BackgroundSchool children have been increasingly recognized as health messengers for malaria control. However, little evidence is available. The objective of this study was to determine the impact of school-based malaria education intervention on school children and community adults.MethodsThis study was conducted in the Dangme-East district of the Greater Accra Region, Ghana, between 2007 and 2008. Trained schoolteachers designed participatory health education activities and led school children to disseminate messages related to malaria control to their communities. Three schools and their respective communities were chosen for the study and assigned to an intervention group (one school) and a control group (two schools). Questionnaire-based interviews and parasitological surveys were conducted before and after the intervention, with the intervention group (105 children, 250 community adults) and the control group (81 children, 133 community adults). Chi-square and Fisher's Exact tests were used to analyse differences in knowledge, practices, and parasite prevalence between pre- and post-intervention.ResultsAfter the intervention, the misperception that malaria has multiple causes was significantly improved, both among children and community adults. Moreover, the community adults who treated a bed net with insecticide in the past six months, increased from 21.5% to 50.0% (p < 0.001). Parasite prevalence in school children decreased from 30.9% to 10.3% (p = 0.003). These positive changes were observed only in the intervention group.ConclusionsThis study suggests that the participatory health education intervention contributed to the decreased malaria prevalence among children. It had a positive impact not only on school children, but also on community adults, through the improvement of knowledge and practices. This strategy can be applied as a complementary approach to existing malaria control strategies in West African countries where school health management systems have been strengthened.

In the last decade, a National School Health Policy (NSHP) has been formulated in several developing countries following the recommendations of the Global School Health Initiative. However, NSHP implementations across the country have not been fully shared. This study aimed to identify factors that have influenced implementation of the NSHP in Lao People's Democratic Republic (Lao PDR). We conducted key informant interviews with 20 NSHP implementers and document reviews. Data were collected at the national level and at three lower administrative levels (provincial, district and school) in three areas (north, central and south). Study areas were selected according to the history of NSHP interventions. We applied content analysis using 12 key components of successful policy implementation and a policy triangle framework. We found that scaling up to nationwide implementation was limited. Results showed the NSHP implementation in Lao PDR was influenced by nine interlinked factors, including extensive planning, resource management, monitoring cycle, the perception gap between national and lower administrative officers, national task-force ownership, ongoing coaching of district educational officers, management skills of school principals, priority of school health and decentralization. Furthermore, these nine factors could be integrated into the existing educational system. In conclusion, for sustainable and nationwide implementation of the NSHP in Lao PDR, the following three factors need to be embedded in the educational system: extensive planning with a clear long-term vision at national level, human resource management including well-organized training at each administrative level and a monitoring cycle to understand the real situation at school level.

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a b s t r a c tKeywords: Depressive symptoms, Serum ferritin, Body iron store, General population, JapaneseIt remains unclear whether levels of body iron store are related to milder forms of depression, which are more common among apparently healthy people. We examined the association between serum ferritin concentrations and depressive symptoms among 312 men and 216 women working in two municipal offices in Japan. Depressive symptoms were assessed by using the Center for Epidemiologic Studies Depression (CES-D) scale. In men, increased prevalence of depressive symptoms (defined by using a cutoff value of ≥ 19) was significantly associated with decreased levels of serum ferritin. In age-and study-site-adjusted models, ORs (95% CIs) for depressive symptoms for men in first, second, third, and fourth quartiles of serum ferritin concentrations were 2.83 (1.01-7.94), 1.74 (0.87-3.49), 1.33 (0.71-2.47), and 1.00 (reference), respectively (p for trend = 0.02). In multivariate-adjusted model, ORs (95% CIs) in first, second, third, and fourth quartiles of serum ferritin concentrations were 2.88 (0.93-8.91), 1.91 (0.90-4.05), 1.28 (0.66-2.49), and 1.00 (reference), respectively (p for trend = 0.03). No significant association was detected in women. Our finding that men with lower levels of serum ferritin concentrations had a higher prevalence of depressive symptoms suggests that adverse psychological effects may be implicated in iron deficiency among middle-age Japanese workers.

BackgroundSchool health promotion has been shown to improve the lifestyle of students, but it remains unclear whether school-based programs can influence family health. We developed an innovative program that enables school children to act as change agents in promoting healthy lifestyles of their mothers. The objective of this study was to examine the effect of the child-initiated intervention on weight, physical activity and dietary habit of their mothers.MethodsA 12-month cluster randomized trial was conducted, with school as a cluster. Participants were mothers with grade 8 students, aged around 13 years, of 20 schools in Homagama, Sri Lanka. Students of the intervention group were trained by facilitators to acquire the ability to assess noncommunicable disease risk factors in their homes and take action to address them, whereas those of the comparison group received no intervention. Body weight, step count and lifestyle of their mothers were assessed at baseline and post-intervention. Multi-level multivariable linear regression and logistic regression were used to assess the effects of intervention on continuous and binary outcomes, respectively.ResultsOf 308 study participants, 261 completed the final assessment at 12 month. There was a significantly greater decrease of weight and increase of physical activity in the intervention group. The mean (95 % confidence interval) difference comparing the intervention group with the control group was −2.49 (−3.38 to −1.60) kg for weight and −0.99 (−1.40 to −0.58) kg/m2 for body mass index. The intervention group had a 3.25 (95 % confidence interval 1.87–5.62) times higher odds of engaging in adequate physical activity than the control group, and the former showed a greater number of steps than the latter after intervention. The intervention group showed a greater reduction of household purchase of biscuits and ice cream.ConclusionsA program to motivate students to act as change agents of family’s lifestyle was effective in decreasing weight and increasing physical activity of their mothers.Trial registrationSri Lanka Clinical Trials Registry SLCTR/2013/011.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0369-7) contains supplementary material, which is available to authorized users.

BackgroundOverall pandemic A (H1N1) influenza vaccination rates remain low across all nations, including Japan. To increase the rates, it is important to understand the motives and barriers for the acceptance of the vaccine. We conducted this study to determine potential predictors of the uptake of A (H1N1) influenza vaccine in a cohort of Japanese general population.Methodology/Principal FindingsBy using self-administered questionnaires, this population-based longitudinal study was conducted from October 2009 to April 2010 among 428 adults aged 18–65 years randomly selected from each household residing in four wards and one city in Tokyo. Multiple logistic regression analyses were performed. Of total, 38.1% of participants received seasonal influenza vaccine during the preceding season, 57.0% had willingness to accept A (H1N1) influenza vaccine at baseline, and 12.1% had received A (H1N1) influenza vaccine by the time of follow-up. After adjustment for potential confounding variables, people who had been vaccinated were significantly more likely to be living with an underlying disease (p = 0.001), to perceive high susceptibility to influenza (p = 0.03), to have willingness to pay even if the vaccine costs ≥ US$44 (p = 0.04), to have received seasonal influenza vaccine during the preceding season (p<0.001), and to have willingness to accept A (H1N1) influenza vaccine at baseline (p<0.001) compared to those who had not been vaccinated.Conclusions/SignificanceWhile studies have reported high rates of willingness to receive A (H1N1) influenza vaccine, these rates may not transpire in the actual practices. The uptake of the vaccine may be determined by several potential factors such as perceived susceptibility to influenza and sensitivity to vaccination cost in general population.

BackgroundIn Savannakhet province, Laos and Quang Tri province, Vietnam, malaria is still an important health problem and most cases are found in the mountainous, forested border areas where ethnic minority groups live. The objectives of this study were to obtain a better joint understanding of the malaria situation along the border and, on the basis of that, improve malaria control methods through better cooperation between the two countries.MethodsFourteen villages in Savannakhet and 22 villages in Quang Tri were randomly selected within 5 km from the border where a blood survey for microscopic diagnosis (n = 1256 and n = 1803, respectively), household interviews (n = 400, both sides) and vector surveys were conducted between August and October 2010. Satellite images were used to examine the forest density around the study villages.ResultsMalaria prevalence was significantly higher in Laos (5.2%) than in Vietnam (1.8%) and many other differences were found over the short distance across the border. Bed net coverage was high (> 90%) in both Laos and Vietnam but, while in Laos more than 60% of the nets were long-lasting insecticide-treated, Vietnam used indoor residual spraying in this area and the nets were untreated. Anopheles mosquitoes were more abundant in Laos than in Vietnam, especially many Anopheles dirus were captured in indoor light traps while none were collected in Vietnam. The forest cover was higher around the Lao than the Vietnamese villages. After this study routine exchange of malaria surveillance data was institutionalized and for the first time indoor residual spraying was applied in some Lao villages.ConclusionsThe abundance of indoor-collected An. dirus on the Laos side raises doubts about the effectiveness of a sole reliance on long-lasting insecticide-treated nets in this area. Next to strengthening the early detection, correct diagnosis and prompt, adequate treatment of malaria infections, it is recommended to test focal indoor residual spraying and the promotion of insect repellent use in the early evening as additional vector interventions. Conducting joint malaria surveys by staff of two countries proved to be effective in stimulating better collaboration and improve cross-border malaria control.

BackgroundArtemisinin resistance in Plasmodium falciparum has been spreading across Southeast Asia. Patients’ adherence to artemisinin-based combination therapy (ACT) is critical to avoid expanding this resistance. The objectives of this research were to examine patients’ adherence to ACT for the treatment of uncomplicated malaria and to examine the healthcare workers’ perception of medication adherence and their dispensing practices for malaria patients in Savannakhet province, Lao PDR.MethodsA prospective observational study of patients and a descriptive study of healthcare workers were conducted in Xepon, Phin, and Nong districts. In the patient study, patients aged 18 years old or older who were prescribed artemether-lumefantrine (AL) at six healthcare facilities between October 2016 and August 2017 were examined. Patient interviews and tablet counts were conducted on the first day of treatment (day 0) and the follow-up day (around day 3). In the healthcare workers study, a self-administered questionnaire survey was conducted.ResultsOf the 54 patients examined, 51 (94.4%) were adherent to the AL regimen. The other three patients stopped medication because they felt better, even though the importance of completing the regimen was explained to all patients when it was prescribed. Among 152 healthcare workers who had ever instructed a malaria patient, 74.3% reported that they occasionally saw a malaria patient who adhered poorly to medication instructions. The healthcare workers perceived the major reasons for poor adherence to be illiteracy and poor understanding of medication instructions by patients. In practice, 27.6% of the healthcare workers did not regularly explain the importance of completing the regimen to patients, and 32.2% did not often or always confirm the patients’ understanding of medication instructions.ConclusionsPatient adherence to AL was high. The healthcare workers perceived that poor adherence was attributable to the patients, i.e., their poor understanding and illiteracy, which appeared to be related to linguistic differences. However, poor adherence also appeared to be attributable to the healthcare workers, who should tell patients of the importance of completing the AL regimen regardless of their improvement in physical condition and also confirm the patients’ understanding of the instructions.Electronic supplementary materialThe online version of this article (10.1186/s41182-018-0125-6) contains supplementary material, which is available to authorized users.