"Go to the people" composed by James Yen or Yen Yang Chu is well known as an instructive poem or credo for rural reconstruction workers in various versions. One version commonly used includes the part of ‘when the task is done, people remark we have done it ourselves.’, but the authorized version by his successor does not include this part. The author tried to explore the roots of the poem and each version through interviewing with key people who knew Dr. Yen and using other information. The author concludes that Yen expressed his message in various ways according to the audience, and understanding the philosophy and spirit behind is most important.
Background: Maternal and child health handbook (MCHH) consists of records of pregnancy, delivery, child development and immunization, as well as child growth charts. MCHH has been utilized in Japan since 1947 and it is now introduced in more than 20 countries in the world. Objectives: The objectives of this study were to collect research documents and reports in the past studies of MCHH and to analysis the effect of MCHH on maternal and child health through systematic review. Methods: The systematic searches were conducted for the studies published between 1980 and October 2011. After the initial screening of titles and abstracts of the studies, we reviewed 57 documents which were studied for MCHH in maternal and child health (MCH) programs or activities. After the final selection, we identified only 5 documents with 43 question items in Indonesia (1999 and 2001), Bangladesh (2003), the Philippines (2009) and Cambodia (2010). Results: The relationship between MCHH and pregnancy care revealed that mothers who used MCHH during pregnancy had higher level of knowledge (OR 1.44, 95% CI: 1.22-1.70) than whose did not use MCHH during pregnancy. The strong significant effects of MCHH were observed in knowledge of antenatal care visit (OR 1.86, 95% CI: 1.59-2.18), and mother should consume more food during pregnancy (OR 1.97, 95% CI: 1.37-2.83). Mothers who got MCHH during pregnancy had safer practice by skilled birth attendants (OR 1.12, 95% CI: 0.95-1.32) and delivered in health facilities (OR 1.31, 95% CI: 1.12-1.53). MCHH showed the effect of knowledge of child health care (OR 1.22, 95% CI; 1.05-1.41). Discussion: This study utilizing meta-analyses showed MCHH had higher association with knowledge of mothers than practice in pregnancy and child health care, although the study has its limitation. The illumination of the relationship between knowledge and practice by the effect of MCHH needs more quantitative analysis in both community and hospital settings in many countries.
Introduction Large-scale natural disasters occur often all over the world. Japan participates in international disaster relief (IDR) operations regularly. Effective IDR medical recording procedures are very important in confusing disaster situations. IDR medical records must be succinct, only containing what is necessary. However, they must have enough information for patients' analysis and evaluation later. The authors investigated what contents are important for effective IDR medical records, and offer a proposal for a standardized record format. Methods In 2005 and 2006, the authors mailed a self-administered questionnaire to survey 51 doctors and nurses who had participated in IDR in the past about what is important for IDR medical records. The IDR Medical Record 2008 format was produced using the results. To evaluate its usefulness, the authors later interviewed 10 specialists of disaster medicine regarding their assessment of the previously proposed IDR Medical Record 2008 format. Results In the first investigation, focused on people who responded to the survey, more than half valued the following features of IDR medical records: "Well organized," "Simple and easy," "Entry language," "Easy to read," "Meets international standards," "Body diagram," "Easy symptom entry," "Durability" and "Combined with prescription." On the other hand, less than half of the participants indicated that they valued: "Compatibility with other organizations," "Electronic file," and "Combined with examination records." For the second investigation, the authors prepared the IDR Medical Record 2008 format by using the result of the first investigation. Then, the authors made the IDR Medical Record 2012 format based on the results of the interviews. Conclusions The authors proposed the IDR Medical Record 2012 format, which is a practical and effective medical record format for IDR operations.
Objectives: In developing countries, measuring household income is difficult. The Wealth Index is an alternative to household income; however, it contains too many items making its use in a healt-related study difficult. Thus, we developed a shorter version of the index appropriate for rural areas in Cambodia and analyzed the relationship between economic status and maternal health knowledge and behavior using the index. Methods: We conducted the study in four health center areas in Kampong Cham Province. We administered structured questionnaires to 640 women who had delivered babies within a year prior to the study. The development of the Cambodian Wealth Index-Rural version (CWI-R) followed the procedures of the Demographic and Health Survey (DHS) Wealth Index. Out of 69 items in the Cambodian DHS, we selected 18 items by assessing the distribution and correlation between the items and then performed principal component analysis. Those items that had principal component scores (PCS) below 0.4 were removed. As a result, we created an 11-item wealth index weighted by PCS; Cronbach’s α was 0.81. We tabulated economic status using quintiles and calculated health behavior and the women’s healt-related knowledge for each quintile. Results: The mean age (SD) of the women was 27.0 (6.4) years. The rate of antenatal and postnatal care and skilled birth attendant increased as economic status improved. Knowledge of risk factors during pregnancy and delivery varied according to item. For prolonged labor and edema, knowledge increased as economic status improved; however, we observed no significant differences for vaginal bleeding. More women who had a higher economic status knew the benefits of Vitamin A and the causes of intestinal parasitic infections. Conclusion: The pattern of maternal knowledge and behavior analyzed with the CWI-R was parallel to the original wealth index, indicating its usefulness as an alternative to the original wealth index.
Introduction: This study elucidates the cultural factors affecting decision-making to seek maternal care in rural Niger, which records one of the highest MMR. Methods: Ethnographic fieldwork (participant observation, ethnographic interview and documentation) was conducted in a Nigerien rural village and data were analyzed qualitatively. Results: The decision-making was affected by a value system holding that "to mention sexuality in public is regarded shamefulness", "delivery is part of daily life", "clinic should be used only when there are problems during delivery", "Albeeri (great adult) never make mistakes". The value of shame resulted in pregnant women tending to conceal their pregnancy and an absence of opportunity for public reproductive health education. The notion that a woman who cannot endure pain is not an Albeeri encourages pregnant women to rely on folk medicine without complaining about any abnormal symptoms and to continue working until shortly before delivery. The exclusion of any person, even a doula, from the scene of delivery in order to avoid witchcraft contributes to unassisted home delivery. These interacting factors cause delayed care. On the other hand, when complications are foreseen during pregnancy, the family’s elder women assess the pregnant woman’s condition and evacuate her to a clinic without her appeal. In case of first delivery, women go back their fathers’ houses to deliver and receive their mothers’ support and women rest for 40 days postpartum. Conclusion: The decision-making is influenced by culturally-defined values related to sex, perceptions of the scene of delivery and abnormalities, and a social structure esteeming elders, and these factors cause a delayed care. However, cultural values also lead to mutual help complementing maternal care. Therefore, it is important for the betterment of maternal health to improve the quality of existing health services and also to link it to the culturally-based childbirth support system.
Objective The purpose of this article is to investigate the extent of depressive symptoms among international students and the characteristics of those at risk. Methods Evidence is derived from self-administered questionnaire interviews of 480 international students enrolled in a university in northern Japan. Depressive symptoms are measured using the Center for Epidemiologic Studies Depression scale. The associations of socio-demographic characteristics with depressive symptoms are examined using multiple logistic regression analysis. Results Of the 480 respondents, 197 (41%) have depressive symptoms. The results indicate that gender, course category, and residential arrangement are significantly associated with the risk of having depressive symptoms. Discussion Depressive symptoms are relatively prevalent, but these are not a generalized condition since these tend to occur among specific sub-groups of international students. There is a need to further investigate the mental illness so that those with elevated risks are identified and given support.
Introduction The economic situation of the Republic of Indonesia has been good with 6% economic growth in 2010. The health provision was affected by the decentralization after 2001, which has caused the prominent diversity in health condition. The health system and health situation in Indonesia are overviewed. Health situation The health indicators of Indonesia have been improving in general though maternal and child health (MCH) indicators are still not good enough compared to the surrounding ASEAN countries. The health budget has been increasing though up to 2% of GDP. The efforts by the Government have increased the number of health facilities as well as health workforce through it is yet to be improved. The Public Health Security Fund has extended its coverage with the target of universal health coverage. The health strategic plan 2010-2014 shows us the master plan of health development, whose vision is to encourage autonomous efforts by the community for health and the equity of health. Conclusions Indonesia is now on the epidemiological and populational transition with double burden of diseases. With the target of universal health coverage, it is urgent need to enhance the health service provision with development of health workforce in order to meet the demand along with enhancement of the health insurance coverage.
Introduction Floods are the most common natural disaster. Although infectious diseases are paid attention in flood settings, public health impact from other diseases has been rarely discussed. In Thailand, a large-scale flood disaster severely affected local people and the societies mainly in the North and Central regions due to unusual heavy rain in 2011. To provide information on health issues from a prolonged flood, we reported the health issues among the patients in several areas of Thailand where a flood lasted more than 1 month. Methods Data on the patients were extracted from records of the collaborated activities between two NGOs in Thailand and Japan in three areas of two provinces in the Central region at the end of November, 2011. The data on the venues were also abstracted: main stations for medical care in three areas and mobile clinics at evacuation centers (tent, temple, and school) in two areas. We evaluated distributions of health issues, and examined the characteristics of the distributions stratifying by place and patients' age. Results High prevalence was observed for muscle and joint pain, chronic diseases, and acute respiratory infections. Among patients with the infections, 96 % or more was those with upper respiratory infections. In the evacuation centers, the prevalence of acute respiratory infections was high (39 %) at school compared to that at other places. The prevalence of muscle and joint pain sharply increased among patients in their 30's, which was highest among those in their 40's and 50's. Conclusions Muscle and joint pain, chronic diseases, and acute respiratory infections were main issues in this flood setting. This study would provide information on potential health issues in the coming floods. Future research is needed to examine whether an occurrence of flood disaster could be associated with increased risk of muscle and joint pain.