Investigation of health care waste management in Binzhou District, China.

In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed. Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that in secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members' knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.

Availability and use of emergency obstetric care services in public hospitals in Laos PDR: a systems analysis.

The maternal mortality ratio in Laos in 2005 was 660 per 100,000 lives birth which was the third highest in Asia-Pacific Region. The objective was to determine the availability and use of emergency obstetric care (EmOC) in provincial and district hospitals in Borikhamxay, Khammouane, and Savannakhet provinces using UN guidelines. A hospital-based cross sectional survey was conducted from January to March 2008. All district (30) and provincial hospitals (3) from three provinces were included. Analysis was based on hospital records reflecting 12 months of facility data. Data indicates that only 14 hospitals (42.4%) were providing EmOC services, i.e., 9 basic, 5 comprehensive services. The proportion of births in EmOC facilities was only 11.2%, the met need was a very low 14.5%, and the cesarean section rate was only 0.9%. The case fatality rate in Borikhanxay province was 2.8%; in Khammouane and in Savannakhet provinces it was less than 1%. Record keeping at hospitals was poor. Signal functions provided in the last three months showed only 48.5% of the facilities performed assisted vaginal delivery. This is the first study in Lao PDR to assess EmOC services. Almost all the indicators were below the UN recommendations. Health planners must take evidence-based decisions to rectify and improve the situation in the hospitals regarding EmOC services. These data can therefore help government to assign and allocate budgets appropriately, and help policymakers and planners to identify systemic bottlenecks and prioritize solutions and will help in improving maternal health.

Introduction of Provider Initiated Testing & Counseling (PITC) to HIV testing for Pregnant Women in Cambodia / 国際保健医療

<b>Objective</b><br> Provider initiated testing and counseling (PITC) for HIV testing, which is not a mandatory HIV testing policy, to pregnant women was being introducing in many countries. The aim of this study was to assess impact and issues raised by the PITC approach for prevention of mother-to-child transmission (PMTCT) of HIV services at an antenatal clinic (ANC) in the capital of Cambodia.<br><b>Method</b><br> Impact of the PITC approach on the acceptance of PMTCT services was determined by comparing quantitative data indicating the uptakes of PMTCT services during the first one year of PITC with the prior one year.<br><b>Results</b><br> The acceptance rate of HIV testing dramatically increased from 35.9% (3,033/8,459) to 95.3% (7,780/8,162) (p<0.001), however the acceptance rate of post-test counseling after tested declined from 92.1% (2,793/3,033) to 73.9% (5,753/7,780) (p<0.001). The return rates of pregnant women tested with partners and without partners to post-test counseling were, respectively, 85.5% (1,913/2,237) and 69.7% (3,840/5,507) in PITC approach (p<0.001) although this difference was not significant in VCT approach.<br><b>Conclusions</b><br> Although it can be agreed that the PITC approach was an effective strategy to increase the uptake of HIV testing, the remarkable declines of the post-test counseling acceptance lead concern about unexpected needs of counselors and the possibility of negative response to the HIV testing by their partners since the women tested without partners in PITC approach are less likely to return to post-test counseling compared to VCT approach. Further investigation on the reasons why some tested women didn’t receive post-test counseling is needed to find out strategies to keep or increase the acceptance of post-test counseling safely in the PITC approach. It was suggested that we still need to take into account the roles of counseling and partners’ involvement in careful consideration of women’s personal safety even in the implementation of PITC approach.

Women's Rights Equal Women's Lives: The Case of Pakistan / 国際保健医療

<b><big>Objectives</big></b><br>The Constitution of Pakistan offer guarantees regarding women s rights, but unfortunately some laws and also customs violate the above commitments seriously affecting the health of women and even endangering their lives. The purpose of the study is to describe various aspects of women s health in Pakistan vis- -vis human rights.<br><b><big>Methods</big></b><br>Review of available literature was undertaken. The scientific electronic database (such as PubMed, Science-Direct & Pakistani database) was searched for women health issues in Pakistan, covering a period from 1980s to present. Published government reports have also been included as sources of information for this paper.<br><b><big>Results</big></b><br>In Asia, Pakistan s, maternal mortality ratio is among the highest; more than half of the women are anemic. Access to health services is deprived whether be it economic, geographical or social. Majority of women are illiterate. Pakistan is among the countries with low gender indices and where female life span is less then men, and men outnumber women. Government spending on health and particularly women health is low compared to other countries.<br><b><big>Conclusion</big></b><br>Women s disproportionate poverty, low social status, gender imbalances, and inadequate maternal services at the community level play a significant role in contributing to maternal deaths. In view of the fact that given accessible, quality health services, many maternal deaths can be avoided, demonstrates maternal mortality is clearly an issue of human rights.<br>There is a strong need that health sector spending is increased, role of women health care providers in rural areas be expanded (such as LHW) and involvement of private and NGO sector to fill gaps in service delivery, be ensured. In order to meet the targets of MDGs, the gender dimensions of demographic and social change need to be stressed further in all policies and development plans, which may result in narrowing of gender disparities and improving women lives.

Towards equal partnership and evaluation of the international organizations: Lessons learnt from JICA projects on polio eradication in Laos / 国際保健医療

As globalization has been accelerated, the partnership is getting important in the international society. JICA projects in Laos on "Public health" and "Pediatric infectious disease prevention" had achieved its goal of regional polio eradication under the strong partnership with Laos government, JICA, WHO and UNICEF. The global commitment at the WHO assembly contributed to the achievement by sharing common goal and partnership, which enabled to draw sufficient financial supports. However, in general, fewer efforts have been done among Japanese researchers/experts to examine the appropriateness of top-down global health policies. JICA should break away form the power of ministries which possess huge vested interests in ODA business so that the agency can find and address problems actively in the project sites. In this way, as one of influential nations in Asia, we can build equal partnerships in the international society, respecting diversity of environment and cultures of developing countries. It is also important to evaluate the funding flows and activities of the international organizations, which have been widely criticized for being lack of transparency.