwhelming trend.

Po-As-C12 First-line screening with non-blood profiles to identify individuals needing further follow-up for diagnosis of type 2 diabetes mellitus in resource-limited setting

SAORI KASHIMA1, KAZUO INOUE2, MASATOSHI MATSUMOTO3, KIMIHIKO AKIMOTO4

1Department of Public Health and Health Policy, Institute of Biomedical & Health Sciences, Hiroshima University, Japan, 2Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Japan, 3Department of Community-Based Medical System, Institute of Biomedical & Health Sciences, Hiroshima University, Japan, 4Akimoto Occupational Health Consultant Office, Japan

Background: Early detection of type 2 diabetes is Results: Diabetes diagnosed were 7.0% in men and 2.6 essential in the low-income countries. However, less % in women respectively. The optimal cut-off levels than half of those persons with diabetes are diag- of age, BMI, and SBP were 48 and 54years, 23.6 and nosed due to limited resources of laboratory tests in 23.1kg/m2, and 130 and 129 mmHg, in men and these countries. We investigated a screening method women. In a multiple-continuous model, age and BMI for use in resource-limited setting based on simple had the highest sensitivity among all combinations, non-blood profiles to identify high-risk individuals but the lowest specificity (sensitivity ＝ 88.6%, speci- with type 2 diabetes. ficity ＝ 42.9% in men, and 87.8%, 54.0% in women). In Methods: Data of 34,300 persons from a health- composite-binary model, a combination of profiles checkup program in Japan was utilized. Non-blood [(BMI or SBP) and age] had a lower sensitivity, but a profiles were used to predict diabetes (fasting plasma better specificity than that in the multiple-continuous glucose of ＞＝ 7.0 mmol/L) included age, body mass models (sensitivity ＝ 64.9% and specificity ＝ 62.1% in index (BMI) and systolic blood pressure (SBP). The men, and 70.3% and 70.4% in women). risk-predicting tools were created based on a single Conclusion: A first-line screening using non-blood profile, a combination of multiple profiles using the profiles can identify high-risk individuals for diabetes. logistic regression model (multiple-continuous model), Model selection should be based on their context of and a combination of multiple profiles (composite- resource-limited settings. binary model).

─ 237 ─ 国際保健医療第 29 巻第 3 号 2014

Po-As-D00 Establishing Regional and District Health Mapping System using Open Source Geographical Information System (GIS) in Madagascar

TOSHIHARU OKAYASU1, SAORI KASHIMA2, JEAN LUIS RAZAFIMAHATRATRA3, HARISOA JULIE NOROVOAHANGY3, JACKY RAHAMEFY4, ANDRIAMIARIZO ANDRIANJATOVO4, KAE FURUKAWA5, HIROO IMAKI6

1JICA Benin, Cotonou, Benin, 2Department of Public Health and Health Policy, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan, 3Health Statistics Service, Ministry of Public Health, Antananarivo, Madagascar, 4National AIDS Program, Ministry of Public Health, Antananarivo, Madagascar, 5JICA Benin, Bujumbura, Burundi, 6Pacific Spatial Solutions, LLC, USA

[Background] A Health mapping is important to Google Earth between 2010 and 2011. To link Data- show a disease distribution and detect high risk are- base and GIS software, we developed health facilities’ as. However, health sectors in developing countries master codes. Then, we used an open source GIS have some major problems to manage a health map- software, Quantum GIS, and developed a training ping such as lack of capability to maintain fundamen- manual. Additionally, we organized 10 GIS training tal geographical information and health related sessions using our manual in 2012 and held the statistics, high cost of commercial GIS software, and national HIV/STI thematic map contest in 2013 with rare opportunities to train staff in regional / district 96 entries. health office. [Result/Discussion] We identified 3361 health facili- [Method] Three of authors were dispatched to JICA ties out of total 3439 through our Google Earth HIV Prevention Strengthening Project in Madagascar workshop. All of 22 regional health offices and 112 between 2009 and 2013. We integrated STI/HIV districts health offices staffs were trained. With the indicators into routine Monthly Activity Reports approach of HSS in health information, the staffs in (RMA) and updated RMA database software in col- national/district/regional level are capable to monitor laboration with Health Statistics Service for Health and analyze several diseases indicators with Heath System Strengthening (HSS). To maintain fundamen- Mapping. Organization of contest would be one of the tal geographical data, we organized 9 workshops to better methods to monitor participants’ follow-up. indentify all heath facilities in district level using

Po-As-D01 Nursing care provided by the family and the roles of the nursing in developing countries-Analysis on reports of Japan overseas Cooperation Volunteers in China-

HIROMI TSUJIMURA1, YOSHIE MORI1, MOYO LEE2, KEIKO SAITO3, KYOKO YAMADA4, KAZUKO TANAKA4

1Graduate School of Health Sciences, Gunma University, Maebashi, Japan., 2Takasaki University of Health and Welfare, Takasaki, Japan, 3Saitam Prefectural University, Saitama, Japan, 4Gunma University, Maebashi, Japan

[Purpose] To clarify the respective roles of family JICA 2001 to 2006. The analysis extracted parts of and a nurse(s) in nursing care in developing countries the reports that referred to the care performed by a and obtain suggestions of international cooperation nurse(s) and family respectively and the care not from Japanese nurses. performed by the nurse(s). [Methods] This study consists of the activity reports [Results] We analyzed the 123 reports that were that were written by JOCV dispatched to China from written by 26 JOCV: 25 nurses and 1 midwife. JOCV

─ 238 ─ Journal of International Health Vol.29 No.3 2014

were dispatched to 21 medical institutions and 5 [Discussion] In China, nurses mainly carry out educational institutions. Many of the descriptions nursing procedures associated with auxiliary medical about the nurses referred to injection and intrave- examinations, while family members assume an nous drips, the suture of wound, artery blood collect- important role in assisting the patients with their ing, etc., which a nurse does not normally perform in daily lives. This is probably due to the fact that Japan, were reported to be performed by nurses in China has a nursing shortage and that patient care China. The Chinese nurses performed among others requires much work other than nursing. Also, it is the medicinal receipt and goods management, considered natural that the family takes care of a accounts, which are normally performed by nurse patient. *This work was supported by Grant-in-Aid aids or clerks in Japan. Descriptions on family care for Scientific Research (No.23659998). included “meal support”, “excretion support” etc.

Po-As-D02 Brended Methods intervention for strengthen the continuing nursing education program in the developing countries

Yae Yoshino1, Altanbagana Surenkholoo3, Yuka Yabashi3

1Kitasato University, School of Nursing, Japan, 2Department of Nursing, Ministry of Health of Mongolia, 3World Bank Tokyo Development Center

Background: Every 5 years nurses must renew Results: Over 6,000 nurses in Mongolia which is license with 30 CE credits in Mongolia. Due to equivalent to 60 % of nursing population in country geographical, infrastructural and financial barriers, participated in 2008- 2013. They shared knowledge nurses face difficulties to maintain licenses and com- with colleagues at their own clinical sites made it petencies especially in the remote area. We have larger impacts. Traveling cost of Japanese lecturers been engaged to maternal and child health (MCH) and Mongolian participants, and time were much nurses to develop CE system to strengthen profes- reduced, which encouraged larger audience. With the sional competencies and improve the quality of MCH series of seminar notes, the first MCH nursing and care. Our goals were to establish sustainable CE midwifery textbook were published collaboratively. system, especially for nurses and midwives in the Conclusion: This collaboration suggests sustainability country. where resources are scarce. Publishing textbook has Methods: Programs designed in collaboration with been a long awaited achievement to close the gap professional bodies, ministry of health, and national within the country. Findings revealed that interven- universities for knowledge translation into local tion improved awareness of risk prevention, parental contexts. It was designed with interactive seminars education classes, better use of MCH handbook, between Japan and Mongolia via World Bank satellite developing nursing protocols, and nursing records. system. Moodle enabled participants to access course Conclusion: CE systems not only facilitate collabora- materials, including documents, videos, and the tion internationally, but also domestically. references.

─ 239 ─ 国際保健医療第 29 巻第 3 号 2014

Po-As-D03 Activities Report on Improving of living conditions by promoting safe water supply, based on the concept of Primary Health Care in Dhital village of Kaski Country, Nepal.

RIE UENO1, Hiroko Sakai2, Manabu Kurokwawa3, Hideaki Nomura1, Junichirou Yanagida1, Satoko Imura1, Kazuo Ono1

1Facalty of Health Sciences Department of Nursing, Kobe Tokiwa University, Hyogo, Japan., 2Morinomiya University of Medical Sciences, 3Kobe City Public Hearth Center

Overview Infrastructure in Nepal has been under- strong link in and outside of their wards. We gave developed, and it has remained difficult to secure health education to those mothers on 1) Water Con- water, as noted the link with health problems, espe- tamination and Diarrhea, 2) Nutritional Improvement cially water borne diarrhea. and the other activities to promote hygiene in daily “Grass Roots” technological cooperation, organized by living. JICA, we have been implementing citizens- Results & Conclusion The previous domestic survey participation-typed project of improving living condi- revealed that the citizens with less literacy had little tions through safe water supply, based on Primary understanding of the importance of the safe water or Health Care. Now we report on the experiences of hygiene, nevertheless, they held the higher inspira- the activities. tion for improving living conditions than the others The Quarter of the concerned residents belong to with higher literacy. Dalit, the 64 % are illiterate. The village consists of 9 Therefore we introduced the more accessible educa- wards, in each exists citizens’ groups, called Mother tional text with many visual representations. In 5 Groups, made of the local mothers, volunteering for exemplary wards, we provided health education, in public health. which over 100 participants in total, not a few male They mostly grasp the state of health and living participated as well, which showed the citizens had conditions of each household and maintained the had strong interest in such education.

Po-As-D04 Cross sectional study of motherʼs care seeking behaviors toward their childrenʼs illness on a hilly area in Nepal

SHIGE KAKINOHANA, MASATAKA HIRAI, HIROMI TAKAHASHI, GURUNG SANU, FUJIKO OMINE, KUMIKO TUJINO, MICHITA TOKESHI, CHIKAKO MAESHIRO, YUMIKO IHA

School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Japan

Purpose: The purpose of this study is to determine the decision to seek care for children by themselves. the factors related to mother’s care seeking behaviors The number of sickness symptoms of the children and home care on a hilly area in Nepal. that the subjects took notice in the past 1 month was Methods: A cross sectional survey with structured 2.5. When their children were sick, 72.1% of them questionnaires was carried out among 147 women went to the hospital, 70.1% went to the health post, who have children under 5 years old in western 60.5% went to a pharmacy to purchase some medi- Nepal in 2011. The women were asked their attrib- cine, and only 30.6% went to the traditional healer. utes, knowledge of symptoms of sickness, care The number of home care related to number of sick seeking behaviors. This survey was approved by the symptom observed by mother and number of ethical clearance board. children. Results: The average age of the subjects and the Conclusions: The results showed that mother’s children was 26.3 and 2.2 years old respectively. The knowledge of physical assessment and number of literacy rate and education status of the subjects was children related to home care. Most of the subjects higher than the national average. Most of them made tended to seek western medical care. It suggests that

─ 240 ─ Journal of International Health Vol.29 No.3 2014

providing mothers the knowledge of sick symptoms mortality rate of Under 5 in rural area in Nepal. with home care recommended is essential to improve

Po-As-D05 Study of the process which women result in a home birth on a hilly area in Nepal

SHIGE KAKINOHANA, HIROMI TAKAHASHI, GURUNG SANU, MASATAKA HIRAI, YASUKO KOJA, FUJIKO OMINE, KUMIKO TSUJINO, CHIKAKO MAESHIRO, YUMIKO IHA

School of Health Sciences, Faculty of Medicine, University of the Ryukyus

＜Objective＞ The objective of this study is to reveal “Distance from medical care” influenced to their the process which pregnant women resulted in a choice. While, some intended to give a birth at home birth and to identify the factors related to the medical facility. “A person except pregnant woman process on the hilly area in Nepal. makes a decision important issues in home” influ- ＜Methods＞ Thirty-six women, gave a home birth enced to choose the delivery place. However, the within two years on the hilly area in Nepal, were woman who intended to have a baby in a hospital, interviewed about their experiences of home birth resulted in a home birth because of “delay in the and daily life by semi-structured questionnaires. decision which goes to the medical facilities”. Modified grounded theory approach was used to ＜Conclusions＞ It is important to give knowledge analyze data. not only pregnant woman but also community includ- ＜Results＞ Fifteen concepts and 7 categories were ing family about the signs and symptoms which generalized. The process which pregnant women delivery begins. At the same time, it is need to show resulted in a home birth was explained as follows. how to deal an abnormal progress of pregnancy and “Giving a birth in daily life”, women “estimate an easy delivery. delivery”, therefore they chose “a home birth”.

Po-As-D06 Cost Analysis Trial for Prevention of Lifestyle-Related Diseases in Sri Lanka

TAKAO SUGIMOTO1, Anuradhani Kasturiratne2, DAISAKU URABE1, YSAUO UCHIDA3

1International Cooperation Dept., St.Mary’s Hospital, Kurume, Fukuoka, Japan, 2Faculty of Medicine, Kelaniya University Kelaniya, Srilanka, 3Faculty of Policy Studies Department, Doshisha Univ., Kyoto, Japan

Introduction In Sri Lanka, the nature of diseases has disease-based hospitalization costs for patients with been changing due to the aging of the population. cerebral infarction, myocardial infarction, an ischemic Furthermore, since the 1980’s the mortality rate of heart disease and diabetes. non-communicable diseases has exceeded the mortali- Result With regard to 1) personnel in charge of coun- ty rate of communicable diseases. I was fortunate termeasures for lifestyle-related diseases, developed a enough to join the project and therefore made an model simulation program for the trial calculation. attempt to introduce cost accounting techniques. With regard to 2) hospitalization costs for 4 diseases Activity In the “Project of Health Promotion and were calculated. For instance, the average hospitali- Improvement of Preventive Healthcare Services” zation period for a patient with cerebral infarction conducted between May 2008 and March 2013, the was calculated as being 3 days, and the average following 2 types of cost accounting were carried out hospitalization cost was 5,836 LKR (4,371 yen) per as cost analysis activities:1) In order to calculate the patient. model cost necessary for the implementation of Discussion A budget necessary for promoting such health checkups. 2) Analysis was conducted on activities nationwide can be calculated based on this

─ 241 ─ 国際保健医療第 29 巻第 3 号 2014

analysis. A calculation of disease-based hospitalization comes of preventive measures in the future from the costs for lifestyle-related diseases can also be made, aspect of cost can be carried out. meaning that a comparison and examination on out-

Po-As-D07 Effect of continuous cooperation for Community Based Rehabilitation (CBR) in Sri Lanka

KOICHIRO TOBINAGA1, DAISAKU URABE2

1Department of Rehabilitation, St. Mary’s Hospital, Kurume, Fukuoka, Japan, 2International Cooperation Department, St. Mary’s Hospital, Kurume, Japan

Introduction: CBR is development of a community to nity. include people with disabilities (PWDs). CBR in Sri Result: The care for PWDs by their family members Lanka had started back in 1980 as a national project. and, the quality of service which SSO and CBR Social Service Officer (SSO) practices CBR program volunteers provided improved. Number of partici- and CBR volunteer supports it. I was attached to pants in a seminar increased. PWDs who stayed Ministry of Social Service and Social Welfare as a inside their houses before tends to go out with their physical therapist of JICA volunteer to promote CBR family members. The workshop for PWDs became program in Rajanganaya, Sri Lanka for 10months in the model activity on CBR project. 2008, 7months in 2009 and 6months in 2012. Conclusion: This activity could extend their liveli- Purpose: The purpose of my activities was to include hood zone and make their recognition for disabilities PWDs into a community by improving knowledge change. CBR practitioners understood about disabili- and skill of people involved in CBR Also by correct- ties better and became to be able to intervene active- ing the recognition of disabilities. ly. I suppose a continuous cooperation can develop Activities: Field visit and seminars were implement- life of PWDs and a community, and furthermore ed. The workshop for PWDs was opened. These empowerment of PWDs and community development activities were reported to a governance and commu- will be able to include PWDs into a community.

Po-As-D08 Assessment of patients with thoracic spinal cord injury in Uzbekistan

KAZUYA OMURO

Independent Researcher,

The aim of this study is to understand the gen- patients required support to move on the floor. In eral tendency of patients in Uzbekistan through as- order to move by a wheelchair, five patients required sessment on basic movements and daily activities by support when it was inside, and only one patient applying general assessment methodology used in could move without such when it was outside. Ob- Japan. serving their daily life, although nine patients out of Eleven individuals living in Uzbekistan with tho- eleven could eat, wash face, and brush teeth inde- racic spinal cord injury participated in the study. The pendently, all the patients could not change clothes, survey was conducted through observation of move- defecate, and take a bath without supports. ments and interview between 2011 and 2012. The study clarified that the abilities of Uzbeki- Informed consent was obtained from the patients stan patients with thoracic spinal cord injury are before the study. different to which generally observed in Japan. The Through the study, it was found that four pa- reasons of the differences could come from their local tients needed third person’s support to roll over as customs that family or neighbors help patients in well as six patients needed the same to sit up. Eight many cases of their life as well as the frequency of

─ 242 ─ Journal of International Health Vol.29 No.3 2014

taking bath and changing cloths is less in Uzbekistan. catheters also caused the result as well. The fact that all the targeted patients use urinary

Po-As-D09 Present Situation and Problem of Stoma Care in Uzbekistan

SAYAKA SUMIDA, YOSHIE MORI

A graduate course of health Sciences, Gunma University, Gunma, Japan

I worked as a Japan overseas cooperation volun- The stoma management is attributable to the teers at the emergency medical service center in following factors; The stoma isn’t constructed in Uzbekistan for two years. This center accepts all consideration for long-term management because emergency patients. A temporary stoma construction there’re many patients dying immediately with operation is carried out to internal organsʼ damage postoperative complication. Nurses don’t care for due to the traffic injury, ileus and intestinal perfora- security and comfort of the patient voluntarily. In tion. As I was engaged in several stoma cares, I addition, they don’t conduct the affairs that their report of stoma care in Uzbekistan. hand pollutes because there’re not enough gloves and Same method and position are used for many water available. case of stoma construction, and these are hard to Problems in the stoma management are; The care. The operation wound is sterilized with alcohol, fixed idea about a surgical procedure and position of the stoma is washed and covers are changed twice the stoma, Lack of consciousness and technical of every day from the following day. Since there aren’t doctors and nurses, Insufficient domestic supply of disposable stoma appliances, they use the rubber medical resources, The lack of nurses knowledge and cover, which the inappropriate and heavy. The insufficient intervention, The intention of the patient patient isn’t taken care when their stoma is polluted, is downplayed. It’s necessary to provide guidance to so they are often complicated with a skin trouble and nurses in consideration for such conditions. infection.

Po-As-D10 The Basic Study on Terminal Care in the Republic of Kazakhstan

SAHO OANA1, TAKAHIRO IWAGAKI2, ATSUSHI SAITO2, 3, AMANTAY ZHANAR3, ZHANNA KARCHIGANOVA4, ATSUSHI OGIHARA5

1School of Human Sciences, Waseda University, Saitama, Japan, 2Graduate School of Human Sciences, Waseda University, Saitama, Japan, 3Faculty of Oriental Studies, Al-farabi Kazakh National University, Almaty, Republic of Kazakhstan, 4Graduate School of Social Sciences, Waseda University, Tokyo, Japan, 5Faculty of Human Sciences, Waseda University, Saitama, Japan

As life expectancy extends and lifestyle changes, more, we conducted semi-structured interview to conditions of terminal care in the Republic of Ka- three Kazakh doctors about problems on terminal zakhstan are changing. In this study, we conducted care. In 10 items of "In dying moments, I want to die surveillance to obtain basic data about terminal care beside family", "Home is more desirable than hospital in Kazakhstan. We made questionnaires written by as place for my death", "Ancestral grave have to be Russian and Japanese language to clarify family preserved carefully and inherited to our children", conception, family behavior, view of life and death, "Do you trust your family", "family’s happiness and and assistance among generations. From September benefits have to be taken priority of own happiness”, 2012 to December 2012,we conducted surveillance to “Time for caring family have to be cherished”, “Oldest 108 Kazakh students and 185 Japanese students as or youngest child should inherit much property”, and control experiment, and analyzed answers. Further- “In all cases, father’s power have to be prized”,

─ 243 ─ 国際保健医療第 29 巻第 3 号 2014

proportions of “I agree very much” and “I agree” in interview, we found that many Kazakh people think Kazakhstan were much higher than that of Japan. much of care giving in their home. However, number Result about “If you are rich, you have to make elder of people who want care in medical facilities for person move in hospital or rest home rather than to reducing burden by family care giving are increasing. nurse that person with family “showed no difference But, these trends were dependent on cities or ethnic between Kazakhstan and Japan. In semi-structured groups.

Po-As-D11 The efficacy of Health Education on the reduction of infectious diseases in an illiterate community

KHALED RESHAD

Karez Health and Educational Services, Szhiuoka, Japan

The NGO karez Health and Educational Services at 9 villages surrounding the clinic. The effect of is carrying daily clinical activities in the Kandahar health education on the early detection of diseases suburb area since past eleven years. Medical educa- and the importance of EPI was of great value, as well tion was performed to the 213,216 mothers of as the necessity of labor of pregnant women carrying children who visited the clinic for medication, and to out in the clinic or health posts under the observation 34,620 habitants living at the 19 Health Posts located of medical staff.

─ 244 ─