Osamu Kunii

Who died as a result of the tsunami? – Risk factors of mortality among internally displaced persons in Sri Lanka: a retrospective cohort analysis

BackgroundDescribing adverse health effects and identifying vulnerable populations during and after a disaster are important aspects of any disaster relief operation. This study aimed to describe the mortality and related risk factors which affected the displaced population over a period of two and a half months after the 2004 Indian Ocean tsunami in an eastern coastal district of Sri Lanka.MethodsA cross-sectional household survey was conducted in 13 evacuation camps for internally displaced persons (IDP). Information on all pre-tsunami family members was collected from householders, and all deaths which occurred during the recall period (77 to 80 days starting from the day of the tsunami) were recorded. The distribution of mortality and associated risk factors were analysed. Logistic regression modelling using the generalized estimating equations method was applied in multivariate analysis.ResultsOverall mortality rate out of 3,533 individuals from 859 households was 12.9% (446 deaths and 11 missing persons). The majority of the deaths occurred during and immediately after the disaster. A higher mortality was observed among females (17.5% vs. 8.2% for males, p < 0.001), children and the elderly (31.8%, 23.7% and 15.3% for children aged less than 5 years, children aged 5 to 9 years and adults over 50 years, respectively, compared with 7.4% for adults aged 20 to 29 years, p < 0.001). Other risk factors, such as being indoors at the time of the tsunami (13.8% vs. 5.9% outdoors, p < 0.001), the house destruction level (4.6%, 5.5% and 14.2% in increasing order of destruction, p < 0.001) and fishing as an occupation (15.4% vs. 11.2% for other occupations, p < 0.001) were also significantly associated with increased mortality. These correlations remained significant after adjusting for the confounding effects by multivariate analysis.ConclusionA significantly high mortality was observed in women and children among the displaced population in the eastern coastal district of Sri Lanka who were examined by us. Reconstruction activities should take into consideration these changes in population structure.

Anemia and Iron Deficiency among Schoolchildren in the Aral Sea Region, Kazakhstan

The objectives of this study were to estimate the prevalence of anemia and iron deficiency among schoolchildren in the Aral Sea region of Kazakhstan and to determine the various factors associated with anemia in this population. We conducted a cross-sectional study of randomly selected schoolchildren. Blood samples were collected for measuring hemoglobin (Hb), serum ferritin (SF), total iron binding capacity (TIBC), and other hematological indices, and subjects were screened for anemia and iron deficiency. Associations between Hb concentration and SF, TIBC, anthropometric, and socioeconomic data were evaluated using regression analysis. The prevalence of anemia was 49.8 per cent although levels were mostly mild. Twenty-two per cent of the children were iron depleted (SF < 12 microg/l). Of the anemic children, 32.4 per cent were found to have iron deficiency anemia (anemia with SF < 12 microg/l). There were significant positive correlations between the levels of Hb and SF, but a negative correlation with serum TIBC. Age, mean corpuscular volume (MCV) and SF were found to be significantly related to Hb by stepwise multiple regression analysis. Multiple logistic regression analysis revealed that anemia was independently related to living district, education of father, and childs age. The results suggest that iron deficiency is an important determinant of anemia in this population; however, whole anemia cannot be solely explained by iron deficiency. Further studies are needed for consideration of micronutrients status, parasite infestation, hereditary disorders, and exposure to environmental pollutants.

Anaemia in relation to low bioavailability of dietary iron among school-aged children in the Aral Sea region, Kazakhstan

This study investigates anaemia related to the sufficiency of dietary iron intake of school-aged children in the Kzyl-Orda region of Kazakhstan. We conducted a cross-sectional study of 97 school-aged children living in Kzyl-Orda. Blood samples were collected for measuring haemoglobin. Dietary intake data were obtained from 24-h dietary recalls. Iron bioavailability was estimated with algorithms adjusting for absorption enhancers (meat, fish and poultry, and vitamin C) and inhibitors (tea and phytates) consumed in the same meal. The median total iron intakes were adequate compared with the median basal iron requirement; however, the median bioavailable iron intakes were well below the median absorbed iron requirement. Available iron was 6.9–7.2% of the total iron intake after adjusting for the absorption enhancers, and was reduced by 3.1–4.4% after adjusting for both enhancers and inhibitors. After adjustment for energy intake, higher iron intake was significantly associated with a decreased prevalence of anaemia (odds ratio, 0.39; 95% confidence interval, 0.16–0.93; P=0.034). Some evidence suggested an association between bioavailable iron intake after adjustment of absorption enhancers and inhibitors (odds ratio, 0.43; 95% confidence interval, 0.18–1.01; P=0.053). In conclusion, low bioavailability of dietary iron seems related to anaemia in the region. Although iron fortification or supplementation programmes can be useful for promoting the anaemia prevention control programme, further efforts for nutritional education suited for family level dietary practice are necessary.

Timing of mortality among internally displaced persons due to the tsunami in Sri Lanka: cross sectional household survey

Abstract Objective To describe the distribution of mortality among internally displaced persons during two and a half months after the Indian Ocean tsunami, 2004. Design Cross sectional household survey with retrospective cohort analysis of mortality. Setting Camps for internally displaced persons due to the tsunami in an eastern coastal district of Sri Lanka. Participants 3533 people from 859 households accommodated in 13 camps. Main outcome measures All cause death and number of missing people. Results 446 deaths and 11 missing people were reported after the 2004 tsunami, of which most (99%) occurred on the day of the tsunami or within three days thereafter. No deaths were reported for the two and a half month period starting one week after the tsunami. Conclusions Most mortality after the 2004 tsunami occurred within the first few days of the disaster and was low in the study area.

Prevalence and severity of asthma and allergies in schoolchildren in Lhasa, Tibet

Background The International Study of Asthma and Allergies in Childhood (ISAAC) demonstrated that large variations existed in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis and eczema throughout the world and that environmental factors and lifestyle customs are major determinants of the prevalence and severity of these diseases. However, the relevant data about children living at high‐altitude locations were considered to be underreported.

Home gardening in urban poor communities of the Philippines

The deficiencies of micronutrients, in particular iron and vitamin A, are common in the Philippines, but their control measures through supplementation and fortification have shown several weaknesses. The present study examines the outcomes of a community-based approach including promotion of home gardening and a diversified dietary practice. A total of 152 mothers in two poor urban communities in Davao City, the Philippines were interviewed with a structured questionnaire. Participants were also asked to keep a brief 7-day self-administered household food record. Focus group discussions were conducted to obtain in-depth information on their attitudes toward home gardening and vegetable consumption. Home garden produce contributed to the diversification of carbohydrate consumed among participants. However, home garden produce reduced the consumption of protein-rich food. There was therefore no discernible improvement in the diets of participants from the consumption of home garden produce. In communities where there was no greengrocer, respondents shared the produce from home gardens. The community-based diet improvement program facilitated home gardening practices, which influenced the dietary practices of the urban poor. The monitoring of food consumption together with community-based programs needs to be expanded in urban poor communities. Our focus group discussion revealed that there was a cognition linking home gardening and vegetable consumption to poverty among some of the participants. More study is necessary on this finding.

The Okinawa Infectious Diseases Initiative

At the Kyushu–Okinawa Group of Eight summit in 2000, Japan announced the Okinawa Infectious Diseases Initiative (IDI) and pledged to spend US

The Dietary Habits of Non-asthmatic Schoolchildren in Lhasa, Tibet

3 billion over a five year period to combat infectious and parasitic diseases in developing countries. The IDI has exceeded expectations, spending more than US

Knowledge, attitude, and practice (KAP) of HIV prevention and HIV infection risks among Congolese refugees in Tanzania.

4 billion over four years. The IDI is a unique initiative with its own philosophical basis and specifically tailored interventions and measures that helped to initiate worldwide political and financial commitments in the fight against infectious diseases. Notably, it promoted partnerships among stakeholders and emphasized comprehensive and inter-sectoral approaches (i.e. coordination and collaboration between health and other sectors). It helped to create a new vision of what is possible in the global effort against communicable diseases and has been instrumental in shaping the changing environments of development assistance, poverty reduction and other trends to reduce the impact of infectious and parasitic diseases.

Anaemia, iron deficiency and vitamin A status among school-aged children in rural Kazakhstan.

The occurrence of asthma symptoms and food consumption frequencies in 13- to 14-year-old schoolchildren was investigated in Lhasa, Tibet (3,658 meters above sea level). A total of 99.2% of the schoolchildren reported that they had not experienced any wheezing during the prior 12 months. Among these students, more than 50% had consumed rice, meat, fruits, and vegetables at least three times per week in the preceding year. More than 70% of the non-asthmatic students rarely consumed margarine; 50% of these students rarely ate fast food; and 40% only occasionally ate fish during the prior 12 months. The dietary habits of the schoolchildren in Lhasa may have some potential beneficial roles in contributing to the low prevalence of asthma in this high altitude region.