Health communication issues related to latent tuberculosis infection treatment support for the foreign-born in Japan / 国際保健医療

Objective  To identify issues in health communication regarding treatment support for foreign-born who are diagnosed as latent tuberculosis infection (LTBI) in Japan, from the perspective of public health centers (PHCs).Methods  A self-administered survey was sent to 469 PHC, between June and July 2020. The survey asked closed and open-ended questions to tuberculosis (TB) program personnel on (1) their experiences of foreign-born patients who were eligible for LTBI treatment but did not start their treatment, and who started treatment but were lost to follow-up, and (2) health communication issues with foreign-born patients. Responses were summarized descriptively for close-ended questions, and analyzed qualitatively for open-ended question.Results  We obtained response from 307 PHCs, regarding 315 foreign-born patients. Twenty-five patients did not initiate, and 52 were lost to follow-up after initiating LTBI treatment. Of the 77 patients who either did not start treatment or were lost to follow-up, 45 apparently could hold everyday conversation in Japanese but had difficulties understanding technical terms, and 19 could not even exchange basic conversation, with PHC staff. Barriers to LTBI treatment initiation and completement, as perceived by PHC staff, included “lack of correct knowledge about TB and LTBI”, “different attitudes to health” and “economic difficulties”. Conclusion  Issues in health communication between PHC staff and foreign-born patients included not only a language barrier, but also the unconscious mind among PHC staff, which sought reasons for refusal or termination of LTBI treatment in patients. We argue that this mind is based on positivism, whereby health personnel consider themselves as the provider of “scientific knowledge” and that “lay persons” can act rationally once enlightened. However, PHC staff may need to reflect upon such position as the provider of scientific knowledge, but instead, learn from foreign-born patients about how they perceive health, TB or LTBI, to conduct better communication.

Delay in health-care-seeking treatment among tuberculosis patients in Japan: what are the implications for control in the era of universal health coverage?

Introduction@#Tuberculosis (TB) patient delay, i.e., the duration from the onset of symptoms to the time of TB diagnosis is one of the issues in TB prevention and control in Japan, where Universal Health Coverage (UHC) has been achieved decades ago. We studied the trends and risk factors for patient delay by three categories, namely short (less than 2 months), medium (more than 2 months and less than 6 months) and long (longer than 6 months)-delay, and discussed implications for social protection measures.@*Methods@#A descriptive cross-sectional study was conducted by analyzing the Japanese TB surveillance data of symptomatic pulmonary TB (PTB) cases registered between 2007 and 2017 (n = 88351).@*Results@#While the number of patients with short delay has decreased significantly, of those with medium and long delay have shown very modest decrease. In fact, the proportion of those with medium delay has steadily increased, from 14.3% in 2007 to 17.0% in 2017. Not having health insurance, receiving social welfare, temporary workers, and history of homelessness were some of the risks identified for patient delay. Male gender and being a full-time worker were two risks specifically associated with long delay.@*Discussion@#

Assessment of the role of community health volunteers in delivering primary health care in Manila, the Philippines / 国際保健医療

Introduction   The Philippines adopted the primary health care (PHC) strategy in 1978 to deliver essential health services in the community related to prevention and control of prevalent health problems. The barangay health workers (BHWs) are expected to play a key role in profiling the health of the community by maintaining and updating a comprehensive dataset of the community, called the “thirteen folders”, through conducting routine house visits (Appendix A). This study aimed to determine the utilization and challenges in updating the 13-folders and its usefulness in conducting community activities of BHWs at the primary care level. Methods  This study utilized a mixed- method of descriptive epidemiology and qualitative analysis, whereby data was collected from various resources as well as structured interview with 20 nurses and 31 BHWs in Districts I and VI, of Manila City. Questions related to activities of BHWs in identifying and profiling communities through house visits, utilization of feedback report and the challenges encountered were asked. Results   None of the health centers met the BHW to community ratio of 1: 20 residents. Only one out of 31 BHWs conducted community visits as required or four times a week. In fact, irregular visits resulted to failure in conducting community profiling and in delays in updating the 13-folder with missing information noted in some folders. The BHWs’ role is perceived by both nurses and BHWs as assisting in objective-specific activities and as health educators. Delays in honorarium and duplicating tasks in updating the 13-folders were revealed as potential issues that could hamper their performance. Conclusion  The BHWs are crucial in assisting health staff towards provision of responsive health services; however, lack of human resource should be addressed to reduce additional workload among BHWs. The 13-Folder is an imperative tool to identify the needs of the community other than health concerns but careful assessment is required to reduce repetitive tasks and to determine its value in improving community health outcomes. The delayed provision of honorarium should be dealt with to avoid further demotivation among BHWs. Finally, a refresher training should be considered to optimized the role of BHWs at the PHC level.

Pulmonary tuberculosis and non-recent immigrants in Japan – some issues for post-entry interventions

Foreign-born persons are considered one of the high-risk populations for tuberculosis (TB), and numerous studies have discussed the potential role of pre-entry TB screening for immigrants. However, rates of TB disease among immigrants can remain high several years after entry. In Japan, approximately 50% of TB among foreign-born persons occurs among those who have entered Japan more than five years before being diagnosed, i.e. non-recent immigrants. However, little attention has been paid so far to the issue of TB control among the non-recent immigrants. A detailed analysis of the Japan Tuberculosis Surveillance data was therefore conducted to describe the characteristics of TB among non-recent immigrants and discuss policy implications in terms of post-entry interventions in Japan. The main findings were as follows: 1) the proportion of pulmonary TB cases aged 65 years and older was higher among non-recent than recent immigrants (9.8% vs 1.2%); 2) the proportion of those with social risk factors including homelessness and and being on social welfare assistance was higher among non-recent than recent immigrants; and 3) the proportion of those detected via routine screening at school or workplace was significantly lower among non-recent immigrants aged between 25 and 64 than among recent immigrants in the same age group (15.4% vs 28.7%). Our results suggested the need to increase the opportunities for and simultaneously improve the take-up rate of community-based screening for non-recent immigrants.

Profile of tuberculosis among the foreign-born population in Japan, 2007–2014

The proportion of foreign-born people among the newly notified tuberculosis (TB) patients has been increasing in recent years and potentially poses a new challenge to TB control in Japan. In this report, we analysed the data from the Japan TB surveillance system between 2007 and 2014 to gain an overview of the trends and characteristics of foreign-born TB patients in Japan. We found that the proportion of foreign-born TB patients was especially high among the younger age groups – 44.1% among the 20–29 years age group in 2014. The largest groups of foreign-born patients were from China and the Philippines; however, the number of those from Nepal and Viet Nam was on the rise. Students comprised the second largest professional category group for TB after regular workers, and its proportion increased over the study period. Compared to Japan-born TB patients, foreign-born patients were more likely to be diagnosed through routine medical check-ups. Treatment successes and patients still on treatment were significantly lower among foreign-born patients than their Japan-born counterparts; and transferred-out and unknown outcomes were higher. Our results indicated that distinctive subgroups within the foreign-born population in Japan, especially students and regular workers, might have a higher risk of developing TB. Measures to ensure early diagnosis and treatment adherence should be adapted to such populations.