Knowledge, attitude, and practice (KAP) of HIV prevention and HIV infection risks among Congolese refugees in Tanzania

Little is known about HIV infection risks and risk behaviours of refugees living in resource-scarce post-emergency phase camps in Africa. Our study at Nyarugusu Camp in Tanzania, covering systematically selected refugees (n=1140) and refugees living with HIV/AIDS (PLWHA) (n=182), revealed that the level of HIV risk of systematically selected refugees increased after displacement, particularly regarding the number having transactional sex for money or gifts, while radio broadcast messages are perceived to promote a base of risk awareness within the refugee community. While condoms are yet to be widely used in the camp, some refugees having transactional sex tended to undertake their own health initiatives such as using a condom, under the influence of peer refugee health workers, particularly health information team (HIT) members. Nevertheless, PLWHA were less faithful to one partner and had more non-regular sexual partners than the HIV-negative group. Our study revealed that community-based outreach by refugee health workers is conducive to risk behaviour prevention in the post-emergency camp setting. It is recommended to increase the optimal use of “radio broadcast messages” and “HIT,” which can act as agents to reach out to wider populations, and to strengthen the focus on safer sex education for PLWHA; the aim being to achieve dual risk reduction for both refugees living with and without HIV/AIDS

Anaemia, iron deficiency and vitamin A status among school-aged children in rural Kazakhstan.

OBJECTIVES: To investigate the prevalence of anaemia and iron deficiency and vitamin A status among school-aged children in rural Kazakhstan and identify factors associated with anaemia in this population. DESIGN: A cross-sectional design. SETTING: School-aged children in rural Kazakhstan. SUBJECTS: Socio-economic and anthropometric information was collected from 159 school-aged children living in the Kzyl-Orda region of Kazakhstan. Blood samples were collected and the concentrations of haemoglobin (Hb), serum iron, serum ferritin (SF), erythrocyte protoporphyrin (EP), serum retinol and beta-carotene, total iron binding capacity (TIBC), transferrin saturation (TS) and other haematological indices were measured. RESULTS: Among the 159 children, the prevalence of anaemia and iron deficiency defined by the multiple criteria model (SF, TS and EP) was 27% and 13%, respectively. Nine per cent had iron-deficiency anaemia and 21% had serum retinol value < 1.05 micromol l(-1). Mean SF and serum iron concentrations and TS were significantly lower in anaemic children than in their non-anaemic peers, while TIBC and EP were significantly higher in children with anaemia. Hb was significantly correlated with serum iron and retinol concentrations. Serum retinol and SF concentrations and mean corpuscular volume were significantly correlated with Hb by multiple regression analysis. CONCLUSIONS: Anaemia among school-aged children in rural Kazakhstan appears to be related to iron indices and vitamin A status

死別体験における悲嘆の回復過程に関する要因の分析

スマトラ沖大地震・インド洋津波によって，突然肉親と死別体験をもった２遺族に面接調査を行った．死別による悲嘆から回復する過程に，どのような要因が関連しているのかについて分析した．その結果，この地域が敬虔な仏教徒であったことから，対象となった２遺族は，信仰が悲しみを緩和する要因として働いていた．さらに近隣の人びとの精神的な支援や，新たな生命の誕生は将来への希望につながり，悲嘆から回復する要因の一つとなっていることが明らかとなった．Two families that experienced the sudden death of relatives in the Sumatra earthquake and Indian Ocean tsunami were interviewed, and the kinds of factors in the process of healing that sadness were analysed. As a result, it was discovered that, given the devoutly Buddhist nature of the area, the two families’ faith worked to relieve their sadness. There was also psychological support from neighbours and hope for the future embodied in the birth of children, which were also factors in healing their sadness

アンバランゴタ地区の被災現状

昨年１２月２６日に，インドネシアのスマトラ島北端沖で発生したスマトラ沖大地震によるインド洋津波被害で，スマトラについで津波による被害が多かったスリランカに，被災６ヵ月後の復興状況，感染症発生状況，被災者の健康調査などを目的に被災地の調査に入った．スリランカ東南部地域の被災状況を報告し，看護職としての援助のあり方や，物資援助について考察した．We visited Sri Lanka, which received the most damage after Sumatra six months after the Sumatra Earthquake struck the northern coast of the Indonesian island last year on December 26 and caused a tsunami in the Indian Ocean. We investigated reconstruction efforts, the spread of infection and the health conditions of survivors in the southeast portion of the island country, made reports on the devastated areas and made observations on health care and aid supplies

Who died as a result of the tsunami? – Risk factors of mortality among internally displaced persons in Sri Lanka: a retrospective cohort analysis

BACKGROUND: Describing adverse health effects and identifying vulnerable populations during and after a disaster are important aspects of any disaster relief operation. This study aimed to describe the mortality and related risk factors which affected the displaced population over a period of two and a half months after the 2004 Indian Ocean tsunami in an eastern coastal district of Sri Lanka. METHODS: A cross-sectional household survey was conducted in 13 evacuation camps for internally displaced persons (IDP). Information on all pre-tsunami family members was collected from householders, and all deaths which occurred during the recall period (77 to 80 days starting from the day of the tsunami) were recorded. The distribution of mortality and associated risk factors were analysed. Logistic regression modelling using the generalized estimating equations method was applied in multivariate analysis. RESULTS: Overall mortality rate out of 3,533 individuals from 859 households was 12.9% (446 deaths and 11 missing persons). The majority of the deaths occurred during and immediately after the disaster. A higher mortality was observed among females (17.5% vs. 8.2% for males, p < 0.001), children and the elderly (31.8%, 23.7% and 15.3% for children aged less than 5 years, children aged 5 to 9 years and adults over 50 years, respectively, compared with 7.4% for adults aged 20 to 29 years, p < 0.001). Other risk factors, such as being indoors at the time of the tsunami (13.8% vs. 5.9% outdoors, p < 0.001), the house destruction level (4.6%, 5.5% and 14.2% in increasing order of destruction, p < 0.001) and fishing as an occupation (15.4% vs. 11.2% for other occupations, p < 0.001) were also significantly associated with increased mortality. These correlations remained significant after adjusting for the confounding effects by multivariate analysis. CONCLUSION: A significantly high mortality was observed in women and children among the displaced population in the eastern coastal district of Sri Lanka who were examined by us. Reconstruction activities should take into consideration these changes in population structure

UVULECTOMY AND OTHER TRADITIONAL HEALING PRACTICES: TRADITIONAL HEALERS‘ PERCEPTIONS AND PRACTICES IN A CONGOLESE REFUGEE CAMP IN TANZANIA

Little is studied about traditional healers‘ perceptions toward and practice of uvulectomy, which is known as a traditional surgical practice mainly in Africa and which sometimes results in severe complications. This study aimed to clarify the perceptions toward and practice of uvulectomy and the other traditional healing practices of traditional healers in a Congolese refugee camp in Tanzania. Interviews were conducted with 149 traditional healers, comprised of 59 registered, 68 non-registered and 22 faith healers. A total of 1.7% of the registered healers and 8.8% of the non-registered healers had ever conducted uvulectomy on children (a median of 2 months to a median of 3 years of age) and had received cash or domestic fowls equivalent to US$1-3 per operation. Although over 80% of the respondents believed traditional treatments to be more effective than modern medicine, less than 20% considered uvulectomy beneficial and in fact about 40% considered it to be harmful. The respondents raised cough, vomiting, appetite loss and other symptoms as an indication for uvulectomy, and death, bleeding, throat pain and other symptoms as harmful effects associated with uvulectomy. In this camp, the healers also performed other surgical procedures, such as male and female circumcision, tattoos and scarification. In conclusion, only a limited number of the traditional healers believed that uvulectomy is beneficial and performed it on infants and young children, and these were mainly non-registered healers who had relatively little collaboration with modern health professionals. In refugee settings where modern health professionals might not be familiar with traditional healing, it is considered crucial to assess the risks of ongoing traditional practices and to strive to achieve more strategic communication between modern and traditional health providers

Timing of mortality among internally displaced persons due to the tsunami in Sri Lanka: cross sectional household survey

Objective To describe the distribution of mortality among internally displaced persons during two and a half months after the Indian Ocean tsunami, 2004. Design Cross sectional household survey with retrospective cohort analysis of mortality. Setting Camps for internally displaced persons due to the tsunami in an eastern coastal district of Sri Lanka. Participants 3533 people from 859 households accommodated in 13 camps. Main outcome measures All cause death and number of missing people. Results 446 deaths and 11 missing people were reported after the 2004 tsunami, of which most (99%) occurred on the day of the tsunami or within three days thereafter. No deaths were reported for the two and a half month period starting one week after the tsunami. Conclusions Most mortality after the 2004 tsunami occurred within the first few days of the disaster and was low in the study area