Objectives: The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health-care accessibility.Methods: Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicoré, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicoré at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training.Results: Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to “provide strong medicine” (P < 0.001) and “provide injections” (P < 0.001), and came to appreciate “go to hospital with a sick person” (P = 0.031) as a function and role of CHWs.Conclusions: The results of the present study indicated that steady approaches to motivate and support CHWs in resource-limited settings could improve performance of CHWs and satisfaction of people in the community regarding the activities of CHWs to sustain their health.
We conducted a case study to assess 1) physical and mental changes; 2) self-assessments of symptoms; 3) coping strategies; and 4) adaptation to physical and mental changes by semi-structured interview survey among Vietnamese female migrant workers working in Japan under the technical intern training Program. We found they experienced female-specific physical changes, and some interns' symptoms worsened because they did not consult anyone about their symptoms. We propose increasing opportunities to learn about possible physical and mental changes caused by migration and to improve health literacy, including prevention, coping, help-seeking, and consultations about health concerns among female technical interns.The International Labor Organization (ILO) estimated that there were 164 million migrant workers worldwide and female migrant workers accounted for 41.6% in 2017 (ILO, 2018). Female migrant workers are making crucial contributions to destination countries as well as in their countries of origin (ILO, 2019).Migrants often face challenges regarding health conditions and rights of access to adequate medical-healthcare services (Nørredam, 2015;Simich et al., 2007). Furthermore, female migrants encounter reproductive health concerns and underserved conditions in addition to general health challenges (Barkensjö et al., 2018;Schmied et al., 2017). To deal with such global challenges, the member states of World Health Organization (WHO) agreed on a global action plan to promote the health of refugees and migrants in 2019 (World Health Organization, 2019).The Japanese government established the Technical Intern Training Program (TITP) to provide an opportunity for people from 14 Asian
Objective: Participation in social activities is associated with physical and psychological health in the community-dwelling elderly population. We examined the two factors of social relations and community health resources, associated with higher self-rated health levels in the community-dwelling elderly.Methods: A total of 145 community-dwelling elderly people ≥ 65 years old from two neighborhood associations in Nagasaki City were recruited for this study, representing 85% of the officially registered ≥ 65-year-old population in the target area. Face-to-face interviews using a structured questionnaire were conducted by trained interviewers in August 2009, with questions related to sociodemographic characteristics, social relationships, and self-rated health (SRH). Community health resources (type and walking distance from home) were evaluated by one of the authors as a community assessment.Results: Seventy-eight community-dwelling elderly people (25 men and 53 women) participated in the study. Elderly people who reported going out every day were more likely to show higher SRH scores (excellent/good) than those going out less often (OR: 3.7; 95% confidence interval [CI]: 1.0, 14.2; P = 0.056). The numbers of interactions with friends in higher and lower SRH groups were 6.5 ± 8.4 (mean ± standard deviation) and 2.4 ± 1.1 (P = 0.01, Mann-Whitney U test), respectively. The numbers of relatives talking on the phone in higher and lower SRH groups were 2.9 ± 1.3 and 2.2 ± 1.2 (P = 0.031, Mann-Whitney U test), respectively. Meeting scores with friends in higher and lower SRH groups were 7.8 ± 5.8 and 4.5 ± 3.6 (P = 0.068), respectively. The scores of community health resources among higher and lower SRH groups were 21.2 ± 1.5 and 20.9 ± 1.4 (P = 0.547), respectively. The scores of community association/activities in higher and lower SRH groups were 3.9 ± 1.0 and 3.6 ± 0.9 (P = 0.227), respectively.Conclusion: This study indicated the importance of interaction with friends and relatives for maintaining higher SRH among community-dwelling elderly people.
Objective: An accidental fire that occurred in a hillside residential area in the city of Nagasaki was evaluated to assess the challenges faced by communities located on sloped terrains and to develop community-based support systems applicable to such hillside residential areas. Methods: Community observations and key-informant interviews were performed in the area affected by the fire. A self-administered questionnaire survey was also conducted among residents of the affected area. Information obtained through community observations of the fire-struck area and key-informant interviews was analyzed and assessed using a two-dimensional (2D) framework. Results: According to community observations and key-informant interviews, initial firefighting efforts were delayed due to lack of preparedness, in addition to geographic factors such as narrow roads and outdoor staircases, which allowed the fire to spread. The livelihood and health support measures for elderly residents requiring evacuation assistance were also insufficient. A hospital neighboring the area affected by the fire accident voluntarily provided some services to evacuees, but support from other nearby organizations/institutions was either not available or not offered. According to the questionnaire answers, elderly residents had little knowledge of the location and proper use of fire hydrants in their area. In addition, 65% of the respondents had never participated in disaster training exercises. From these results, the following three points could be determined: 1) The geographic features of the hillside residential area enhanced the spread of the fire. 2) The multi-sector support systems for evacuees were inadequate, collaboration among the existing systems was insufficient, and the roles of those systems were not fully clarified in advance. 3) Elderly residents in the hillside residential area did not have sufficient the knowledge and/or ability to engage in fire prevention activities and had inadequate firefighting skills. Conclusions: It is important to improve disaster preparedness knowledge and training for local residents on ordinary times. Additionally, cross-sector collaborative disaster response, harmonious management, and support systems must be ensured and sustained before, during, and after disasters.
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