Objectives High adolescent fertility rates still persist in many developing countries. Adolescent childbearing often leads to negative outcomes including physical and mental disorders of mothers, a high incidence of infant death and household poverty. Obviously, it is important to explore the determinants of adolescent reproduction and its related behaviour to ensure its prevention. This study assesses the impact of the level of female autonomy and status of the community on adolescent childbearing, age of sexual debut and age of marriage. Methods This paper uses the pooled micro data from the Demographic and Health Survey Nicaragua 1998 and 2001. A logistic model is used to estimate the impact of the level of female autonomy and status of the community on adolescent childbearing, age of sexual debut and age of marriage. These variables are aggregated for each municipality using data on women aged over 20. Four female community autonomy variables are used. They are the percentage of women who have the final say on: own healthcare, making large household purchases, visit to family or relatives, and what food is to be cooked each day. Three variables of female status in the community are mean age at first marriage, mean age differences between spouses, and the percentage of those enrolled in secondary level education. Results Analysis proved that the level of autonomy and status of women in the community influence adolescent childbearing, age of sexual debut, and age of marriage. Particularly, the probability of younger sexual debut and younger marriage decreases when a community has a higher level of female autonomy and status. Conclusion The results indicate the importance of community intervention to strengthen female autonomy and promote female status in order to prevent adolescent childbearing.
Background Mortality statistics are key inputs for evidence based health policy at national level. However mortality statistics alone does not provide necessary information for further identification of improvement opportunities which could be manageable in local health systems in the place where vital registration system is not established. This study intends to disclose the profile of death events among the urban poor, with aim to identify improvement opportunities from the view of quality management of local health system. Methods Eleven communities in Ancol, Jakarta, were selected for the survey, and the information of death events were collected from community leaders of rukun warga (RW), village office, health centers, hospitals, and public cemeteries. The families or co-habitants of the deceased cases under 55 years old were interviewed. Results Two hundred and twenty four of death events were identified. The number reported in the demography statistics was 114 in 24 months during the same period, while 67 cases less than 55 years old were investigated by interview regarding history prior to death. . Thirty-eight percent died at healthcare facilities while 59% died at home. Private services were consulted as frequently as public services. Case studies based on history review revealed “improvement opportunities” in local health systems, and some of those critically contributed to eventual deaths which would be prevented by improvement in quality management of local health systems. Conclusion Community death events were good tracer for assessment of actual performance of local health systems as well as for identifying improvement opportunities.
Introduction This study was undertaken to identify needs of training and educational materials on international nutrition by career stage. Methods Focus Group Discussions (FGD) and a questionnaire survey were conducted in September and October 2008. In FGD, the participants were divided into three groups; undergraduate students who can potentially be involved in future nutrition activity for international cooperation (“students”), graduate students in international health or young workers involved in international cooperation through researches or programs on nutrition (“young”), and the experts who have worked for international nutrition cooperation (“experienced”). The results of FGD and questionnaire survey were categorized using the modified KJ methods. Results The numbers of FGD participants were two for “students”, four for “young” and seven for “experienced”. The questionnaires were completed by 119 undergraduate students. The specific issues they expected to learn in the field of international health and nutrition were the current situation in developing countries for the “students” and the process to identify the specific problems for the “young” and “experienced” The skills they would like to acquire were English proficiency for the “students” and “young” and understanding of the working fields as well as communication skills for the “young” and “experienced”. As for the necessary experience to get a job of international cooperation, working experience as a dietitian in Japan was stated by all groups. Additionally, the “young” mentioned overseas experience and the “experienced” suggested adaptability to different cultures as well as interpersonal skills. Conclusions This study identified communication skills as the needs common to all groups, while different needs were also identified by one›s career stage; especially educational needs among the “students” and training needs among the “young” and “experienced”. It is urgently required to develop training and educational materials on international nutrition that would meet the needs of each career stage.
Introduction The purpose of this paper is to contribute to those who would be involved in rehabilitation in Uzbekistan and who require deepening their understanding of medical and welfare system of the country. The research has significance in the sense that there are very few Japanese articles that touch upon the rehabilitation system and also people with disabilities in Uzbekistan until present. Method The information was collected from August 2010 to June 2012. During the two years of my work as a physical therapist at the National Centre of Rehabilitation and Prosthesis Invalids in Uzbekistan, the research methodologies were formal and informal interviews, observations and field visits. Results In Uzbekistan, these is no educational system which can give a diploma of physical therapist or occupational therapist, therefore, medical doctors and nurses play significant roles to see patients and to practice therapy in the Rehabilitation Centre. By observing the situation at the Rehabilitation Centre, there were many differences between Uzbekistan and Japan in environment of rehabilitation. In Uzbekistan, more than half of patients had some orthopedics diseases. Also, the annual number of patients admitted to the Centre was above 4,000 as well as the average number of days for hospitalization in the Centre was around two weeks. Conclusion Observing the situation of the Rehabilitation Center in Uzbekistan, medical perspective is taken into consideration as one and only important methodology in rehabilitation. On the other hand, social and vocational rehabilitations are not well-considered in the Centre. It is crucial to include and develop the social and vocational rehabilitation systems for people with disabilities to fit in the community as they were before.
The health assessment of refugees is an essential component of the refugee resettlement process from both humanitarian and public health perspectives. In 2010, Japan became the first country in Asia to initiate a third country resettlement program and the number of refugees accepted to Japan may increase in the future. In this article, we provide an overview of the US refugee admission program with an emphasis on the overseas and domestic medical management to serve as useful information for development of better medical management system for Japan-bound refugees. Refugees are screened and admitted to the US through the US Refugee Resettlement Program which is an interagency effort involving international organizations such as the Office of the United Nations High Commissioner for Refugees and International Organization for Migration, US governmental, and non-governmental agencies. In pre-departure medical screening, refugees are screened for communicable diseases of public health significance such as active tuberculosis and untreated sexually transmitted diseases, physical or mental disorders with associated harmful behaviors, and drug abuse and addiction using technical instructions provided by the Centers for Disease Control and Prevention. Sputum culture and sensitivity tests were added to the tuberculosis screening protocol in 2007 and the number of tuberculosis cases among refugees has been decreasing. Domestic medical health assessment is recommended within 90 days after arrival. Recommendations for the initial medical screening are tailored based on country of origin and receipt of presumptive treatment. Sponsoring volunteer agencies and the provision of medical interpretation service play important roles in facilitating medical visits for refugees. While the US medical screening system has many strengths including the presence of well-developed screening guidelines and medical interpretation systems, areas of improvement include communication across the continuum of care, standardization of medical screening processes across states, and screening and treatment of psychiatric disorders.