Contribution of the Japan International Cooperation Agency health-related projects to health system strengthening

BACKGROUND: The Japan International Cooperation Agency (JICA) has focused its attention on appraising health development assistance projects and redirecting efforts towards health system strengthening. This study aimed to describe the type of project and targets of interest, and assess the contribution of JICA health-related projects to strengthening health systems worldwide. METHODS: We collected a web-based Project Design Matrix (PDM) of 105 JICA projects implemented between January 2005 and December 2009. We developed an analytical matrix based on the World Health Organization (WHO) health system framework to examine the PDM data and thereby assess the projects’ contributions to health system strengthening. RESULTS: The majority of JICA projects had prioritized workforce development, and improvements in governance and service delivery. Conversely, there was little assistance for finance or medical product development. The vast majority (87.6%) of JICA projects addressed public health issues, for example programs to improve maternal and child health, and the prevention and treatment of infectious diseases such as AIDS, tuberculosis and malaria. Nearly 90% of JICA technical healthcare assistance directly focused on improving governance as the most critical means of accomplishing its goals. CONCLUSIONS: Our study confirmed that JICA projects met the goals of bilateral cooperation by developing workforce capacity and governance. Nevertheless, our findings suggest that JICA assistance could be used to support financial aspects of healthcare systems, which is an area of increasing concern. We also showed that the analytical matrix methodology is an effective means of examining the component of health system strengthening to which the activity and output of a project contributes. This may help policy makers and practitioners focus future projects on priority areas

Reducing salt intake for prevention of cardiovascular diseases in high-risk patients by advanced health education intervention (RESIP-CVD study), Northern Thailand: study protocol for a cluster randomized trial

BACKGROUND: Decreasing salt consumption can prevent cardiovascular diseases (CVD). Practically, it is difficult to promote people’s awareness of daily salt intake and to change their eating habits in terms of reducing salt intake for better cardiovascular health. Health education programs visualizing daily dietary salt content and intake may promote lifestyle changes in patients at high risk of cardiovascular diseases. METHODS/DESIGN: This is a cluster randomized trial. A total of 800 high-CVD-risk patients attending diabetes and hypertension clinics at health centers in Muang District, Chiang Rai province, Thailand, will be studied with informed consent. A health center recruiting 100 participants is a cluster, the unit of randomization. Eight clusters will be randomized into intervention and control arms and followed up for 1 year. Within the intervention clusters the following will be undertaken: (1) salt content in the daily diet will be measured and shown to study participants; (2) 24-hour salt intake will be estimated in overnight-collected urine and the results shown to the participants; (3) a dietician will assist small group health education classes in cooking meals with less salt. The primary outcome is blood pressure change at the 1-year follow-up. Secondary outcomes at the 1-year follow-up are estimated 24-hoursalt intake, incidence of CVD events and CVD death. The intention-to-treat analysis will be followed. Blood pressure and estimated 24-hour salt intake will be compared between intervention and control groups at the cluster and individual level at the 1-year follow-up. Clinical CVD events and deaths will be analyzed by time-event analysis. Retinal blood vessel calibers of CVD-risk patients will be assessed cross-sectionally. Behavioral change to reduce salt intake and the influencing factors will be determined by structured equation model (SEM). Multilevel regression analyses will be applied. Finally, the cost effectiveness of the intervention will be analyzed. DISCUSSION: This study is unique as it will recruit the individuals most vulnerable to CVD morbidity and mortality by applying the general Framingham CVD risk scoring system. Dietary salt reduction will be applied as a prioritized, community level intervention for the prevention of CVD in a developing country. TRIAL REGISTRATION: ISRCTN3941627

The relationship between atopic dermatitis and indoor environmental factors : a cross-sectional study among Japanese elementary school children

Objectives: This study aimed to determine that home environmental factors were associated with atopic dermatitis in Japanese elementary school children. Methods: In this cross-sectional study, a total of 4,254 children in 12 public elementary schools in Sapporo city in Hokkaido, Japan were examined. Atopic dermatitis was defined using the International Study of Asthma and Allergies in Childhood questionnaire. The questionnaires also contained 14 questions about the child’s home environment. To obtain multivariate-adjusted ORs for atopic dermatitis in relation to the home environment, we controlled for possible confounders including gender, school grade, parental history of allergies, number of siblings, and whether the child was firstborn. The study participants were then divided into two groups according to gender, and a stratified analysis was performed to obtain adjusted ORs for atopic dermatitis in relation to the home environment. Results: The prevalence of atopic dermatitis in our sample was 16.7 %. Using fully adjusted models, the risk factors for atopic dermatitis were found to be the household use of a non-electric heating system without a ventilation duct to the outside (compared to the use of an electric heating system), having visible mould in the house, having a mouldy odour in the house, and condensation on the windowpanes in the house odds ratios (OR 1.25–1.54). In our stratified analysis, having visible mould and having a mouldy odour in the house were relevantly found to be risk factors for boys (OR 1.28–1.64). However, these associations were not found among girls. Conclusions: To improve children’s health, further study is needed to corroborate the findings

Relationship of general trust with individual health and life related factors among frail elderly residents at home in Hokkaido rural areas in Japan

General Trust (GT), defined as a default expectation of other people’s trustworthiness, is assumed to be a predictor for promotion of health and welfare in individuals as well as for strengthening of social capital in the community. An improvement of health and quality of life of the elderly is recently a crucial agenda. Thus, the purpose of the study was to explore which factors regarding health and life associated with GT among frail elderly people living at homes in Japanese rural area. The study selected the subjects who were designated within three mildest degrees in seven stages of long-term care levels and who met at an item and more in the national basic check-list. 209 participants were interviewed by trained health personnel using a structured questionnaire. GT was measured by a dichotomous outcome of inquiring “do you trust people in general?”. In the univariable analysis, educational status (p = 0.004), activity competence index including instrumental activity of daily living (IADL) (p = 0.020), Mini-Mental State Examination (MMSE) (p = 0.029) and Self-rating Depression Scale (SDS) (p = 0.010) were significantly related to GT. By logistic regression analysis using a stepwise method with a likelihood ratio, educational status alone was significantly associate with GT (p = 0.010, odds ratio = 1.195 [95% confidence interval; 1.043 - 1.371]). Health related factors had nothing to do with GT. Our finding suggested that the higher educated elderly might have had more opportunities to encounter the others and more indispensability to deliberately discern their trustworthiness than the lower, and consequently had higher GT through social intelligence being strengthened