Pesquisa participativa e as estratégias de promoção da saúde integral da criança no Sistema Único de Saúde (SUS) / Investigación participativa y las estrategias de promoción de la salud integral del niño en el Sistema Brasileño de Salud (SUS) / Participative research and comprehensive child healthcare promotion strategies in the Brazilian National Health System (SUS)

Neste artigo, discutem-se aspectos metodológicos de uma investigação que tomou a promoção da participação dos envolvidos como desafio. Interessou compreender os sentidos atribuídos por equipes de Saúde da Família à Caderneta de Saúde da Criança (CSC) e ao desenvolvimento infantil. A pesquisa-intervenção promoveu o compartilhamento de pontos de vista entre pesquisadores e trabalhadores em grupos focais com utilização de narrativas, construindo condições para que os participantes se tornassem protagonistas da investigação proposta. A realização dessa estratégia promoveu: 1) maior apropriação do instrumento; 2) aprofundamento e reposicionamento quanto a questões cristalizadas nos modos de funcionamento das equipes; 3) validação dos resultados da pesquisa. Tais resultados indicam que há uma contribuição das pesquisas participativas para a consolidação do SUS, pois, ao proporem o acesso a um plano comum como estratégia metodológica, promovem também maior engajamento das equipes em relação aos temas propostos.(AU)

En el artículo se discuten aspectos metodológicos de una investigación que consideró la promoción de la participación de los envueltos como un desafío. El interés se concentró en entender los sentidos atribuidos por equipos de Salud de la Familia a la Cartilla de Salud del Niño (CSC, por sus siglas en portugués) y al desarrollo infantil. La investigación-intervención promovió la compartición de puntos de vista entre investigadores y trabajadores en grupos focales con utilización de narrativas, construyendo condiciones para que los participantes pasaran a ser protagonistas del estudio propuesto. La realización de esta estrategia promovió: 1) mayor apropiación del instrumento; 2) profundización y reposicionamiento con relación a cuestiones cristalizadas en los modos de funcionamiento de los equipos; 3) validación de los resultados del estudio. Tales resultados indican que hay una contribución de los estudios participativos para la consolidación del SUS, puesto que al proponer el acceso a un plan común como estrategia metodológica también promueven un mayor compromiso de los equipos en relación a los temas propuestos.(AU)

The article discusses methodological aspects of an investigation aimed at promoting the involvement of participants as a challenge. We were interested in understanding how family health teams made sense of the child handbook - Caderneta de Saúde da Criança, and child development. The intervention-research promoted the sharing of viewpoints among researchers and providers in focal groups with the use of narratives making it possible for the participants to become key players of the proposed investigation. The implementation of the strategy promoted: 1) the greater ownership of the instrument, 2) the deepening and repositioning regarding crystalized issues in the functioning of teams, and 3 ) the validation of research results. These results indicate that there is a contribution of participatory research to the consolidation of SUS because they propose access to a common plan as methodological strategy and promote greater engagement of the teams in relation to the proposed themes.(AU)

The Effect of Home-Based Records on Maternal and Child Health Knowledge and Practices in Indonesia: Meta—analyses from the Indonesian Demographic and Health Surveys / 国際保健医療

<b>Objectives</b><BR>  The objective of the study was to analyze the effects of home-based records on pregnancy, delivery, and child health care in Indonesia.<BR><b>Methods </b><BR>  The data were obtained from women who had children under 5 years old at the time of the collection of the 2002, 2007, and 2012 Indonesia Demographic and Health Surveys. The study divided women into two groups: those who used the Maternal and Child Health Handbook (MCHHB) or antenatal card (AC) as a home-based records group, and those who did not use MCHHB or AC as the control group. We calculated the adjusted odds ratios and expressed the effects using meta-analysis methods. <BR><b>Results</b><BR>  The study revealed that, compared with the control group, the home-based records group had more knowledge and better practices during pregnancy, delivery, and child health care (e.g., immunization). The home-based records group knew how to solve the problems of complications during pregnancy and used skilled birth attendants for delivery. This study also found that husbands in the home-based records group were involved in discussing the delivery location, finding transportation, and identifying a blood donor. <BR><b>Conclusions</b><BR>  This study showed that home-based records had strong associations with the knowledge and practices of women regarding pregnancy, delivery, and child health care.

A needs survey of medical service for foreign residents in Japan from the viewpoint of medical practitioners-Report of a survey for doctors in Gunma medical association and Gunma pediatric association- / 国際保健医療

<B>Introduction</B><BR>Recently, an increasing number of registered foreigners get married and bear children in Japan. At the same time, a variety of needs for maternal and child health (MCH) impose burden for medical practitioners. A questionnaire survey was conducted to clarify the situation of MCH service for foreign residents.<BR><B>Method</B><BR>Self-report questionnaires developed by “The study group for MCH in a multiethnic and multicultural society” were sent by mail to the pediatricians registered in the Gunma medical association or Gunma pediatric association. In total, target number was 299. The survey period was between 2003/10/6-11/3.<BR><B>Result</B><BR>The number of valid response was 167. Out of 167, 155 doctors replied to have experience of caring foreigners. 75% of them had the experience of trouble in communication. For the question of the need of translator, 76.8% of doctors answered “absolutely necessary” or “necessary if the quality of translation is high enough”. Desired competencies for translators were “Accurate translation of diagnosis, hands on of treatment strategy” or “To help taking detailed patient's history”.<BR>For the experience of using MCH handbook in foreign languages, 52.9% of doctors answered “Never used it”.<BR><B>Discussion</B><BR>We found that the majority of doctors had difficulty in communicating with foreigners.<BR>To meet the doctors' requirement for the competency of translator, two strategies should be considered. One is to develop professional medical translator through education of basic medical knowledge or Japan's health care system. The other is to train foreigners already engaging in translation.<BR>For communication tools development, user friendly concept should be reflected including 1) adscript of foreign and Japanese languages, 2) illustration usage and 3) eye-friendly materials for elderly. Contents should have explanations including 1) diagnosis and treatment policy for common disease, 2) ways of coping with common symptoms, and 3) the information of a variety of Japan's welfare services.

Introducing a Maternal Child Health Handbook in the Province of Dajabon, Dominican Republic: Prospects and Issues from the Perspectives of Sustainability and Replicability / 国際保健医療

<b>Introduction</b><br>In the Caribbean country of the Dominican Republic, specifically in the northwestern Province of Dajabón bordering Haiti, a Maternal and Child Health (MCH) handbook, “History of My Health” was introduced through the technical cooperation of the Inter-American Development Bank's Japan Program with the leadership of the Provincial Office of the Secretary of Health. This report describes the implementation process and results, examines the project's sustainability and replicablility, and shares good practices and lessons learned.<br><b>Activities</b><br>The implementation of the project can be divided into three phases: first, development of a Dominican version of MCH handbook, local awareness raising, capacity building of health personnel, and the establishment of monitoring system were areas of high priority; the second phase centered around the improvement of MCH handbook with participatory approach and the continuation of the capacity building of health personnel; and the last phase focused on the sustainability through local management-precisely securing recurrent costs of the project.<br><b>Results</b><br>The evaluation and regular monitoring visits revealed positive results: as for pregnant women, the handbooks were well accepted for their friendliness, simplicity, durability and mobility, and the rate of their receiving antenatal and postpartum cares at designated clinics or hospitals increased; as for newborns and children, the immunization coverage improved while common problems such as diarrhea decreased; and as for health personnel, the handbook helped clarify the division of work and enhanced their sense of responsibility, communication, and continuity and integration of service. Currently, 359 trained health personnel use MCH handbook in all of the 22 health establishments in the Province, covering around 98% of the target population.<br><b>Conclusions</b><br>To achieve self-sustainability, this pilot project suggests that the use of MCH handbook needs to be institutionalized through the bottom-up approach and to integrate into the existing rural and national health care system through the top-down approach.

Effect of the Maternal and Child Health Handbook on Maternal and Child Health Promoting Belief and Action: Thailand Case / 国際保健医療

In Thailand, the maternal and child health (MCH) handbook has been used for nearly two decades in one of the MCH activities. A cross-sectional study was conducted to assess the utilization of the MCH handbook, and to analyze the relation to mother's MCH promoting belief and action. The data was collected from 224 mothers at one district in Kanchanburi province, Thailand, from January to February in 2005. About the utilization of the MCH handbook by mothers, there was a low rate of reading (14.3% mother had read all of the contents) and self-recording (0.9% mother had recorded every part). Multiple regression coefficients showed utilization of the MCH handbook was related to both mother's MCH promoting belief (p=0.001) and action (p=0.039). This was the strongest predictor variable of mother's MCH promoting belief. Other factors which significantly related to MCH promoting belief were family income, age, and education, and relation to action were marital status, occupation and age. According to the findings of this study, for MCH promotion, mothers' belief and action can be inspired through utilizing the MCH handbook and comprehensive assessment.