Introduction
Recently, the increasing prevalence of chronic and lifestyle-related diseases has become the most crucial global health issue, even in low- and middle-income countries. However, current health systems are often unable to address the large burden of such diseases because of their poor capacity. In Sri Lanka, a country facing such issues, we implemented a school initiative project, the effect of which expanded beyond the school to the student's family as well as the local community. The project was aimed at prevention of chronic and lifestyle-related diseases among adults through school children's activities.
Activities
Major interventions such as workshops and regular publication of newsletters including the results of the workshops were implemented at four selected primary and secondary schools in the Southern Province of Sri Lanka. The newsletters the children brought home facilitated their communication with the parents regarding health issues. All the schools conducted health camps, which children planned and managed themselves, and incentive funds were offered to support the children's activities.
Results
Through discussion and learning at the workshops, children's self-confidence and self-reliance might be enhanced, particularly in regard to developing their health literacy. The health camps and incentive funds helped promote children's autonomy and capability. The attendance rate of the students at the four schools has increased since the inception of the project, while a questionnaire survey showed that the proportion of parents who smoked has decreased.
Conclusion
The trial suggested that school children have the potential not only to improve their own health but also to help their parents and the broader community adopt a healthier lifestyle. Application of the child-to-child strategy may be useful to deal with chronic and lifestyle-related diseases of adulthood as it expands to the child-to-parents and the child-to-community approach.

The 2009 pandemic of novel swine-origin influenza A (H1N1) highlighted the importance of community mitigation measures such as voluntary isolation. During the pandemic, we investigated the voluntary isolation behavior of patients with influenza during the 7-day period after they visited an outpatient clinic at a hospital in Tokyo, Japan. A questionnaire-based survey was conducted on patients diagnosed with influenza. Of a total of 14 patients, 13 (93%) visited a workplace, school or other potentially crowded setting at least once in the 7-day period after presentation. Five patients (36%) visited a potentially crowded setting either with a fever or on the day after having a fever. The voluntary isolation behavior of Japanese people with influenza did not necessarily adhere to the Japanese government recommendation that people with influenza-like illness stay home for 7 days following the onset of symptoms.

  A Health Promoting Schools (HPS) program was conducted among primary and secondary school children in Southern Province, Sri Lanka. The HPS program included implementation of health education and workshops, as well as publication of school newsletters that communicated the material the children discussed and learned in school to their families. The study aimed to determine whether the HPS program had any effects on the health of the school children, their parents and teachers.
  A total of 22 adults (nine parents, nine school teachers, and four school principals) were invited for in-depth individual interviews and reported their views on changes after the implementation of the project. The interviewees reported that the school children substantially improved their behaviors regarding dietary habits, basic hygiene, lifestyle, and exercise. They also expressed that the school environment improved. They indicated direct and indirect changes in their own awareness and attitudes, as well as in other family members.
  After the implementation of the HPS program, improved health behaviors and subsequent improved health across two generations were observed. Beyond providing students with health knowledge, more emphasis on motivating children to spread their health knowledge in their communities will make a more effective health intervention.

In Niger, insecticide-treated bed nets (ITNs) have been distributed to the target group of households with young children and/or pregnant women at healthcare facilities in the course of antenatal/immunization clinics. With the aim of universal coverage, ITNs were additionally distributed to households through strengthened community health committees in 2009. This study assessed the impact of the community-based net distribution strategy involving community health committees in the ITN coverage in Boboye Health District, Niger. A cross-sectional survey was carried out on 1,034 households drawn from the intervention area (the co-existence of the community-based system together with the facility-based system) and the control area (the facility-based system alone). In the intervention area, 55.8% of households owned ITNs delivered through the community-based system, and 29.6% of households exclusively owned ITNs obtained through the community-based system. The community-based system not only reached households within the target group (54.6% ownership) but also those without (59.1% ownership). Overall, household ITN ownership was significantly higher in the intervention area than in the control area (82.5% vs. 60.7%). In combination, the community-based system and the facility-based system achieved a high ITN coverage. The community-based system contributed to reducing leakage in the facility-based system.

Although long-lasting insecticide-treated bednets (LLINs) have been widely used for malaria control, little is known about how the condition of LLINs affects the risk of malaria infection. The objective of this cross-sectional study was to examine the association between the use of LLINs with holes and caregiver-reported malaria diagnosed in children under five years of age (U5). Data were collected in Boboye health district, Niger, in 2010. Surveyors conducted interviews and bednet inspections in 1,034 households. If a household had a U5 child, the surveyor asked the caregiver whether the child had experienced a fever episode in the past two weeks that entailed standard treatment for uncomplicated malaria at a healthcare facility. The authors analyzed the association between the use of LLINs with holes and caregiver-reported malaria episodes in U5 children using logistic regression, adjusted for possible confounders. Of the 1,165 children included in the analysis, approximately half (53.3%) used an intact LLIN while far fewer (10.6%) used a LLIN with holes. Compared to children using an intact LLIN, children using a LLIN with holes were significantly more likely to have a caregiver-reported malaria episode (8.7% vs. 17.1%; odds ratio: 2.23; 95% confidence interval: 1.24–4.01). In this study site, LLINs with holes were less protective than intact LLINs.

Although long-lasting insecticide-treated bednets (LLINs) have been widely used for malaria control, little is known about how the condition of LLINs affects the risk of malaria infection. The objective of this cross-sectional study was to examine the association between the use of LLINs with holes and caregiver-reported malaria diagnosed in children under five years of age (U5). Data were collected in Boboye health district, Niger, in 2010. Surveyors conducted interviews and bednet inspections in 1,034 households. If a household had a U5 child, the surveyor asked the caregiver whether the child had experienced a fever episode in the past two weeks that entailed standard treatment for uncomplicated malaria at a healthcare facility. The authors analyzed the association between the use of LLINs with holes and caregiver-reported malaria episodes in U5 children using logistic regression, adjusted for possible confounders. Of the 1,165 children included in the analysis, approximately half (53.3%) used an intact LLIN while far fewer (10.6%) used a LLIN with holes. Compared to children using an intact LLIN, children using a LLIN with holes were significantly more likely to have a caregiver-reported malaria episode (8.7% vs. 17.1%; odds ratio: 2.23; 95% confidence interval: 1.24–4.01). In this study site, LLINs with holes were less protective than intact LLINs.