Implementation of an online-based JICA Knowledge Co-Creation Program on capacity development among African community health professionals / 国際保健医療

Introduction  Asahikawa Medical University has been conducting a JICA Knowledge Co-Creation Program (KCCP) “Health Administration for Community Health Officers in Africa” in Japan since 2008. Due to the COVID-19 pandemic, the KCCP in 2020 was a hybrid of distance learning and following on-site training in Japan, which the latter was canceled thereafter. This paper reports on how this hybrid program was organized and implemented.Methods: Preparation  The program was held in January-February 2021, with eight official participants from five countries and nine observers from two countries. The participants were required to engage in self-learning by PowerPoint materials with lecturers’ audio descriptions and zoom-based interactive meetings. The PowerPoint materials were freely accessible at our Google Drive account. There were 10 zoom sessions during the program.Results: Implementation  At the beginning, all the lecture materials were converted to mp4 clips and uploaded to a Youtube channel due to the difficulties downloading heavy files with limited internet connection. A total of 24 videos were created with an average length of 58 minutes in each. Zoom-based interactive meetings were held regularly in the morning in the African continent. Almost all of the sessions were productive, but the participants were sometimes interrupted due to a weak network environment or their regular work assignments. Most provided contents were well understood.Discussion  Despite some technical and environmental difficulties, the new-style, web-based training course facilitated the participation of observers as well as regular participants, providing more opportunities for interaction and discussion among trainees than a previous old-fashioned, on-site program. Improvement of the training environment particularly for participants is necessary to produce better training outcomes in the future, such as renting a hotel room and securing virtual connections.

A follow-up study in three African countries on the JICA training course “Health Systems Management for Regional and District Health Management Officers” / 国際保健医療

Introduction  Asahikawa Medical University (AMU) has conducted a 7-week JICA training course “Health Systems Management for Regional and District Health Management Officers” since 2008 and trained a total of 132 participants from 22 countries. In order to assess how trainees applied their public health knowledge and skills obtained through the training course to their communities, we conducted interviews in Kenya, Malawi, and Liberia to explore their current public health problems and to identify what programs are required for our further training course to improve their health system.Methods  Among 29 trainees in three countries in total, 15 were face-to-face interviewed and 6 were phone-interviewed on February 2019. The rest was missing but we identified five of their current position.Results  The trainees made best use of knowledge and skills obtained from following lectures and/or field trips in their communities, such as “Project Cycle Management”, “Maternal and child health”, “Public health centers’ visit”, “Waste management including water supply and sewage treatment”, “School health”, “Tele-medicine”, and “5S-KAIZEN”. They also requested us to provide following lectures and field visits to tackle with their future health problems, such as “Japan’s experience to achieve the Universal Health Coverage”, “Health system strengthening”, “Disaster medicine and management”, “Non-communicable diseases”, and “Capacity development”.Discussion & Conclusions  By face-to-face or phone interviews in three countries, we grasped ideas of current health problems and verified an effectiveness of our training programs in each country. We also helped the trainees, their co-workers, community people (volunteers) to increase the motivation of their relevant works and activities through the field visit. Therefore, in order to provide a better training program, we further need to enhance international cooperation between us and African countries as well as to strengthen our training capacities including regular follow-up systems to ex-trainees.

A focus group interview of university students7 health in Sri Lanka / 国際保健医療

<B>Objective</B><BR>Despite the steady high prevalence of infectious diseases, Sri Lanka has an increasing awareness of lifestyle-related health diseases. To lower their risks in the future, making better lifestyle choices and establishing patterns of healthy behavior during young adulthood are essential. The purpose of this qualitative study was to explore current issues of university students' health behaviors and their environments.<BR><B>Methods</B><BR>The study was conducted in a university of the Central Province, Sri Lanka. Four graduate students in the Faculty of Medicine and three senior students in the Faculty of the Arts were interviewed in a focus group. Interviews were tape-recorded, transcribed, and analyzed inductively.<BR><B>Results</B><BR>The results yielded three core categories: little interests in health, unhealthy lifestyles, and lower usage of the Student Health Center. In addition, three major health problems were observed among the participants: eating habits, substance use, and mental health. Students had little paid attention to their health. It also showed passive participation on a health check-up. Additionally students' hidden risky behaviors were observed: alcohol intake and smoking. Mental health problem is one of the great health concerns among the students. Although the School Health Center was available, the gaps between its provisions of services and students' needs are an important issue.<BR><B>Discussion and Conclusion</B><BR>Students need to pay more attention on their health conditions and the importance of preventive health. Furthermore, to improve the current university health services, accessibility, usability, and students' needs should be carefully reviewed in the context of advocacy of preventive health behaviors.

A Review of UNGASS-Based Outcomes and Impact of HIV/AIDS Programs in Eight sub-Saharan Countries / 国際保健医療

<B>Introduction</B><br>Whereas the numbers of new HIV infections and deaths due to AIDS have been reduced or stabilized, they remain high in sub-Saharan Africa. To further control the generalized epidemics and their consequences, countries have continued strengthening their programs to prevent new infections and deaths: however, program outcomes and impact at the national level are not well understood. The purpose of the review was to describe the country-level outcomes and impact of HIV/AIDS programs in eight sub-Saharan African countries in order to highlight future action agenda to meet universal access and policies related to Millennium Development Goals (MDGs).<br><B>Methods</B><br>The review used 16 of the 25 program outcome and impact indicators prescribed by the United Nations General Assembly Special Session (UNGASS). The review reported on the percentages accomplished by each country in their programs, categorized these figures into high (80% and higher), moderate (50-79%) and low (below 50%), and highlighted the domains in which outcomes and impact were high.<br><B>Results</B><br>Across countries, with the exception of Tanzania, programs had achieved nearly universal or universal outcomes and impact, but their coverage was limited to 2-5 program domains. Moreover, in domains with multiple target groups, such as in the provision of antiretroviral therapy and in the promotion and distribution of condom use, the programs were unable to produce high-end results for the affected populations. To further reduce their infections and deaths and to advance towards universal access and MDGs, countries must make their program outcomes and impact comprehensive and equitable.<br><B>Conclusion</B><br>Almost all national programs have high level accomplishments, but they must broaden their domain and audience coverage to further control the generalized epidemics and deaths in the eight countries. National responses must collect and analyze all the UNGASS data systematically and regularly in order to determine current HIV/AIDS knowledge and behaviors, ascertain program effects, and inform future actions.

Current HIV/AIDS Knowledge, Perceptions and Practices among the General Population in Kandy, Sri Lanka: Program Implications / 国際保健医療

<b>Introduction</b><br> Recent strategic plans for HIV/AIDS control in Sri Lanka have stressed the need to focus prevention interventions on most-at-risk populations and similarly laid out the importance of improving HIV/AIDS awareness among the general population. Programmatic attention has to be strengthened to effectively change AIDS-related poor knowledge, low risk perceptions and risky sexual practices at the individual level, and avert an epidemic. While current data on at-risk populations are available to inform interventions, there is paucity of latest evidence for the general population programs.<br><b>Methods</b><br> In April-May 2009, a cross-sectional study involving 1,239 population-based and randomly selected respondents aged 15-49 was completed in Kandy, Sri Lanka (response rate=87.2%). The study collected data on HIV/AIDS knowledge, perceptions and sexual practices among the general population to supply current information for the intervention. Data were analyzed using univariate, bivariate and multivariate approaches. <br><b>Results</b><br> While almost all respondents were aware of HIV/AIDS, sizeable proportions (44.7-76.2%) knew little about the types of sexually transmitted infections, and about the transmission modes and prevention methods of HIV/AIDS. Although 80% of respondents had low risk perceptions and were mostly at low risk behaviorally, their knowledge of HIV/AIDS was inadequate. They assessed their risks and practiced unsafer sex without the benefit of having evidence-based knowledge. The knowledge, perceptions and practices were significantly associated with gender, marital status, education, religion, and/or residence.<br><b>Conclusions</b><br> The gaps in substantive knowledge on HIV/AIDS suggest that no effective information and other related types of support have been provided to the general population in Sri Lanka. In the context of the need to contribute to sustaining the low prevalence of HIV in the country, a base of scientific knowledge and wider advocacy programs should be developed.

Community-based Evaluation of Health-seeking Behavior of People with Animal Bite Injuries in a District of Sri Lanka / 国際保健医療

<b>Introduction</b><br> Of the 55,000 deaths per year due to rabies, 56% occur in Asia and 44% in Africa. Despite the existence of the national rabies control program in Sri Lanka, rabies is still prevalent, suggesting that animal bite victims may have failed to observe the proper first aid measures and seek immediate medical treatment. The purpose of this study is to describe the health-seeking behavior among animal bite victims of a selected population in Kandy District, Sri Lanka. The influences of subjects’ demographic characteristics to these behaviors were studied.<br><b>Methods</b><br> We conducted face-to-face interviews in May 2006 among households with family members having history of animal bite injuries. Data on health-seeking behaviors such as first aid measure application, immediate medical consultation, and completion of post-exposure prophylaxis (PEP) were obtained. The association between behaviors and demographic characteristics were evaluated using Chi-square test or the Fisher’s exact test.<br><b>Results</b><br> Of the 6968 sample population, 357 (5.1%) had history of animal bites one year prior to the survey. Most of the subjects performed first aid measures (n=297, 83.2%) and sought medical treatment (n=319, 89.4%) within 24 hours (n=295, 82.6%) of the injury. Only 9.8% (n=35) of the subjects completed the PEP. There was no association between health-seeking behavior and demographic characteristics. Two subjects died having symptoms that resembled rabies without completing the necessary PEP, and two animal specimens were sent for laboratory testing that confirmed one case of feline rabies one year prior to the study.<br><b>Conclusion</b><br> In general, the health-seeking behaviors of the subjects were not influenced by their demographic characteristics which may contribute to greater difficulties in controlling rabies. To strengthen the rabies control program, effective education of both the public and health sectors by thorough and adequate wound washing, and strict adherence with the recommended treatment schedule is of paramount importance.

Knowledge, Attitudes, and Practices Survey of Rabies in a Community in Sri Lanka

Objectives: The primary objective of this study was to determine the level of knowledge, attitudes and practices (KAP) of rabies management and control of a sample population. The secondary objective was to compare the KAP with respect to rabies management and control between urban and rural areas and between pet and non-pet owners. Methods: This cross-sectional study was carried out by conducting face-to-face interviews using structured questionnaires among 1570 respondents from selected households in the Kandy District, Sri Lanka. Results: Approximately 58% of the sample population was pet owners. Among all the respondents, there was a high level of awareness (90%) that dogs are the most common rabies reservoir, that the disease is fatal (79%), and that rabies can be prevented by vaccination (88%). Most of the subjects (96%) would seek treatment from a doctor or a hospital after being bitten by a dog. Although 76% of the respondents said that their pet dogs were vaccinated, only one-half were able to present a vaccination certificate upon request. The subjects from the urban areas would submit the head of an animal for rabies evaluation (69%) compared with those from the rural areas (57%). Pet owners (93%) are more aware that dog rabies vaccines are available from authorized offices than non-pet owners (87%). Conclusions: The level of awareness of rabies and the level of receptiveness to rabies control measures are high. There is a difference in the attitudes and pet care practices relevant to rabies control between urban and rural areas. Pet owners tend to be more cooperative to rabies control activities. The attitudes and practices of the respondents may reflect the inaccessibility of facilities and the lack of services that would enable community participation in rabies control.

Knowledge, attitudes, and practices survey of rabies in a community in Sri Lanka

<p><b>OBJECTIVES</b>The primary objective of this study was to determine the level of knowledge, attitudes and practices (KAP) of rabies management and control of a sample population. The secondary objective was to compare the KAP with respect to rabies management and control between urban and rural areas and between pet and non-pet owners.</p><p><b>METHODS</b>This cross-sectional study was carried out by conducting face-to-face interviews using structured questionnaires among 1570 respondents from selected households in the Kandy District, Sri Landa.</p><p><b>RESULTS</b>Approximately 58% of the sample population was pet owners. Among all the respondents, there was a high level of awareness (90%) that dogs are the most common rabies reservoir, that the disease is fatal (79%), and that rabies can be prevented by vaccination (88%). Most of the subjects (96%) would seek treatment from a doctor or a hospital after being bitten by a dog. Although 76% of the respondents said that their pet dogs were vaccinated, only one-half were able to present a vaccination certificate upon request. The subjects from the urban areas would submit the head of an animal for rabies evaluation (69%) compared with those from the rural areas (57%). Pet owners (93%) are more aware that dog rabies vaccines are available from authorized offices than non-pet owners (87%).</p><p><b>CONCLUSIONS</b>The level of awareness of rabies and the level of receptiveness to rabies control measures are high. There is a difference in the attitudes and pet care practices relevant to rabies control between urban and rural areas. Pet owners tend to be more cooperative to rabies control activities. The attitudes and practices of the respondents may reflect the inaccessibility of facilities and the lack of services that would enable community participation in rabies control.</p>