A trial to mobilize NGO health volunteers to improve tuberculosis patient care in Sana'a City, Yemen.

OBJECTIVES: The study aims to show the feasibility of involvement of Non-Governmental Organization (NGO) health volunteers with regular monitoring mechanism on tuberculosis (TB) control in Sana'a City, Yemen. METHODS: Interventions to mobilize NGO health volunteers with regular monitoring field visits in two selected districts with approximately 400,000 population in Sana'a City were conducted. 52 NGO health volunteers who belonged to a domestic NGO were trained on TB case finding and case holding activities by the national TB control programme staff during the fourth quarter of 2004. RESULTS: 136 new smear-positive TB cases were enrolled from January 2005 to September 2006. The cure rates indicated significant improvement from 73.4% to 84.6% after start of the intervention (p = 0.023). The cure rate of patients whose treatment partners were health volunteers was significantly higher than patients whose treatment partners were health centre staff (93.3% vs. 79.8%, Exact p = 0.045). CONCLUSION: The present study showed the favourable results of the implementation of the intervention in two selected districts in Sana'a City with regards to the treatment outcomes. The National Tuberculosis Control Programme has decided to expand the NGO's health volunteers' involvement as treatment partners to at least urban settings in Yemen.

[Case-surveillance of measles in Aichi Prefecture in 2007].

PURPOSE: Under the Japanese Infectious Disease Prevention Law, measles was monitored by the national epidemiological surveillance system through reports from sentinel clinical institutions until December 2007. In order to obtain rapid and precise information on measles outbreaks and take necessary actions, a case-surveillance system was introduced in Aichi Prefecture in February 2007. In this report, measles cases reported through the case-surveillance system were examined for characteristics of infection and the utility of the system. METHOD: The case-surveillance system for measles started in Aichi in February 2007, all local medical institutions being requested to provide a set of information on every measles case immediately after the clinical diagnosis was made. Reported data were processed by ourselves and real-time surveillance results were shown in our web site. Data were analyzed and compared with measles data from the national epidemiological surveillance system, reported by the sentinel clinical institutions in Aichi. RESULTS: A total of 212 cases were registered through the case-surveillance from February to December 2007, including 123 (58.0%) adult cases (over 15 years old of age). In contrast, only 56 cases were registered in Aichi by the national epidemiological surveillance in 2007 including 11 adult cases (19.6%), indicating considerable under-representation of adult measles cases by the sentinel survey. Of the case-surveillance cases, 56 (26.4%) had an immunization history, 88 (41.5%) were without a history, and 68 (32.1%) were unknown, indicating that primary and/or secondary vaccine failure occurred in at least 26.4%. DISCUSSION: The results of the case-surveillance of measles in Aichi provided useful information on characteristics of measles infection and proved to be effective in detecting the occurrence of measles rapidly and accurately. In order to achieve the Japanese target of measles elimination by 2012, it will be necessary to further strengthen the monitoring system and measures to contain spread of the disease.

Risk factors for first acute myocardial infarction attack assessed by cardiovascular disease registry data in Aichi Prefecture.

Recently, in Western countries, metabolic syndrome as well as such classical risk factors as hypertension and smoking has been considered to be closely associated with the occurrence of acute myocardial infarction (AMI). Therefore, we conducted a case-control study to investigate how the co-morbidity of obesity or thinness with hypertension, hyperlipidemia and diabetes mellitus would affect AMI occurrence among Japanese aged 30 to 69. Cases were comprised of 788 patients (590 men and 198 women) registered in the "Aichi Prefecture Cardiovascular Disease Registry Program" during hospitalization due to their first AMI attack. Controls were 2,300 randomly sampled inhabitants (1,142 men and 1,158 women) who responded to the questionnaire survey on lifestyle. We decided BMI < 18.5 as thin, 18.5 < or = BMI < 25.0 as normal, and BMI > or = 25.0 as obese, then divided subjects into six groups according to the presence or absence of histories of the above-mentioned three diseases in connection with their physique. In both sexes, multivariately adjusted odds ratios of first AMI attacks were much higher in groups with such histories (men, 4.14 to approximately 5.07; women, 5.62 to approximately 15.24) than in those without them (men, 0.90 to approximately 1.13; women, 1.54 to approximately 3.03) regardless of physique. Only in women, obesity uncombined with histories was significantly associated with AMI occurrence and not obesity but thinness intensified the association between histories and AMI. Among the six groups, population attributable risk percent was highest in the normal physique group with histories. It was suggested that persons with disease histories should be carefully treated irrespective of the presence or absence of obesity.

[Analysis of complications and prognosis for different types of stroke patients registered between 1993 and 2000 in Aichi Prefecture].

PURPOSE: This study was designed to analyze complications and prognosis for different types of stroke patients registered in Aichi Prefecture between 1993 and 2000. METHODS: A total of 23,979 out of 27,304 registered patients in the Aichi stroke patient registration program with 4 type of strokes (cerebral thrombosis (CRT), cerebral embolism (CRE), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)) were analyzed for complications and prognosis (survival, disability, dementia), with reference to gender, age-groups, and types of stroke. RESULTS: A total of 13,365 (55.7%) male (65.5 +/- 12.2 yr: Mean +/- SD) and 10,614 (44.3%) female (69.7 +/- 13.3 yr) patients were registered. As the type of stroke, CRT comprised the highest percentage, both in males (49.5%) and females (41.1%), followed by ICH (males: 30.4%, females: 29.8%). The percentage of SAH in females (17.3%) was found to be about twice as high as that in males (8.3%). Analyses of complications revealed hypertension to be the greatest risk factor in both sexes (about 50%), followed by history of stroke (males: 20.1%, females: 16.2%). Male patients had a significantly higher overall survival rate (84.7%) than females (81.0%) (P <0.001). SAH was associated with the lowest survival rate in both sexes (about 60%), with statistical significance (P<0.001). Development of disability or/and dementia as sequela of stroke was higher in females (disability: 54.5%, dementia: 21.1%) than in males (44.2%, 15.1%, respectively) (P< 0.001). Logistic regression analyses revealed that the factors most contributing to death were advanced age, a history of stroke, heart disease, and renal insufficiency. For the development of disability and dementia, being femal, of advanced age, with a history of stroke, heart disease, and renal insufficiency were important. Abnormal lipid metabolism appeared to be a protection factor regarding prognosis (survival, disability, dementia). CONCLUSIONS: This study demonstrated that hypertension is the most frequently reported complication for all types of stroke except CRE, and logistic regression analyses revealed that the factor contributing most to prognosis (survival, disability, dementia) was a history of stroke. The results suggested the importance of: i) removing hypertansion as the most significant risk factor, as well as diabetes and heart disease in order to prevent strokes; and ii) preventing re-attack(s) of stroke in order to improve the prognosis.