Daisuke Nonaka

School-based participatory health education for malaria control in Ghana: engaging children as health messengers

BackgroundSchool children have been increasingly recognized as health messengers for malaria control. However, little evidence is available. The objective of this study was to determine the impact of school-based malaria education intervention on school children and community adults.MethodsThis study was conducted in the Dangme-East district of the Greater Accra Region, Ghana, between 2007 and 2008. Trained schoolteachers designed participatory health education activities and led school children to disseminate messages related to malaria control to their communities. Three schools and their respective communities were chosen for the study and assigned to an intervention group (one school) and a control group (two schools). Questionnaire-based interviews and parasitological surveys were conducted before and after the intervention, with the intervention group (105 children, 250 community adults) and the control group (81 children, 133 community adults). Chi-square and Fishers Exact tests were used to analyse differences in knowledge, practices, and parasite prevalence between pre- and post-intervention.ResultsAfter the intervention, the misperception that malaria has multiple causes was significantly improved, both among children and community adults. Moreover, the community adults who treated a bed net with insecticide in the past six months, increased from 21.5% to 50.0% (p < 0.001). Parasite prevalence in school children decreased from 30.9% to 10.3% (p = 0.003). These positive changes were observed only in the intervention group.ConclusionsThis study suggests that the participatory health education intervention contributed to the decreased malaria prevalence among children. It had a positive impact not only on school children, but also on community adults, through the improvement of knowledge and practices. This strategy can be applied as a complementary approach to existing malaria control strategies in West African countries where school health management systems have been strengthened.

Association between serum ferritin concentrations and depressive symptoms in Japanese municipal employees

It remains unclear whether levels of body iron store are related to milder forms of depression, which are more common among apparently healthy people. We examined the association between serum ferritin concentrations and depressive symptoms among 312 men and 216 women working in two municipal offices in Japan. Depressive symptoms were assessed by using the Center for Epidemiologic Studies Depression (CES-D) scale. In men, increased prevalence of depressive symptoms (defined by using a cutoff value of ≥ 19) was significantly associated with decreased levels of serum ferritin. In age- and study-site-adjusted models, ORs (95% CIs) for depressive symptoms for men in first, second, third, and fourth quartiles of serum ferritin concentrations were 2.83 (1.01-7.94), 1.74 (0.87-3.49), 1.33 (0.71-2.47), and 1.00 (reference), respectively (p for trend=0.02). In multivariate-adjusted model, ORs (95% CIs) in first, second, third, and fourth quartiles of serum ferritin concentrations were 2.88 (0.93-8.91), 1.91 (0.90-4.05), 1.28 (0.66-2.49), and 1.00 (reference), respectively (p for trend=0.03). No significant association was detected in women. Our finding that men with lower levels of serum ferritin concentrations had a higher prevalence of depressive symptoms suggests that adverse psychological effects may be implicated in iron deficiency among middle-age Japanese workers.

Predictors of the Uptake of A (H1N1) Influenza Vaccine: Findings from a Population-Based Longitudinal Study in Tokyo

Background Overall pandemic A (H1N1) influenza vaccination rates remain low across all nations, including Japan. To increase the rates, it is important to understand the motives and barriers for the acceptance of the vaccine. We conducted this study to determine potential predictors of the uptake of A (H1N1) influenza vaccine in a cohort of Japanese general population. Methodology/Principal Findings By using self-administered questionnaires, this population-based longitudinal study was conducted from October 2009 to April 2010 among 428 adults aged 18–65 years randomly selected from each household residing in four wards and one city in Tokyo. Multiple logistic regression analyses were performed. Of total, 38.1% of participants received seasonal influenza vaccine during the preceding season, 57.0% had willingness to accept A (H1N1) influenza vaccine at baseline, and 12.1% had received A (H1N1) influenza vaccine by the time of follow-up. After adjustment for potential confounding variables, people who had been vaccinated were significantly more likely to be living with an underlying disease (p = 0.001), to perceive high susceptibility to influenza (p = 0.03), to have willingness to pay even if the vaccine costs ≥ US

Joint malaria surveys lead towards improved cross-border cooperation between Savannakhet province, Laos and Quang Tri province, Vietnam

44 (p = 0.04), to have received seasonal influenza vaccine during the preceding season (p<0.001), and to have willingness to accept A (H1N1) influenza vaccine at baseline (p<0.001) compared to those who had not been vaccinated. Conclusions/Significance While studies have reported high rates of willingness to receive A (H1N1) influenza vaccine, these rates may not transpire in the actual practices. The uptake of the vaccine may be determined by several potential factors such as perceived susceptibility to influenza and sensitivity to vaccination cost in general population.

Public and private sector treatment of malaria in Lao PDR

BackgroundIn Savannakhet province, Laos and Quang Tri province, Vietnam, malaria is still an important health problem and most cases are found in the mountainous, forested border areas where ethnic minority groups live. The objectives of this study were to obtain a better joint understanding of the malaria situation along the border and, on the basis of that, improve malaria control methods through better cooperation between the two countries.MethodsFourteen villages in Savannakhet and 22 villages in Quang Tri were randomly selected within 5 km from the border where a blood survey for microscopic diagnosis (n = 1256 and n = 1803, respectively), household interviews (n = 400, both sides) and vector surveys were conducted between August and October 2010. Satellite images were used to examine the forest density around the study villages.ResultsMalaria prevalence was significantly higher in Laos (5.2%) than in Vietnam (1.8%) and many other differences were found over the short distance across the border. Bed net coverage was high (> 90%) in both Laos and Vietnam but, while in Laos more than 60% of the nets were long-lasting insecticide-treated, Vietnam used indoor residual spraying in this area and the nets were untreated. Anopheles mosquitoes were more abundant in Laos than in Vietnam, especially many Anopheles dirus were captured in indoor light traps while none were collected in Vietnam. The forest cover was higher around the Lao than the Vietnamese villages. After this study routine exchange of malaria surveillance data was institutionalized and for the first time indoor residual spraying was applied in some Lao villages.ConclusionsThe abundance of indoor-collected An. dirus on the Laos side raises doubts about the effectiveness of a sole reliance on long-lasting insecticide-treated nets in this area. Next to strengthening the early detection, correct diagnosis and prompt, adequate treatment of malaria infections, it is recommended to test focal indoor residual spraying and the promotion of insect repellent use in the early evening as additional vector interventions. Conducting joint malaria surveys by staff of two countries proved to be effective in stimulating better collaboration and improve cross-border malaria control.

Is staying overnight in a farming hut a risk factor for malaria infection in a setting with insecticide-treated bed nets in rural Laos?

This study aimed to examine the care-seeking choices for treatment of a febrile illness compatible with malaria in the public and private sectors in Lao PDR. We conducted interviews with 745 heads of household in 14 villages in the Sekong province, using a structured-questionnaire. We asked each about who the care-providers were for febrile illness episodes affecting their household members during the past year. If patients used more than one care-provider for a single episode over a period of time, we identified patterns of the care-sequences for the initial and subsequent care choices. Then, we analyzed the relationship between the initial care choices and secondary care choices for care-providers by Chi-square test, categorizing care-providers into public (hospital, health centre, and village health volunteer) and private care-providers (private pharmacy, informal retailer, faith healing and herbs). As a result, we found that 624 patients sought care at least once, 255 (40.9%) twice, and 66 (10.6%) three times or more during a single episode. Of 138 patients who started with a public care-provider and then sought a secondary care, 71 (51.4%) switched to a private care-provider. In contrast, of 117 patients who started with a private care-provider and then sought a secondary care, 82 (70.1%) switched to a public care-provider (p<0.001). In conclusion, although most patients who failed being treated by a private care-provider switched to a public one, some exclusively relied on care within the private sector. An intervention is necessary to make the private sector an integral component of malaria treatment in Lao PDR.

Content analysis of primary and secondary school textbooks regarding malaria control: A multi-country study

BackgroundOvernight stays in farming huts are known to pose a risk of malaria infection. However, studies reporting the risk were conducted in the settings of poor net coverage. This study sought to assess whether an overnight stay in a farming hut is associated with an increased risk of malaria infection if insecticide-treated bed nets (ITNs) are properly used.MethodsA pair of cross-sectional surveys was carried out in the Lamarm district of Sekong province, Laos, in March (dry season) and August (rainy season) in 2008. Questionnaire-based interviews and blood examinations were conducted with farmers and their household members from three randomly selected villages in March (127 households, 891 people) and August (128 households, 919 people). Logistic regression analysis, adjusted for potential confounding factors, was used to assess the association between malaria infection status and frequency of overnight stays for the two weeks prior to the study in both the seasons.ResultsIn March, 13.7% of participants reported staying overnight in a farming hut at least once in the previous two weeks. The percentage increased to 74.6% in August. Not only adults but also young children stayed overnight as often as adults. The use of an ITN the preceding night was common both in farming huts (66.3% in March, 95.2% in August), and in main residences (85.8% in March, 92.5% in August). Logistic regression analysis showed no statistical association between malaria infection status and frequency of overnight stays in farming huts in either study period. However, people sharing one family type net with five people or more were significantly more likely to have malaria than those sharing a net with up to two people in the dry season.ConclusionsThis study showed that staying overnight in farming huts was not associated with an increased risk of malaria infection in the setting where ITNs were widely used in farming huts. It suggests that malaria infection during overnight stays in farming huts might be preventable if ITNs are properly used in rural Laos.

Factors influencing the National School Health Policy implementation in Lao PDR: a multi-level case study

Background In tropical settings, malaria education at school is potentially useful, but textbook content related to malaria education has so far received little attention. This study aimed to examine whether school textbooks contain sufficient knowledge and skills to help children in primary and lower secondary schools and their family members to cope with malaria. Methodology/Principal Findings This was a descriptive, cross-country study. We collected textbooks that were used by children in grades one to nine from nine countries endemic for malaria: Laos, Cambodia, Nepal, Bangladesh, Sri Lanka, Zambia, Niger, Benin, and Ghana. Two reviewers per country identified descriptions about malaria by seeking the term “malaria” or a local word that corresponds to malaria in languages other than English. The authors categorized the identified descriptions according to the content of the descriptions. Additionally, the authors examined whether the identified contents addressed life skill messages. Of a total of 474 textbooks collected, 35 contained descriptions about malaria. The most commonly included content was transmission mode/vector (77.1%), followed by preventive measures (60.0%), epidemiology (57.1%), cause/agent (54.3%), signs/symptoms (37.1%) and treatment (22.9%). Treatment-related content was not included in any textbooks from four countries and textbooks failed to recommend the use of insecticide-treated bed nets in five countries. Very few textbooks included content that facilitated prompt treatment, protection of risk groups, and use of recommended therapy. Conclusion/Significance Textbooks rarely included knowledge and skills that are crucial to protect schoolchildren and their families from malaria. This study identified the need for improvement to textbook contents regarding malaria.

Village health volunteers’ social capital related to their performance in Lao People’s Democratic Republic: a cross-sectional study

In the last decade, a National School Health Policy (NSHP) has been formulated in several developing countries following the recommendations of the Global School Health Initiative. However, NSHP implementations across the country have not been fully shared. This study aimed to identify factors that have influenced implementation of the NSHP in Lao Peoples Democratic Republic (Lao PDR). We conducted key informant interviews with 20 NSHP implementers and document reviews. Data were collected at the national level and at three lower administrative levels (provincial, district and school) in three areas (north, central and south). Study areas were selected according to the history of NSHP interventions. We applied content analysis using 12 key components of successful policy implementation and a policy triangle framework. We found that scaling up to nationwide implementation was limited. Results showed the NSHP implementation in Lao PDR was influenced by nine interlinked factors, including extensive planning, resource management, monitoring cycle, the perception gap between national and lower administrative officers, national task-force ownership, ongoing coaching of district educational officers, management skills of school principals, priority of school health and decentralization. Furthermore, these nine factors could be integrated into the existing educational system. In conclusion, for sustainable and nationwide implementation of the NSHP in Lao PDR, the following three factors need to be embedded in the educational system: extensive planning with a clear long-term vision at national level, human resource management including well-organized training at each administrative level and a monitoring cycle to understand the real situation at school level.

Behavior of Adult Influenza Patients during the 2009 Pandemic after Outpatient Clinic Presentations at a Hospital in Tokyo, Japan

BackgroundImproving the performance of community health workers (CHWs) is a global issue. The relationship between CHWs and their community may impact their performance. In Lao People’s Democratic Republic (Lao PDR), CHW are called village health volunteers (VHV). Lao PDR has a problem with VHV inactivity, especially in rural areas. This study focused on which aspects of social capital are related to VHV performance.MethodsThis research represents a cross-sectional study with a quantitative survey based primarily on interviews using a semi-structured questionnaire. Interviews were conducted with 149 VHVs living and working in the Sepon District. VHV performance evaluation was measured with scores on a 5-point scale, and the cutoff point for designating performance as good or poor was set at the median score. This evaluation of VHV performance was conducted as a self-evaluation by VHVs and by health center staff who were supervisors of the VHVs. Measurement of social capital was accomplished using the short version of the Adapted Social Capital Assessment Tool (SASCAT). For statistical analyses, logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI).ResultsThe results of multiple logistic regression adjusted by moderator variables showed that citizenship activities in the structural social capital component of SASCAT were significantly related to performance in self-evaluation by VHVs (adjusted OR: 2.10, 95% CI: 1.19-3.71) and the evaluations by health center staff (adjusted OR: 1.67, 95% CI: 1.01-2.77). Support from groups (adjusted OR: 1.87, 95% CI: 1.27-2.76) and cognitive social capital (adjusted OR: 7.48, 95% CI: 2.14-26.10) were found to be significantly associated but only for VHV self-evaluation.ConclusionsThe results suggest that individuals who interact with important figures in the community and who cooperate with other villagers whenever problems arise, i.e., have social capital, exhibit good performance as VHVs. These findings suggest that increasing citizenship activities could increase the retention rate of CHWs and help improve their performance. Citizenship activities could also be used as a predictive indicator when selecting new CHWs.