“What should be taught in the lectures of International Health?” is the important issue in the field of education on health, because there is few standard, guideline, or consensus about the contents of lectures on International Health now in Japan. Therefore, each school, such as medical university, nursing school, post-graduate school, and so on, has different curriculums on International Health.
In this occasion, I would like to propose that the Association of International Health should formulate some recommendations on “what should be taught” in this field of International Health for the students of different specialties. These recommendations can be meaningful to standardize the curriculums on International Health in schools on health and to be the first step to provide the study opportunities for the students who are interested in International Health but have few opportunities to learn it. In addition, some “new point of view or sense” which we can learn through the humanitarian assistance activities for developing countries should be included in the lectures for fostering the humanities of the students.

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Health is heavily influenced by behavioral, social and environmental determinants as well as the biomedical characteristics of individuals. The World Health Organization announced the Health Promotion Charter in Ottawa, Canada in 1986 as a strategy to enable people to have control over and improve these health determinants. This is therefore essential to prevent disease and illness due to risky behavior as well as unsound social and natural environments. Whereas all developing countries have numerous health issues regarding behavior and environment, they need the Health Promotion strategy. Japan has so far implemented a lot of programs of health education and environment improvement to control over such determinants. Thus, Japan should promote and disseminate the Health Promotion project more in international health cooperation through official development assistance for developing countries.

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Background
The Pacific Islands is an area with one of the world's highest prevalence of obesity and diabetes. The Republic of the Marshall Islands (RMI) is an independent country of the Micronesian that extends along latitude 4 to 18 degrees north. In the past, several studies reported regarding the prevalence of diabetes among the people of the Pacific Islands. However, there is no report yet with respect to diabetes in Majuro, the capital of RMI. In RMI, diabetes and obesity are also recognized to be a serious problem, but the present state of affairs prevents an understanding of the situation.
Objectives
The purpose of the present study was to investigate the present situation and the prevalence of diabetes and obesity in Majuro.
Methods
The participants were Marshallese visited our thyroid cancer-screening program. Among those participants who undertook thyroid cancer screening, the Body Mass Index (BMI) and hemoglobinA1c (HbA1c) levels were taken of 850 participants. Participants with an HbA1c level of 6.5% or more were put into the diabetes group and participants with a BMI of 30 and over were the obese group. Prevalence was adjusted using the Majuro population based on 1999 national census and using world standard population of Segi.
Results
The age-adjusted prevalence of diabetes in aged 20 years and over in Majuro was 22.1%. After standardization, the prevalence was 31.0%.
Conclusion
The results suggest there is a high rate of diabetes in RMI similar to other pacific islands. It could be concluded, based on this research, that there is a crisis situation with regards to diabetes in the RMI. There is also a need for epidemiological research to be on a random sample of the population.

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Objective
To assess the effects of the utilization of Maternal and Child Health Handbook (MCHH) in West Sumatra on the utilization of maternal health services.
Methods
A repeated cross sectional study design was used. Three consecutive surveys were conducted in two districts, in 1999, 2001 and 2003, involving respectively 611, 621, and 630 mothers (pregnant and/or with one or more children under age three) as respondents. Respondents for each survey were selected from the same sub-districts and villages, using a multistage random sampling method. Data were collected primarily by using a pre-tested structured questionnaire. Multiple logistic regression analyses were carried out to estimate the net effects of the MCHH on mother's use of maternal health services.
Results
After controlling for other influencing factors, utilization of MCHH was found to be associated with better maternal knowledge regarding antenatal care (ANC), tetanus toxoid (TT) immunization and skilled birth attendance. MCHH utilization was also associated with higher likelihood of mothers' utilizing ANC, TT immunization and family planning services, and of use or planned use of skilled birth attendance. Simply owning the handbook did not affect maternal knowledge and was only associated with higher utilization of skilled birth attendance.
Discussion
The MCHH needs some modification, taking into account the educational level of the targeted mothers. Appropriate health care provider training is needed to promote the use of the MCHH as a tool for encouraging and focusing communication between mothers and health care providers, as well as to ensure that health care providers are able to use the handbook.
Conclusion
Utilization of the MCHH has the potential both to improve maternal knowledge and to increase the utilization of maternal health services. For maximum benefits, the handbook should be actively used by both mothers and health care providers.

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Introduction
In the Caribbean country of the Dominican Republic, specifically in the northwestern Province of Dajabón bordering Haiti, a Maternal and Child Health (MCH) handbook, “History of My Health” was introduced through the technical cooperation of the Inter-American Development Bank's Japan Program with the leadership of the Provincial Office of the Secretary of Health. This report describes the implementation process and results, examines the project's sustainability and replicablility, and shares good practices and lessons learned.
Activities
The implementation of the project can be divided into three phases: first, development of a Dominican version of MCH handbook, local awareness raising, capacity building of health personnel, and the establishment of monitoring system were areas of high priority; the second phase centered around the improvement of MCH handbook with participatory approach and the continuation of the capacity building of health personnel; and the last phase focused on the sustainability through local management-precisely securing recurrent costs of the project.
Results
The evaluation and regular monitoring visits revealed positive results: as for pregnant women, the handbooks were well accepted for their friendliness, simplicity, durability and mobility, and the rate of their receiving antenatal and postpartum cares at designated clinics or hospitals increased; as for newborns and children, the immunization coverage improved while common problems such as diarrhea decreased; and as for health personnel, the handbook helped clarify the division of work and enhanced their sense of responsibility, communication, and continuity and integration of service. Currently, 359 trained health personnel use MCH handbook in all of the 22 health establishments in the Province, covering around 98% of the target population.
Conclusions
To achieve self-sustainability, this pilot project suggests that the use of MCH handbook needs to be institutionalized through the bottom-up approach and to integrate into the existing rural and national health care system through the top-down approach.

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Backgroud
Sri Lanka is a developing and multiracial country, located in the Indian ocean near the equator, with a population of approximately 20 million. It has a parliamentary democratic system of government and over 80% of hospitals belong to government and medical services are free of charge. Literacy rate of Sri Lanka is higher than the neighbouring countries of the region, and the government's health policies, based on the promotion of Maternal & Child and Geriatric health, are on the way to success.
According to the Health Master Plan (HMP) by the Ministry of Healthcare & Nutrition (MOH&N) ,the health problems in this country are classified into three categories based on epidemiological and medical economics:
i) Continuing Problems such as dengue fever, ii) Emerging Problems such as HIV/AIDS, and iii) Evolving Problems such as lifestyle-related diseases.
It is apprehensive that the health conditions and economics of individual Sri Lankan and Nation's economics will be compelled to face the multiple burdens in the near future.
JICA's Technical Support (JTS)
JTS on the first prevention against non-communicable diseases (NCDs) has been already started by JICA after receiving the request by the government of Sri Lanka in order to avoid the catastrophic situations pointed out by HMP. Futhermore, the trend analyses on the data of inpatients suffered 59 types of communicable or NCDs from 1983 to 2003 were performed to propose the tagets and contents of the new JTS. As a result, ffifteen diseases were statistically significant, and nine out of the above15 cases were NCDs.
Because lifestyle-related diseases such as ischemic heart disease, cardiovascular diseases occupy four positions out of five leading causes of death in recent past of Sir Lanka, new model system which combines the first prevention and screening of high-risk persons and early treatment system was proposed to MOH&N.
The flow of the basic model projiect, composed of two screening steps to detect the specific persons having high-risks such as obesity, hypertension, high cholesterol, etc., is classified into three groups to receive optimum healthcare sevices at the nearby hospitals.
Fortunately, MOH&N made a request for the new JTS based on this proposal to the government of Japan. Consequently, the budget of this project proposal was approved and is now under the practical arrangements by JICA.

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