Introduction Maternal mortality ratio is widely used to provide a general sense of size of the problem of maternal deaths. However, it cannot be used to measure progress of maternal health programme on an annual basis and to compare geographic areas, because of its wide range of errors. This research estimates maternal mortality in six districts by using “unmet obstetric need” indicator in Tambacounda region, Senegal and describes possible application of the indicator to monitor, evaluate and facilitate maternal mortality reduction. Methods We used data on caesarean sections performed in seven health facilities in Tambacounda and Kaolack regions in 2005, and calculated rates of the intervention for the residents of Tambacounda. We estimated maternal mortality ratios for selected severe obstetric complications in six districts by calculating the number of deficits for the caesarean sections for absolute maternal indications, which were the number of women who developed life-threatening events but could not receive the appropriate interventions for the diseases. Results The rates of caesarean sections for all indications and for absolute maternal indications in the six districts ranged from 0.3 to 2.0% and from 0.1 to 0.9%, respectively. The estimated maternal mortality ratio for the absolute maternal indications in Tambacounda region was 651 (95%CI 554-761). Statistically significant differences in the ratios were observed between Koumpentoum district (maternal mortality ratio 966, 95%CI 741-1239) and Goudiry (877, 588-1260), and Kédougou (249, 119-457) and Bakel (296, 128-584). Conclusions This study method enabled us to distinguish the difference in maternal mortality ratios for the selected severe obstetric complications between the small districts. It implies that the “unmet obstetric need” indicator can be used to compare geographic areas, to monitor trends, and to evaluate programme impact as well as baseline data to establish necessary measures to decrease maternal deaths.
Objectives Vietnam, where leprosy used to be highly endemic, through governmental implementation of MDT in 1983 and nationwide disease control efforts, has achieved WHO's leprosy elimination goal at a national level since 1995. However, a number of patients who suffered from leprosy prior to the governmental control programme remain institutionalised. Although these patients have severe physical disabilities, social services provided to improve their quality of life appear inadequate. The purpose of this study is to report the findings of an investigation of the current state of leprosy and to clarify the problems of leprosy control in Vietnam. Methods 402 leprosy patients from two leprosy hospitals and four leprosy resettlement villages in Vietnam were investigated their disabilities on upper limb, inferior limb, and facial appearance. And their disabilities classified according to the WHO classification scheme for disabilities in leprosy patients. Results The group “Visible deformity or damage present” (G2) made up 70.1% of the study participants; the group “Anaesthesia present, but no visible deformity or damage” (G1) made up 18.9%; the group “No anaesthesia, no visible deformity or damage” (G0) made up 10.9%. More than half of those with visible physical disabilities were in their 60s or 70s. The level of disability of pre-MDT leprosy sufferers was significantly more severe than that of the post-MDT group. Conclusions The effect of MDT for prevention of occurrences of physical disability was reaffirmed, but for many patients who contracted the disease prior to the implementation of MDT in Vietnam, the after-effects of leprosy are ongoing and they are forced to live in resettlement villages due to their disability. Vietnam has reduced the prevalence rate, but there are still a number of former patients who are not receiving adequate help. Providing help that is needed to raise their quality of life is the next step.
Introduction Even though many oversea training programs end in developing an action plan from what they learned during the course, follow-up opportunities are quite limited. Group training program on maternal and child health for Francophone African countries are conducted in Japan since 2003, organized by National Center for Global Health and Medicine and funded by Japan International Cooperation Agency. Follow-up activities in Senegal and Benin are reported with lessons learned. Methods Training organizer team made a semi-structured interview with 11 trainees, 6 superintendents and 4 Japanese advisors, asking “Do trainees implement what they planned at the end of the training course in Japan? If not, what are the difficulties implementing their plans?” Organizer team also provided some interventions to solve the problems they faced. Results In Senegal, actions were not implemented yet, because plans were shared neither with their superintendents nor with Japanese advisors working with trainees as project counterparts. Organizer team set up a meeting with all stakeholders to clarify the objectives and outcomes of the training course within the concept of the project. This process made the superintendents understand and support the action plans, and facilitated to start implementing them. In Benin, trainees started activities by themselves based on their action plan under a small financial support from a Japanese advisor. It was rather easy, because they were decision makers of a hospital, but they faced difficulties to manage the staff to continue the activities. Organizer team encouraged them to continue the activities during the meeting in the hospital. Conclusions Appropriate participants can be selected and training could be effective, when cooperation project are well defined and the role of advisors is clear in the follow-up. Involvement of decision makers or superintendents for the selection and follow-up process can be a contributing factor to improve the effectiveness of the training.
Zambia is one of the HIV high burden countries in Sub Saharan Africa. Government of Zambia has been expanding Antiretroviral Therapy (ART) service nationwide at district level. However, it is still hard to access to ART service for PLHIVs who live in rural. In terms of accessibility, the service must be expanded to rural health centre level, but there are many challenges to expand the quality services into such resource limited setting, especially in the shortage of health providers. JICA's “Integrated HIV and AIDS Care Implementation Project at District Level” launched at April 2006 to improve the quality and accessibility of HIV and AIDS care services in rural Zambia. Two districts in rural area, namely Mumbwa and Chongwe, were selected as project sites. The Project introduced the “mobile ART service” at rural health centre level using the existing health system. Mobile ART services enable a rural health centre that cannot offer ART by itself to provide ART services through the human resource and technical support/assistance of the District Hospital. Mumbwa and Chongwe District Health Management Team (DHMT) started mobile ART services in the first Quarter of 2007, therefore access to ART service in districts has been improved and contributed to increase of ART clients and reduce the defaulter rate within first 6 months of treatment. The project also tried to introduce the community involvement to overcome the shortage of human resources. We found that Mobile ART services involving the community are beneficial and effective, and help ART services expansion to rural health facilities where resources are limited, and as close as possible to places where clients live. The strategies we experienced were cited in “the National Mobile HIV Services Guidelines” published by the MoH and will be able to be duplicated in other resource-limited areas of not only Zambia but also other developing countries.
Integrated Vector Management (IVM) is defined as "a rational decision-making process for the optimal use of resources for vector control". The approach seeks to improve the efficacy, cost-effectiveness, ecological soundness and sustainability of disease-vector control. The ultimate goal of IVM is to prevent the transmission of vector-borne diseases such as malaria, dengue, lymphatic filariasis, leishmaniasis, schistosomiasis and Chagas disease. WHO promotes the principles of IVM as set out in the “Global strategic framework for integrated vector management”. It lists five key elements of IVM: capacity building; advocacy and social mobilization; legislation framework; evidence-based decision-making; and integrated approaches. This framework is in line with the global plan for 2008-2015 to combat neglected tropical diseases through delivery of multi-intervention packages, which also promotes the IVM approach. In 2008, WHO produced the position statement on IVM to support the advancement of IVM as an important component of vector-borne disease control. The member states are invited to accelerate the development of national policies and strategies, while international organizations, donor agencies and other stakeholders are encouraged to support the capacity strengthening necessary for implementation of IVM. In order to take the next step and to transform the framework and policies into actual implementation, the first IVM stakeholders meeting was held in Geneva in November 2009. The meeting developed a roadmap aimed at strengthening evidence-based decision-making for new initiatives and recommended the establishment of a partnership mechanism to facilitate effective information sharing and foster better collaboration with regards to the implementation of IVM. This paper introduces the IVM position statement in Japanese language with the aim of disseminating the concept and approach of IVM in Japan.
Objective This study examined when it is most effective to introduce the subject of international health nursing into the curriculum for Japanese nursing students. Methods The study population was third and fourth year nursing students. The study used a self-reported anonymous questionnaire and an examination of student understanding of international health nursing. The questionnaire was administered during the first and the final lectures on international health nursing. The author analyzed 127 data points in the self-reported questionnaire administered during the first lecture, 96 data points in the self-reported questionnaire administered during the final lecture and 137 data points in the examination about understanding of international health nursing which was administered within one week after the final lecture. Results The fourth year students were significantly more likely to have higher scores than the third year students in self-reported evaluation of learning results and in examinations to measure understanding of international health nursing (p<0.001 respectively) . Experience in overseas travel increased self-reported evaluations of learning results (p<0.001). The fourth year students were also more likely to have experience in overseas travel than the third year students (p<0.001) . After controlling for confounding factors, the fourth year students were significantly more likely to have higher scores than third year students in the self-reported evaluation of learning results: Common Odd Ratio: 249.26, 95%Confidence Interval: 35.56-1747.31 for understanding of health problems in developing countries; Common Odd Ratio: 71.91, 95%Confidence Interval: 14.77-350.17 for understanding of diseases in developing countries. Conclusion This study suggests that the learning effects in regard to the subject of international health nursing increase among nursing students when they study it in the fourth year.