京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第20623号 / 社医博第81号 / 社新制||医||9(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 木原 正博, 教授 中川 一路, 教授 平家 俊男 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Abstract Objectives: Diarrheal disease is a global health challenge that assumes gigantic importance with regard to child health in developing countries like Pakistan. Prompt medical attention and proper use of Oral Re-hydration Therapy (ORT) by mothers helps prevent dehydration and secondary complications among affected children. However, ORT use among mothers in Pakistan is low. This study seeks to examine how various socio-demographic factors impact the use of ORT and dispensary treatment among mothers of children affected with diarrhea. Methods:Data from Pakistan Demographic Health Survey (2012-2013) was used for the study. The study sample consisted of women aged 15-49 years old resident in Punjab region (N= 505) with children under five years old who had diarrhea within two weeks of the survey. Chi-square tests and logistic regression analyses were used to determine relationships between maternal socio-demographic characteristics and use of ORT and dispensary care. P-values Results: After controlling for place of residence, educational level and frequency of watching television, caregivers whose children had fever with diarrheal episodes had nearly two-fold increased odds of using ORT treatment [OR= 1.9, (95% CI: 1.28-2.82)], compared to those whose children did not have fever. Similarly poor and middle class socioeconomic status (SES) participants had 3 times increased odds [OR= 2.76, [95% CI: 1.1 -6.89)] of using dispensary treatment when compared to upper class mothers. Place of residence was not a significant predictor of ORT or dispensary use. Discussion: These findings are consistent with other studies that show that mothers’ socioeconomic status are a good indicator of their knowledge about ORT use, and health care seeking behavior. On the other hand, maternal place of residence was not a significant predictor of ORT use, or consultation at a dispensary, even though other studies have found significant associations. Conclusion: Interventions aimed at improving low-income mothers’ knowledge about diarrhea management can include lay medical personnel, such as dispensers, who are often the easily accessible medical resource to this population. Therefore, dispensers should be provided with further training to increase their knowledge and skills in treating children with diarrhea. Future studies that are more rigorous should be conducted to examine this public health issue.

Magister Public Health - MPH / Aim: The aim of this study was to assess the prescribing practices and availability of antimalarial drugs to children under five years of age in primary health care facilities in Bondo district.

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

Introdução - A anemia é considerada um dos maiores problemas de saúde pública da atualidade, afetando as populações de quase todos os países, sobretudo aqueles onde predominam padrões dietéticos deficientes e fatores ambientais adversos. Objetivo - Investigar a prevalência e os fatores associados à anemia em crianças menores de cinco anos e mulheres em idade reprodutiva entre a população atendida pela Estratégia da Saúde da Família (ESF), no estado do Maranhão. Métodos Foi realizado um estudo de corte transversal de base populacional. A amostra se constitui de 978 crianças de seis a 59 meses e 978 mulheres de 15 a 49 anos de idade cadastradas na ESF em 21 municípios escolhidos por sorteio sistemático probabilístico entre as quatro macrorregiões e capital do Estado. A coleta de dados foi realizada em entrevistas domiciliares por meio de questionário aplicado junto às mães ou responsáveis pelas crianças, contendo informações sobre a situação socioeconômica e demográfica e de segurança alimentar da família, e das condições de saúde das mulheres e das crianças. Foram medidos peso e altura, para avaliação do estado nutricional e feita a dosagem da concentração de hemoglobina do sangue capilar com leitura imediata pelo hemoglobinômetro portátil Agabe®. A associação entre a anemia e as variáveis foi verificada primeiramente por análise bivariada e posteriormente por regressão de Poisson, segundo modelo hierarquizado. Resultados A prevalência média de anemia entre as mulheres foi de 36, por cento para o estado do Maranhão e 55,1 por cento para a capital, São Luís. Entre as crianças, a prevalência também foi mais elevada na capital (68,7 por cento ) em relação ao estado como um todo (51,6 por cento ). Tanto as mulheres como as crianças apresentaram prevalências mais elevadas na área urbana. O grupo de 6-23 meses de idade foi mais afetado pelo problema (65 por cento ) do que o de 24-59 meses (42 por cento ), assim como aquele cujas mães também apresentavam anemia (63,6 por cento ). A análise de regressão identificou como fatores de risco para a anemia em crianças ter idade inferior a dois anos, presença de anemia materna, coabitação de três ou mais crianças menores de cinco anos no domicílio e residir na capital do estado. Para as mulheres os fatores de risco associados à anemia foram morar na capital e estar acima do peso. Conclusões As elevadas prevalências de anemia encontradas em crianças e mulheres no Maranhão a configuram como um problema de saúde pública entre a população atendida pela ESF. É necessária a busca de intervenções factíveis de serem aplicadas uma vez que, tanto o Programa Nacional de Suplementação do Ferro, para lactentes, como o de fortificação das farinhas de trigo e de milho vigentes no Brasil não conseguiram fazer com que a prevalência avaliada através dos grupos crianças e mulheres em idade fértil esteja no limite aceitável. Igualmente há que considerar que dos fatores de risco detectados poucos são susceptíveis a modificação e estão relacionados ao consumo de alimentos e seus fatores determinantes / Introduction - Anemia is considered one of the greatest public health problems today, affecting populations of almost all countries, especially those where lacking dietary patterns and adverse environmental factors predominate. Objective - To investigate the prevalence and factors associated with anemia in children under five and women of childbearing age in the state of Maranhão. Methods - A cross-sectional study was carried out. The sample was comprised of 978 children aged six to 59 months and 978 women aged 15 to 49 years old enrolled in Family Health Strategy (FHS) in 21 counties selected by systematic random probability among the four geographical regions of the state and the capital. Data collection was performed on household interviews through questionnaire applied to mothers or childrens caretakers, containing information on demographic and socioeconomic status and household food security, and women and childrens health conditions. Weight and height were measured to assess nutritional status and followed by hemoglobin concentration of the blood capillary with immediate reading by Agabe ® portable hemoglobin. The association between anemia and the variables was checked first by bivariate analysis, followed by Poisson regression with a hierarchical model. Results - The prevalence of anemia among women was 36.0 per cent for the state of Maranhão and 55.1 per cent for capital, São Luís. Among children, the prevalence was also higher in the capital (68.7 per cent ) compared to the state as a whole (51.6 per cent ). Both women and children had a higher prevalence in urban areas. The group of 6-23 months of age was most affected by the problem (65 per cent ) than that of 24-59 months (42 per cent ), as one whose mothers also had anemia (63.6 per cent ). The regression analysis identified as risk factors for anemia in children age less than two years, the presence of maternal anemia, cohabitation of three or more children under five at home and reside in the capital. For women the risk factors associated with anemia were living in the capital and being overweight. Conclusions - The high prevalence of anemia in children and women found in Maranhão configure anemia as a public health among the population served by the FHS. It requires the implementation of feasible intervention measures for the control and prevention of this disease once, both, the National Iron Supplementation for infants, such as the fortification of wheat and corn flour current in Brazil failed to make the prevalence evaluated through children and childbearing age groups is on the acceptable limits. Its also necessary to consider that among the risk factors identified few are susceptible to modification and are related to food consumption and its determinants

Introdução - A anemia é considerada um dos maiores problemas de saúde pública da atualidade, afetando as populações de quase todos os países, sobretudo aqueles onde predominam padrões dietéticos deficientes e fatores ambientais adversos. Objetivo - Investigar a prevalência e os fatores associados à anemia em crianças menores de cinco anos e mulheres em idade reprodutiva entre a população atendida pela Estratégia da Saúde da Família (ESF), no estado do Maranhão. Métodos Foi realizado um estudo de corte transversal de base populacional. A amostra se constitui de 978 crianças de seis a 59 meses e 978 mulheres de 15 a 49 anos de idade cadastradas na ESF em 21 municípios escolhidos por sorteio sistemático probabilístico entre as quatro macrorregiões e capital do Estado. A coleta de dados foi realizada em entrevistas domiciliares por meio de questionário aplicado junto às mães ou responsáveis pelas crianças, contendo informações sobre a situação socioeconômica e demográfica e de segurança alimentar da família, e das condições de saúde das mulheres e das crianças. Foram medidos peso e altura, para avaliação do estado nutricional e feita a dosagem da concentração de hemoglobina do sangue capilar com leitura imediata pelo hemoglobinômetro portátil Agabe®. A associação entre a anemia e as variáveis foi verificada primeiramente por análise bivariada e posteriormente por regressão de Poisson, segundo modelo hierarquizado. Resultados A prevalência média de anemia entre as mulheres foi de 36, por cento para o estado do Maranhão e 55,1 por cento para a capital, São Luís. Entre as crianças, a prevalência também foi mais elevada na capital (68,7 por cento ) em relação ao estado como um todo (51,6 por cento ). Tanto as mulheres como as crianças apresentaram prevalências mais elevadas na área urbana. O grupo de 6-23 meses de idade foi mais afetado pelo problema (65 por cento ) do que o de 24-59 meses (42 por cento ), assim como aquele cujas mães também apresentavam anemia (63,6 por cento ). A análise de regressão identificou como fatores de risco para a anemia em crianças ter idade inferior a dois anos, presença de anemia materna, coabitação de três ou mais crianças menores de cinco anos no domicílio e residir na capital do estado. Para as mulheres os fatores de risco associados à anemia foram morar na capital e estar acima do peso. Conclusões As elevadas prevalências de anemia encontradas em crianças e mulheres no Maranhão a configuram como um problema de saúde pública entre a população atendida pela ESF. É necessária a busca de intervenções factíveis de serem aplicadas uma vez que, tanto o Programa Nacional de Suplementação do Ferro, para lactentes, como o de fortificação das farinhas de trigo e de milho vigentes no Brasil não conseguiram fazer com que a prevalência avaliada através dos grupos crianças e mulheres em idade fértil esteja no limite aceitável. Igualmente há que considerar que dos fatores de risco detectados poucos são susceptíveis a modificação e estão relacionados ao consumo de alimentos e seus fatores determinantes / Introduction - Anemia is considered one of the greatest public health problems today, affecting populations of almost all countries, especially those where lacking dietary patterns and adverse environmental factors predominate. Objective - To investigate the prevalence and factors associated with anemia in children under five and women of childbearing age in the state of Maranhão. Methods - A cross-sectional study was carried out. The sample was comprised of 978 children aged six to 59 months and 978 women aged 15 to 49 years old enrolled in Family Health Strategy (FHS) in 21 counties selected by systematic random probability among the four geographical regions of the state and the capital. Data collection was performed on household interviews through questionnaire applied to mothers or childrens caretakers, containing information on demographic and socioeconomic status and household food security, and women and childrens health conditions. Weight and height were measured to assess nutritional status and followed by hemoglobin concentration of the blood capillary with immediate reading by Agabe ® portable hemoglobin. The association between anemia and the variables was checked first by bivariate analysis, followed by Poisson regression with a hierarchical model. Results - The prevalence of anemia among women was 36.0 per cent for the state of Maranhão and 55.1 per cent for capital, São Luís. Among children, the prevalence was also higher in the capital (68.7 per cent ) compared to the state as a whole (51.6 per cent ). Both women and children had a higher prevalence in urban areas. The group of 6-23 months of age was most affected by the problem (65 per cent ) than that of 24-59 months (42 per cent ), as one whose mothers also had anemia (63.6 per cent ). The regression analysis identified as risk factors for anemia in children age less than two years, the presence of maternal anemia, cohabitation of three or more children under five at home and reside in the capital. For women the risk factors associated with anemia were living in the capital and being overweight. Conclusions - The high prevalence of anemia in children and women found in Maranhão configure anemia as a public health among the population served by the FHS. It requires the implementation of feasible intervention measures for the control and prevention of this disease once, both, the National Iron Supplementation for infants, such as the fortification of wheat and corn flour current in Brazil failed to make the prevalence evaluated through children and childbearing age groups is on the acceptable limits. Its also necessary to consider that among the risk factors identified few are susceptible to modification and are related to food consumption and its determinants

L’accès financier limité aux soins de santé a suscité l’instauration de politiques sanitaires de subvention des soins en Afrique. Au Burkina Faso, une ONG, en complémentarité avec la politique sanitaire nationale subventionne à 100% depuis septembre 2008 les soins et les médicaments pour les enfants de moins de cinq ans dans le district sanitaire de Dori. L’intervention regroupe formation du personnel soignant, supervisions et suppression de paiement des soins et des médicaments. L’objectif de l’étude est d’analyser l’effet de cette intervention sur l’adéquation des prescriptions médicales. Neuf centres de santé ont été pris en compte. Au total 14956 ordonnances d’enfants de moins de cinq ans ciblés par l’intervention ont été sélectionnées par échantillonnage systématique à partir des registres de consultation un an avant et un an après l’instauration de l’intervention. Quatorze prescripteurs ont été interviewés. Les prescriptions ont été analysées par comparaison au référentiel de l’OMS ainsi qu’au référentiel national. Le discours des prescripteurs a été analysé en vue de comprendre leur perception de leur changement de pratiques depuis de début de la subvention. L’intervention a eu pour effet de diminuer l’utilisation des injections (Rapport de cote (RC) =0,28; p<0,005) dans le cas des infections respiratoires aiguës (IRA). Elle a entraîné une diminution de l’utilisation inappropriée des antibiotiques dans les cas de paludisme seul (RC=0,48; p<0,0005). Le nombre moyen de médicaments par ordonnance a également diminué de 14% dans les cas d’IRA (p<0,0005). Les prescripteurs ont affirmé pour la plupart que leurs pratiques se sont soit maintenues soit améliorées. L’intervention a entrainé une amélioration de l’adéquation des prescriptions médicales dans certains cas. / The limited financial access to health care has encouraged the creation of health policies for subsidizing care in Africa. In Burkina Faso, an NGO, in line with the national health policy has been subsidizing care and medicines for children under five years in the health district of Dori since September 2008. The program includes training of health workers, supervision and removal of fees for health care and medication. The aim of the study was to analyze the effect of this free care program on the adequacy of drugs prescriptions. Nine health centers were taken into account. A total of 14,956 prescriptions of the target group of children under five years were collected from consultation records a year before and after the introduction of free care program. In addition, fourteen prescribers were interviewed. The prescriptions were analyzed in comparison to the WHO and the national reference. The prescribers’ responses were analyzed to understand their perception of their change in practice since the introduction of the free care program. The study showed that the free care program had an effect by decreasing the use of injections (Odds Ratio (OR) =0.28, p < 0.005) in acute respiratory infections (ARI) cases. It also led to decrease in inappropriate use of antibiotics in the case of malaria (OR=0.48, p<0.0005). The average number of drugs per prescription was also found to have decreased by 14% (p<0.0005) in ARI cases. Several prescribers asserted that their practices are maintained or improved. The program leads to an improvement in the adequacy of drugs prescriptions.

No description available.

Child rights, especially the right to health for children, is a concept of human development. The aim of this qualitative study is to explore the obstacles to gender equality in the right to healthcare for children under five years in East Champaran, Bihar, North India. Ten key informant interviews and nine focus group discussions with mothers, fathers, grandmothers and grandfathers were conducted to research the barriers of guardians to accessing healthcare for their children, including their root beliefs and choices, which causes health inequalities. It was found that a strong patriarchal tradition predominates in these communities in North India, which favour sons and disadvantages daughters in healthcare provision. Despite the existing child rights and human rights policies that have been legislated, in India traditional practices that discriminate against female children remain dominant in the society, and limit development in East Champaran, Bihar, North India. / Development Studies / M.A. (Development Studies)