Recent studies reveal that Sub-Saharan African (SSA) countries are now experiencing rapid scaling up of health services and improvement of health status. It is reported that services related to HIV/AIDS, tuberculosis and malaria are rapidly expanding especially after 2005. According to the latest household surveys (such as Demographic and Health Surveys and Malaria Indicator Surveys) conducted after 2000, annual rate of reduction in under five mortality rate of 5% or more is observed in more than 10 countries. This revolutionary change in SSA was triggered at least partly by development assistance for health (DAH), which increased 5 folds after 2000. On the other hand, DAH to SSA by the Japanese government (bilateral basis only and excluding contributions to multi-lateral organizations and global health partnerships such as GFATM) represents merely 1% of the total, which is equivalent to $0.1 per person living in Africa. The impact, therefore, may be limited. Increase in quantity of DAH including partial support for recurrent expenditures, contribution to rule making and monitoring of DAH use within the partner coordination framework, better targeting on selected number of countries, focus on health systems strengthening, and scientific and multi-sectoral analysis of success factors of high-performing countries, are recommended as future directions of Japanese DAH to SSA.
Introduction This study's aim was to determine how the villagers' concept of health and health seeking behavior were affected by attributes, self-rated health and the Health Locus of Control (HLC) in Southern Lao P.D.R. (Laos). The results of this study may be used to assist those involved with health work in Laos. Methods In June 2009, the study was conducted in the L District of Savannakhet Province, Laos. Out of 141 people over 20 years old approached, of whom 70 were men and 71 women, 138 completed the questionnaire (97.8%). The concept of health was examined by descriptive analysis, and the self-rated health was described by age through logistic regression analysis. A chi-squared test by sex and academic background was also conducted. Each health behavior was analyzed using multiple regression analysis by age, sex, academic background, self-rated health and the HLC. Results The concept of health was described as “sabay (comfortable)” or “sabay-dee (comfortable and good)”. There was statistical difference of self-rated health between ages, but none between sexes. For the influence of health behavior factors, “Elderly”, “Modernization”, “Advanced medicine”, “Self-effort”and “feeling unwell” were extracted. When villagers feel unwell, they have access to both vitamin injection (modern medicine) and “Mo-lao”(traditional medicine). Conclusions The villagers' concept of health in the subject area was determined by not only the physical, but also the spiritual well-being of the society. Elderly people used both traditional and modern medicine. Further study may be required to show how the villagers, who use either modern or traditional medicine determine their health seeking behavior. It is also suggested to provide those villagers with adequate information about medical resources and nutrition.
Objectives The objective of this study is to identify barriers and facilitators of anti-retroviral treatment (ART) continuation among ART patients in Zambia. It also aims to explore ART scale-up approach while reducing defaulters. Methods In October 2009, we obtained ART statistics, interviewed District Health Management Team (DHMT) in Livingstone, Zambia, and conducted Focus Group Discussion (FGD) with 27 ART defaulters who were traceable, where participants shared experience in relation to why they gave up and how they resumed treatment. Results Although ART facilities have been increased in Livingstone, half of the facilities are not equipped with CD4 count machine, which affects timely commencement of treatment. Anti-retrovirals (ARV) and consultation are basically offered free of charge to ART patients, yet patients have to pay X-ray and co-morbidity treatment. On average, 22.7% of ART patients stopped visiting ART facilities. Especially in large-scale ART centre, defaulters were not followed up. FGD revealed the process of how defaulters developed hopelessness and pill burden, which were triggered and influenced by several factors including hunger, poverty, stigma, side-effects and co-morbidities. Some stopped medication as they thought being cured after condition recovered. Others attributed discontinuation to the accessibility of service and the attitude of ART centre staff. Default was attributed by internal (inadequate knowledge, weak motivation) and also external (hunger, medical service system) factors. It is inevitable to empower patients with adherence management by strong motivation to treatment and supportive environment. Conclusion Financial empowerment of patients, free-service of co-morbidity treatment and side effect mitigation are desirable for sustainable ART scale-up. Defaulter follow-up, continuous regular adherence counseling and ART roll-out to small-scale clinics are inevitable to reduce defaulters.
Installation of toilet is an important issue for improvement of sanitary condition all over the developing countries. A Japanese NGO is trying to improve toilets which are planned to fit the rural environment in a village of an ethnic minority, the Hmong people, in northern Thailand. The toilet installed in a nursery school can produce methane gas from septic tank for cooking of lunch. The overflowed water from septic tank is able to be used for fertilizer in a kitchen garden. The concept of this toilet is the minimization of the release of carbon dioxide in the human life by the ecological use of human faces and urine that consume much energy for appropriate treatment in developed countries. The system will be developed to be one of an ideal model of the recycle system of natural resource. This project of innovating toilet is useful for the educational materials of the model of sustainable development for not only for under developing countries but also for developed countries in that it reminds us the traditional culture of utilization of human feces in Japan.
The human immunodeficiency virus (HIV) epidemic and dual infection of tuberculosis (TB) and HIV are now altering the role of chest radiography (CR) in TB control. The role has been gaining increasing importance, especially as HIV-associated TB and childhood TB are less likely to show positive smears. However, CR with poor image quality can cause misdiagnoses or require repeated examinations, wasting economic resources and exposing patients to unnecessary radiation. In order to improve the image quality of CR, the Tuberculosis Coalition for Technical Assistance (TBCTA) developed an assessment tool for CR categorized on the basis of six factors as “excellent,” “good,” “fair,” and “poor.” With the aim of disseminating the assessment tool, five-day international training sessions were held in Cambodia and Kenya in 2009. This field report summarizes the international training activities and documents the findings after the trainings. A total of thirty-four participants from 14 countries were trained and assigned to conduct an assessment upon their return. The results from nine countries showed that the quality of CR ranged from 90% excellent or good in Bangladesh to over 90% fair or poor in Afghanistan. Of 69 health facilities, only 4 apply more than 120kV and above. This is one of the considerable factors behind the sub-optimal quality of CR in these countries.
In Bangladesh, the Bangladesh Nursing Council (BNC) legally decides the curriculum for nursing and midwifery education and appoints nurses and midwives. The BNC had revised the curriculum in 2006, and it is currently educating based on a new curriculum for the Diploma Nursing Course. In the new curriculum, the BNC aims at strengthening the capabilities of nursing and midwifery professionals according to the care needed by each patient, cultivating the critical thinking skills of these professionals, and addressing the needs of nursing and midwifery based on communities. However, the shortage of health care professionals cannot be compensated only with the Diploma Nursing Course. Private nursing and midwifery education are being continued as Certificate Nursing Courses. In Bangladesh, in the stage transitorium of nursing and midwifery education, it will be a subject how health talented people's shortage of quantitative is coped with with strengthening of the education for the quality enhancement of nursing and midwifery from now on.