1.Survey on the Awareness of Children's Illness by Their Mothers of Minorities Living in Northern Hilly Area, Lao P. D. R.
Tsutomu KOBAYASHI ; Hideki YAMAMOTO
Journal of International Health 2008;23(3):181-190
Objectives
Many ethnic groups live in northern hilly area in Lao people’s Democratic Republic. We can find some delays of development by the geographical and cultural reasons. This research clarified what kind of awareness about children’s health among the minority people living with their specificlifestyles and circumstances.
Methods
The participatory research for health problems was conducted to Khamu people at C-village in northern Laos. Data were analyzed qualitatively. Mothers who have children aged less than 10 years, were interviewed about illness of children and its treatment. The author interviewed about health problems with some key persons who were important position in the village.
Results
At C-village, they produced sticky rice which was their staple food. They depended on other food from forests. Mothers are aware that their children were always healthy when children were vigorous. Mothers brought their children to the hospital in spite of its long way when children got illness. Children had some experiences of malaria, diarrhea and other illnesses. Villagers stored up the knowledge of illness by themselves with their experience that children getting serious by specific illness. The key persons were also aware of health problems, for example malaria or parasite diseases.
Conclusion
At C-village, in recent years they didn’t suffer serious starving. Houses were comfortable because of its well-ventilated against hotness but structure of their houses can’t prevent children’s health by the aggression of mosquito, and smoke from kitchen. Their lives were exposed to some harmful influence; by malaria and pastured animals. About children’s health, mothers were aware of some specific illness and brought children to hospital. Mothers thought that their children had not any problems of health when they were vigorous and active. Many children had suffered some illness and villagers stored up the knowledge of illness by themselves with their experience that children got serious situation by specific illness.
The key-persons and villagers expected infrastructural developments such as the high-way which was under construction at that time.
2.Health Problems Due to Agricultural Decline in Cambodia- The Effects by the Superfluous Shift to a Cash Crop -
Tsutomu KOBAYASHI ; Hideki YAMAMOTO
Journal of International Health 2009;24(2):107-113
Introduction
Currently Cambodia depends on imported foods from Viet Nam and Thailand. To address this situation, the Asian Sustainable Village Network OKAYAMA that the author belongs to, has been cooperating with Cambodian Federal Farmers Organization, a local NGO to undertake a farming project. The importance of agricultural promotion mainly in vegetable farming sector was examined and it is hoped that this project will reduce malnutrition in Cambodia, particularly among the rural poor who suffer with malnutrition, disease and disorder related conditions and will make Cambodia a sustainable society.
Method
In order to determine agricultural conditions, we investigated market places in Phnom Penh and examined utilizing farmland in Kampong Cham. In addition, we visited market places in rural districts and farmers' homes to gain more information about eating habits of the population. To find out farming production we referred to statistical data from Cambodian Ministry of Agriculture. A PubMed review was undertaken to determine aspects of malnutrition.
Results
Phnom Penh is a very busy place for the daily sale of perishable vegetables which are predominantly transported from Viet Nam. Cambodia, despite of its little irrigation system, and another technical problems is sufficient in its production due to its large farming area. Recently, cassava cultivation has increased in Cambodia in order to meet increasing demands in bio-fuel. We came to know that Cambodians do not have a favorable opinion about vegetables imported from Viet Nam. One of the dissatisfaction voted by the people in Cambodia is that the vegetables from Viet Nam have excessive chemical contamination and they lack in freshness. Restaurants and supermarkets in Phnom Penh preferred local products if they were available. In farming areas the production and consumption of vegetables are limited. For many, vegetables are a luxury. Meals predominantly consist of rice, small dried salted fish and some herbs. This situation is considered a leading factor of malnutrition.
Conclusion
As a result of the limited production and supply of vegetables in Cambodia, vegetable consumption is limited and viewed as a luxury. This situation has led to a mal-balanced diet and requires considerable effort to uplift vegetable production in Cambodia to reverse the imbalance of nutritional intake. Thus it can be very well said that agricultural promotion in Cambodia, particularly in vegetable sector is deemed extremely important for the future development of Cambodia.
3.The Survival of Vibrio cholerae in the Natural Environment of Zambia : Fish, the suspicious Gateway of Cholera Outbreak?
Tsutomu KOBAYASHI ; Hang'ombe B.MUDENDA ; Hideki YAMAMOTO
Journal of International Health 2010;25(1):33-39
Preface and Objectives
Cholera has recently become more serious in African countries. In southern Africa, a serious cholera outbreak was reported in 2008. Here we investigate Vibrio cholerae in aquatic environments, rivers, tube well waters, fish tissues, and aquatic plants in Zambia.
Methods
The sampling was conducted on Kafue and Zambezi rivers as well as at public wells. The samples included river water, mud, fish, floating grass, and well water. All samples were enriched in alkaline peptone water (APW) and streaked on thiosulfate citrate bilesalts saccharos (TCBS) Vibrio agar. Some types of colonies were isolated using polymyxin mannose tellurite (PMT) agar. All water samples were analyzed for enterobacteria as well as vibrio contamination. River and shallow tube well water samples were analyzed for E. coli.
Results
Samples, including fish tissues, river, and tube well waters, except for the fish intestines, were found to be contaminated with vibrios when cultured on TCBS Vibrio agar.
Deep tube well water was not contaminated with vibrios or E. coli. V. cholerae El Tor was not detected through sampling and culturing on PMT agar. E. coli was detected in river and shallow tube well water samples.
Discussion
Vibrios were detected in Zambia’s aquatic environments. Cholera outbreak may occur. Vibrio contaminations in fish have been reported from Bangladesh, Laos, Kenya, and India. Fish is a good source of protein to improve person’s nutritional status. However, it must be treated properly so that any contamination of residential areas is avoided. Therefore, people must pay attention to fish.
Conclusion
Here several types of V. cholerae were isolated from different aquatic environments. Fish is a nutritious diet, but contaminated Vibrios fish must be treated so that it will not contaminate residential areas. We must investigate the gateway of cholera outbreaks in Zambia.
4.Emerging Population Ageing Challenges in Africa: A Case of Ethiopia
Abu G. Moges ; Nanako Tamiya ; Hideki Yamamoto
Journal of International Health 2014;29(1):11-15
Population ageing is an emerging challenge in Ethiopia whose demographic features indicate slow but steady changes. As of 2010, about 5.1 percent of the Ethiopian population were 60 years old or over whereas 53.1 percent are younger than 15. If current demographic projections for Ethiopia hold, population ageing would accelerate and 10.3 percent of its population, or about 19.4 million people, will join the club of the elderly by 2050.
Objective
To analyze the trend and possible consequences of population aging in Ethiopia and explore policy options.
Method
Use date from Demographic and Health Survey and United Nations population estimates and projections to assess the current as well as likely future demographic dynamics in the country.
Results
Ethiopia is facing daunting demographic growth and population aging challenges without the commensurate financial and infrastructural resources. It is time to pursue policies that jointly address the problems of unsustainable population growth and rapid population aging.
5.Effect of Maternal Education and Outreach Services on Child Mortality in a Zambian Village
Tsutomu SHIODA ; Nanako TAMIYA ; Kouichiro TABUCHI ; Osamu YOSHIDA ; Hideki YAMAMOTO
Journal of International Health 2009;24(2):77-86
Objective
To examine the effects of the educational status of mothers and outreach services on childhood mortality in a Zambian village
Methods
The study design was a cross-sectional descriptive study. A survey was carried out in a village of Zambia in 2007. Five Japanese medical and nursing students interviewed mothers who had children under five years old. A structured questionnaire was used to collect information on social and educational factors and their experience of child deaths. In total, 73 mothers were interviewed, but three subjects were excluded because their records were inadequate. Information on the remaining 70 subjects was analyzed. The relationship between the dependent variable (child death rate per household) and independent variables (mother's characteristics, community circumstances) was examined. In this study, we used “the numbers of babies or young children who had died without defining age by care takers in a household” (child death rate per household) as a measure of child mortality.
Results
Of the 70 mothers, 30 were literate (42.9%). 33 mothers received health information from an outreach program and 22 from community health workers (CHWs).
The mother's education and the availability of health information from the outreach program were significantly related to lower child death rate per household (p=0.015 and p=0.019 respectively). The relationship between the mother's literacy and child death rate per household also showed an inverse tendency. Mothers with some education who received health information from the outreach program had reduced child death rate per household.
After stratification by maternal age (younger or older than 30 years), greater education, literacy and outreach program of the younger mothers were more strongly associated with decreased child death rate per household.
Conclusions
Education and community learning are important for the health of children. Maternal educational level and a community-based approach have strong impacts on child survival.
6.Association between the Combination Therapy and Underlying Diseases for Hypertensive Patients by a Drug Utilization Survey
Yukari YAMAMOTO ; Hitoshi SATO ; Hiroshi INOUE ; Ryuichi HAYASHI ; Hideki ORIGASA
Japanese Journal of Pharmacoepidemiology 1997;2(2):83-89
Objective : To examine the association between the combination therapy of calcium antagonists with angiotensin converting enzyme (ACE) inhibitors and underlying diseases for hypertensive patients.
Design : Cross-sectional survey of the drug utilization.
Methods : This survey included 603 hypertensive patients who had visited Toyama Medical and Pharmaceutical University Hospital, Toyama, Japan more than twice from January to June in 1996 and received the prescriptions of calcium antagonists and/or ACE inhibitors. Main outcome measure was the combined medication of calcium antagonists with ACE inhibitors. Underlying diseases under consideration were diabetes mellitus (DM), hyperlipidemia (LIPID), ischemic heart disease (IHD), chronic heart failure (CHF), and ischemic stroke (STROKE).
Results : Out of 603 hypertensive patients, 57.5% received only calcium antagonists, 23.7% received only ACE inhibitors, and 18.7% received both of them. Patients with either IHD or CHF tended to receive the combination therapy as compared to DM or LIPID. Although men tended to receive the combination therapy, a gender effect might be a confounder for the association. Logistic regression showed a 33% increase (P=0.265) in frequency of the combination therapy in patients with IHD after adjusting for age and gender.
Conclusion : Some underlying diseases were associated with more frequent prescriptions of the combination therapy for hypertensive patients, especially with ischemic heart diseases. This result should be regarded as an exploratory stage although the pattern of antihypertensive drug use could be reasonably explained from the pharmacological sense.
7.Clinical Effects of Oren-to in Patients with Tongue Pain.
Mamoru TSUKUDA ; Shigeru FURUKAWA ; Hideki MATSUDA ; Jun KAGA ; Hiroko YAMAMOTO
Kampo Medicine 1994;45(2):401-405
Oren-to extract alone was administered to 28 patients who had pain in the tongue but without organic lesions, and who had either a “hypofunctioning constitution” or a “normal functioning constitution”. The patients were predominantly women in their 50's. Treatment was continued for at least two months. The results were excellent in nine, good in 15, and unchanged in four. No side-effects attributable to Oren-to were observed. When the effect was compared in patients with and without dryness of the mouth, no significant difference was found. Thus it was shown that Oren-to was effective in the treatment of pain in the tongue in patients with either 'hypofunctioning constitution“ or ”normal functioning constitution“, regardless of whether they ”had dryness of the mouth or not. It seems that this preparation is also effective for the treatment of pain in the tongue in patients with psychosomatic disease who have a “hypofunctioning constitution” or “normal functioning constitution”. We discuss our study focusing on this condition.
8.Treatment Results of Femoral Neck Fractures in the Elderly Patients.
Shoji KUMAKI ; Kouichiro YAMAMOTO ; Kazuhiko YUMOTO ; Hideki KURIBAYASHI
Journal of the Japanese Association of Rural Medicine 1998;47(2):96-100
We studied the outcome of the surgical treatments, mainly on the walking ability, of the 113 femoral neck fractures of 113 limbs in the elderly, 70 and over, who were admitted in our hospital during the period between Nov. 1992 and Nov. 1996.
Sixty-six of the 113 cases (60.0%) regained the pre-traumatic walking abilities. The rest of the cases, particularly patients over age 85, failed to make good recoveries because of advanced age aging, presence of various complications, types of fractures, and/or poor pre-traumatic walking abilities.
Among various types of complications, dementia appeared as the number one factor in the poor recuperation. We, therefore, recommend that speech therapy as well as occupational therapy be used in the elderly with dementia to arrest further deterioration, and those without to prevent the occurrence of dementia during the perioperative periods with particular emphasis on the preoperative period while patients are still in bed with their legs under traction.
The cases with inside neck fractures of Garden classification type III/IV recovered excellently, for which we applied bipolar arthroplasty (bipolar prosthesis with femoral stem). This is because the bipolar arthroplasty technique ensured much firmer fixation at the fracture site, earlier rising from bed, and earlier weight bearing than in the case of other operative techniques.
The cases with the unstable lateral type of fractures, that are to be cured in osteosynthesis, and so treated by the Ender technique, did not recover well, because of infirm fixation at the fracture site, late rising and bearing times, and eventual concurrence and/or worsening of dementia.
We, therefore, inclined to think that bipolar arthroplasty surgery would be more appropriate for the case of an unstable, complex type of fracture than the Ender fixation maneuver would be, because the former ensures the better outcome.
9.Clinical Results of Treatment for Achilles Tendon Rupture in Farmers.
Shoji KUMAKI ; Hideki KURIBAYASHI ; Kouichiro YAMAMOTO ; Kazuhiko YUMOTO
Journal of the Japanese Association of Rural Medicine 1999;48(4):588-594
In our department, we use Jinnaka's Rehabilitation method as a means of aftertreatment of patients who underwent surgery to repair fresh Achilles tendon ruptures. In this paper, we compared the results of tendon ruptures in farmers with those in other occupational workers, who visited our hospital for surgical treatment from April 1990 to December 1996. The data required in this study were collected by interviewing each patient by telephone.
We repaired 22 tendons in farmers, another 22 tendons in manual, laborers, and 36 tendons in non-manual laborers (office workers, 32 tendons and housewives, 4 tendons.) The average period of follow-up was 4 years and 3 months. Re-rupture was observed in only one of the non-manual laborers. The average age of the farmer group was 50.4 years, which was higher than those of the other two groups-43.0 years for the manual laborer group, and 38.4 years for the non-manual laborer group. 83.3% of the patients in the non-mnual laborer group could return to engaging in sports. However, a smaller number of patients, 50.4%, look part in sports in either the farmer group or the manual laborer group respectively.
This low rate of comeback to sports in the farmer group may reflect their belief that physical exercise is unnecessary in light of the farmer's life style.
There are some reports that claim that farmers should engage in some kinds of sport, repeatedly and at regular intervals, to promote and maintain their health, because physical activity in farming is not necessarily sufficient or appropriate from the view point of health preservation.
It is good to promote the idea that farmers, who perform physical labor, should also take part in some kind of sport.
10.Human Resource Development in International Medical Cooperation in the United Kingdom
Susumu TANIMURA ; Shoji SAKANO ; Hideki YAMAMOTO ; Shunsaku MIZUSHIMA ; Akira ISHII ; Tsutomu MIZOTA
Journal of International Health 2005;20(2):2_38-2_43
Medical doctors in the United Kingdom who wish to work overseas have severe problems such as job security on return, childcare, and uncertain career due to lack of institutionalised career path in the field of international medical cooperation. The same applies in Japan. It is, however, different from Japan that media for job opportunities and career related information have been far developed.
Recently, Department of Health, the UK has started to encourage human resource development in the field, which hold out the hope to extricate from severe situation of human resources in the future.