Introduction

  This study focused on the many foreign reproductive-age women living in Nagasaki and Sasebo city, and aimed to reveal the elements of “communicative competence in providing perinatal care for foreign women” as thought necessary by nurses and midwives engaged in perinatal care in Nagasaki prefecture.

Methods

  A self-administered questionnaire was posted to 207 nurses and midwives working in 10 out of the 25 medical institutions which provide obstetric services in Nagasaki and Sasebo city of which consent to research cooperation was obtained. The questionnaire consisted of basic demographic information, questions specific to foreigners and 38 questions relating to “communicative competence in providing perinatal care for foreign women”. The questions were to be answered on a scale of 1 to 4: “1-not at all necessary”, “2-not very necessary”, “3-somewhat necessary”, and “4-very necessary”, and were analyzed by factor analysis.

Results

  141 out of 207 nurses and midwives responded to the questionnaire (response rate 68.1%), of which 120 were valid for analysis (valid response rate 58.0%). 111 out of the 120 (92.5%) were experienced in perinatal care for foreign women . Among the 38 questions relating to “communicative competence in providing perinatal care for foreign women”, responses to 36 questions scored an average of 3.0 points or higher. Factor analysis on the responses to these questions revealed the following eight elements: “cross-cultural understanding“, “resource utilization”, “problem solving”, “cross-cultural respect”, “verbal communication”, “non-verbal communication”, “self-cultural understanding”, and “preparation for delivery”.

Conclusions

  Nurses and midwives engaged in perinatal care in Nagasaki and Sasebo city recognize eight elements of “cross-cultural understanding”, “resource utilization”, “problem solving”, “cross-cultural respect”, “verbal communication”, “non-verbal communication”, “self-cultural understanding”, and “preparation for delivery”, as the necessary “communicative competence in providing perinatal care for foreign women”.

Objectives: The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health-care accessibility.
Methods: Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicoré, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicoré at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training.
Results: Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to “provide strong medicine” (P < 0.001) and “provide injections” (P < 0.001), and came to appreciate “go to hospital with a sick person” (P = 0.031) as a function and role of CHWs.
Conclusions: The results of the present study indicated that steady approaches to motivate and support CHWs in resource-limited settings could improve performance of CHWs and satisfaction of people in the community regarding the activities of CHWs to sustain their health.

Objectives: The patterns of purchasing prescription antimicrobials with or without a prescription from retail pharmacies in Ulaanbaatar, Mongolia, were examined in relation to purchasers’ socioeconomic status and price of the product.
Methods: A survey was conducted at 250 randomly selected pharmacies in Ulaanbaatar. A total of 619 customers were interviewed, and the medicines they bought at the stores were examined by medical doctors. The use of prescriptions and advice in purchasing medicines and sociodemographic characteristics of the subjects were determined.
Results: Interviews were conducted with 297 customers who purchased prescription antimicrobials in front of the store in which they made their purchase. Among these 297 customers, only 19.5% (n=58) purchased medicine with a formal prescription, and 37.4% (n=111) purchased medicines on their own initiative and without the guidance of medical professionals. Purchase without a prescription was not associated with the subjects’ gender, age, educational status or area of residence. Lower-priced antimicrobials were purchased without prescriptions more frequently than those with a higher price (P<0.05).
Conclusion: The purchase of antimicrobials without prescriptions is common across all sociodemographic strata in Ulaanbaatar, Mongolia. Considering the increases in number of retail pharmacies and in sales of antimicrobials associated with economic development, measures to enforce regulations and to promote education among the general public and pharmacy professionals are required.

Objectives: The factors associated with quality of life (QOL) and anthropometric measurements as outcomes of food consumption were examined among school-age children in Tanzania.

Methods: A cross-sectional study was undertaken in September 2013 in Tanzania. Anonymous self-administered questionnaire surveys were conducted in the Kiswahili language among primary school children in the fifth and/or sixth grade aged 10–14 years. The survey probed sociodemographic characteristics such as age, gender, living with family members, number of meals/snacks per day, food consumption in the previous 24 hours, and QOL, as well as anthropometric measurements (height and weight). The Rohrer index was calculated based on height and weight. After presenting the mean and standard deviation (SD) of height, weight, and the Rohrer index score by age and gender, the Rohrer index score was categorized into three groups (low weight, normal weight, and overweight) and analyzed according to sociodemographic characteristics and food consumption using the chi-square test. Furthermore, the QOL score was analyzed using the t test. Multivariate linear regression analysis was used to analyze the associations between the QOL score and sociodemographic characteristics and food consumption.

Results: A total of 694 children (male: 312; female: 382) participated in this study. According to the Rohrer index, 273 (39.3%) children were classified as low weight, 353 (50.9%) were normal weight, and 68 (9.8%) were overweight. A total of 459 (66.1%) children reported having had three or more meals and/or snacks on the day before the study. In addition, 127 (18.3%) children had not eaten any protein-rich food on the day before the study, although almost all had eaten at least one carbohydrate-rich food per day. Regardless of region, location, gender, and age, living without parents was associated with short stature (P = 0.010). A high QOL score was associated with having three or more meals and/or snacks per day (P < 0.001).

Conclusions: The security of physiological needs such as a guarantee of three meals per day could contribute to higher QOL among underserved children.

Objectives: The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health care accessibility.
Methods: Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicore, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicore at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training.
Results: Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to “provide strong medicine” (P < 0.001) and “provide injections” (P < 0.001), and came to appreciate “go to hospital with a sick person” (P = 0.031) as a function and role of CHWs.
Conclusions: The results of the present study indicated that steady approaches to motivate and support CHWs in resource-limited settings could improve performance of CHWs and satisfaction of people in the community regarding the activities of CHWs to sustain their health.

Background
 According to the state of the world's children 2006, 28% of children under five years of age in sub-Sahara Africa are malnourished, which has serious effects on these children's health and lives.
 Extensive research has been conducted on child malnutrition in a variety of developing countries. These studies have established scientific indexes to lead and coordinate international action to assist the needy. Central African Republic, however, has been a blind spot. Therefore, the present study was conducted in order to clarify the nutritional status and associated factors of 6 to 24-month-old children in the district of Boy-rabe, Bangui, Central African Republic.
Methods
 Participants were mothers with children aged 6-24 months who visited either a government-run clinic or the NGO-run clinic, Amis d'Afrique, between August 26th and September 16th of 2006. Mothers were interviewed using a structured questionnaire and measurements of the children's weight and length were collected. Weight, length, and age data were compared with child growth standards proposed by the WHO to calculated z-scores for evaluatinglength-for-age (wasting), weight-for-length (stunted growth), and weight-for-age (underweight). The following factors were investigated for their association to malnutrition in children: “demographic characteristics”, “access to food”, “maternal and child-care practices”, and “poor water/sanitation and inadequate health services”.
Results
 A total of 126 mother-child pairs participated in this study and valid data from 109 pairs were subjected to analysis. The rates of wasting, stunted growth, and underweight children were 20.2%, 61.5% and 42.2%, respectively.
 Incomplete vaccination (p=0.043) and the mother not having a partner (p=0.046) were significantly associated with wasting. Stunted growth was found to be associated with older child's age (p<0.001), older mothers' age (p=0.005), mothers who had stopped breast-feeding (p=0.031), insufficient breast-feeding (p=0.032), mothers with child death experience (p=0.022), mothers with a number of delivery experiences (p=0.026) and mothers with a partner (p=0.042). Underweight children were associated with incomplete vaccination (p=0.043) and mothers with child death experience (p=0.046).
Conclusion
 In total, 8 factors were found to be significantly associated with child's malnutrition and household/family level. In particular, severe acute malnutrition, or wasting, was related to insufficient vaccination, while chronic malnutrition, or stunted growth, was significantly associated with breast-feeding.

Objective: Participation in social activities is associated with physical and psychological health in the community-dwelling elderly population. We examined the two factors of social relations and community health resources, associated with higher self-rated health levels in the community-dwelling elderly.Methods: A total of 145 community-dwelling elderly people ≥ 65 years old from two neighborhood associations in Nagasaki City were recruited for this study, representing 85% of the officially registered ≥ 65-year-old population in the target area. Face-to-face interviews using a structured questionnaire were conducted by trained interviewers in August 2009, with questions related to sociodemographic characteristics, social relationships, and self-rated health (SRH). Community health resources (type and walking distance from home) were evaluated by one of the authors as a community assessment.Results: Seventy-eight community-dwelling elderly people (25 men and 53 women) participated in the study. Elderly people who reported going out every day were more likely to show higher SRH scores (excellent/good) than those going out less often (OR: 3.7; 95% confidence interval [CI]: 1.0, 14.2; P = 0.056). The numbers of interactions with friends in higher and lower SRH groups were 6.5 ± 8.4 (mean ± standard deviation) and 2.4 ± 1.1 (P = 0.01, Mann-Whitney U test), respectively. The numbers of relatives talking on the phone in higher and lower SRH groups were 2.9 ± 1.3 and 2.2 ± 1.2 (P = 0.031, Mann-Whitney U test), respectively. Meeting scores with friends in higher and lower SRH groups were 7.8 ± 5.8 and 4.5 ± 3.6 (P = 0.068), respectively. The scores of community health resources among higher and lower SRH groups were 21.2 ± 1.5 and 20.9 ± 1.4 (P = 0.547), respectively. The scores of community association/activities in higher and lower SRH groups were 3.9 ± 1.0 and 3.6 ± 0.9 (P = 0.227), respectively.Conclusion: This study indicated the importance of interaction with friends and relatives for maintaining higher SRH among community-dwelling elderly people.

Objective: An accidental fire that occurred in a hillside residential area in the city of Nagasaki was evaluated to assess the challenges faced by communities located on sloped terrains and to develop community-based support systems applicable to such hillside residential areas.Methods: Community observations and key-informant interviews were performed in the area affected by the fire. A self-administered questionnaire survey was also conducted among residents of the affected area. Information obtained through community observations of the fire-struck area and key-informant interviews was analyzed and assessed using a two-dimensional (2D) framework.Results: According to community observations and key-informant interviews, initial firefighting efforts were delayed due to lack of preparedness, in addition to geographic factors such as narrow roads and outdoor staircases, which allowed the fire to spread. The livelihood and health support measures for elderly residents requiring evacuation assistance were also insufficient. A hospital neighboring the area affected by the fire accident voluntarily provided some services to evacuees, but support from other nearby organizations/institutions was either not available or not offered. According to the questionnaire answers, elderly residents had little knowledge of the location and proper use of fire hydrants in their area. In addition, 65% of the respondents had never participated in disaster training exercises. From these results, the following three points could be determined: 1) The geographic features of the hillside residential area enhanced the spread of the fire. 2) The multi-sector support systems for evacuees were inadequate, collaboration among the existing systems was insufficient, and the roles of those systems were not fully clarified in advance. 3) Elderly residents in the hillside residential area did not have sufficient the knowledge and/or ability to engage in fire prevention activities and had inadequate firefighting skills.Conclusions: It is important to improve disaster preparedness knowledge and training for local residents on ordinary times. Additionally, cross-sector collaborative disaster response, harmonious management, and support systems must be ensured and sustained before, during, and after disasters.

Objectives: To compare experiences regarding the perpetration of intimate partner violence among Japanese university freshmen between 2008 and 2014.Study design: Two-stage cross-sectional study.Methods: A self-administered questionnaire survey was completed in both 2008 and 2014 by students at the same university.Results: There were significant reductions in episodes of verbal harassment (adjusted odds ratio [AOR]: 0.601, 95% confidence interval [CI]: 0.382, 0.945, P = 0.027) that occurred when a boy/girlfriend said “you don’t give me priority” to his/her partner when they did not see them (AOR: 0.450, 95%CI: 0.207, 0.979, P = 0.044), and also in instances of irritation that resulted when a boy/girlfriend disobeyed his/her partner (AOR: 0.385, 95%CI: 0.161, 0.921, P = 0.032) from 2008 to 2014. The perpetration scores were reduced from 1.87 ± 0.16 in 2008 to 1.41 ± 0.117 in 2014 (t test, P = 0.016). The perpetration scores in 2014 were significantly lower than those in 2008, regardless of gender, age, university faculty, and participation in lectures/seminars about domestic violence (DV) and/or dating DV (P = 0.030).Conclusions: Findings showed reductions in some types of harassment, as well as in perpetration scores, between 2008 and 2014 among Japanese university freshmen at the same university. However, further study is required to determine the factors related to the perpetration of harassment.