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• Community health research based on the primary health care approach

• Risk factor analysis and intervention planning for malaria control

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• Impact of health systems reform on COVID-19 control in Sierra Leone: a case study.

  Jones-Konneh TEC, Kaikai AI, Bah IB, Nonaka D, Takeuchi R, Kobayashi J

  Tropical medicine and health   51 ( 1 ) 28   2023.05 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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• They do not have symptoms - why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study.

  An Y, Teo AKJ, Huot CY, Tieng S, Khun KE, Pheng SH, Leng C, Deng S, Song N, Nonaka D, Yi S

  BMC pulmonary medicine ( BMC Pulmonary Medicine )  23 ( 1 ) 83   2023.03 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  Abstract Background Latent tuberculosis (TB) infection has been known as a seedbed for TB disease later in life. The interruption from latent TB infection to TB disease can be done through TB preventive treatment (TPT). In Cambodia, only 40.0% of children under five years old who were the household contacts to bacteriologically confirmed TB cases were initiated with TPT in 2021. Scientific studies of context-specific operational challenges in TPT provision and uptake among children are scarce, particularly in high TB-burden countries. This study identified challenges in TPT provision and uptake among children in Cambodia from the perspective of healthcare providers and caregivers. Methods Between October and December 2020, we conducted in-depth interviews with four operational district TB supervisors, four clinicians and four nurses in charge of TB in referral hospitals, four nurses in charge of TB in health centers, and 28 caregivers with children currently or previously on TB treatment or TPT, and those who refused TPT for their eligible children. Data were audio recorded along with field notetaking. After verbatim transcription, data analyses were performed using a thematic approach. Results The mean age of healthcare providers and caregivers were 40.19 years (SD 12.0) and 47.9 years (SD 14.6), respectively. Most healthcare providers (93.8%) were male, and 75.0% of caregivers were female. More than one-fourth of caregivers were grandparents, and 25.0% had no formal education. Identified key barriers to TPT implementation among children included TPT side effects, poor adherence to TPT, poor understanding of TPT among caregivers, TPT risk perception among caregivers, TPT’s child-unfriendly formula, TPT supply-chain issues, caregivers’ concern about the effectiveness of TPT, being non-parental caregivers, and poor community engagement. Conclusion Findings from this study suggest that the national TB program should provide more TPT training to healthcare providers and strengthen supply chain mechanisms to ensure adequate TPT drug supplies. Improving community awareness of TPT among caregivers should also be intensified. These context-specific interventions will play a crucial role in expanding the TPT program to interrupt the development from latent TB infection to active and ultimately lead to ending TB in the country.

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• Barriers to childhood tuberculosis case detection and management in Cambodia: the perspectives of healthcare providers and caregivers.

  An Y, Teo AKJ, Huot CY, Tieng S, Khun KE, Pheng SH, Leng C, Deng S, Song N, Nonaka D, Yi S

  BMC infectious diseases ( BMC Infectious Diseases )  23 ( 1 ) 80   2023.02 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  Abstract Background Diagnosis and treatment of tuberculosis (TB) in children remain challenging, particularly in resource-limited settings. Healthcare providers and caregivers are critical in improving childhood TB screening and treatment. This study aimed to determine the barriers to childhood TB detection and management from the perspectives of healthcare providers and caregivers in Cambodia. Method We conducted this qualitative study between November and December 2020. Data collection included in-depth interviews with 16 healthcare providers purposively selected from four operational districts and 28 caregivers of children with TB and children in close contact with bacteriologically confirmed pulmonary TB residing in the catchment areas of the selected health centers. Data were analyzed using thematic analyses. Results Mean ages of healthcare providers and caregivers were 40.2 years (standard deviation [SD] 11.9) and 47.9 years (SD 14.6), respectively. Male was predominant among healthcare providers (93.8%). Three-fourths of caregivers were female, and 28.6% were grandparents. Inadequate TB staff, limited knowledge on childhood TB, poor collaboration among healthcare providers in different units on TB screening and management, limited quality of TB diagnostic tools, and interruption of supplies of childhood TB medicines due to maldistribution from higher levels to health facilities were the key barriers to childhood TB case detection and management. Caregivers reported transportation costs to and from health facilities, out-of-pocket expenditure, time-consuming, and no clear explanation from healthcare providers as barriers to childhood TB care-seeking. Aging caregivers with poor physical conditions, lack of collaboration from caregivers, ignorance of healthcare provider's advice, and parent movement were also identified as barriers to childhood TB case detection and management. Conclusions The national TB program should further invest in staff development for TB, scale-up appropriate TB diagnostic tools and ensure its functionalities, such as rapid molecular diagnostic systems and X-ray machines, and strengthen childhood TB drug management at all levels. These may include drug forecasting, precise drug distribution and monitoring mechanism, and increasing community awareness about TB to increase community engagement.

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• Primary health care situations in remote rural villages of the Savannakhet province, Lao People's Democratic Republic.

  Nonaka D, Inthavong N, Takahashi K, Chanthakoumane K, Toyama Y, Luangphaxay C, Pongvongsa T, Kounnavong S

  Tropical medicine and health ( Tropical Medicine and Health )  50 ( 1 ) 90 - 90   2022.11 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  BACKGROUND: To improve the health of the rural population in the Lao People's Democratic Republic (Lao PDR), the government has emphasized a primary health care approach in the Health Sector Reform Strategy by 2025. The objective of the present study was to describe the health-related situations of remote rural villages of the Lao PDR to inform strategies for promoting primary health care in such villages. METHODS: Ten remote rural villages were purposively selected from the catchment areas of two health centers in the Xepon district, Savannakhet province. The surveyors collected data by conducting a questionnaire-based interview with village health volunteers and by observing the village environment in 2018. The survey focused on village situations on the eight elements of primary health care (health education; food supply and nutrition; safe water and basic sanitation; maternal and child health care; immunization; prevention and control of locally endemic diseases; treatment of common diseases and injuries; and provision of essential drug). RESULTS: The common health problems were diarrhea, followed by malaria, and cough. The identified possible risk factors for the health problems were not washing hands with soap, open defecation, not boiling drinking water, not exclusively breastfeeding, presence of animal feces on the village ground, absence of garbage management system, not using a bed net when sleeping in the forest, and exposure to indoor cooking and tobacco smoke. In many villages, villagers were not able to eat enough food and did not eat protein-rich food and vegetables daily. CONCLUSIONS: Potential risk factors for the reported common health problems were often prevalent in the study villages. Villagers can address most of these risk factors, as interventions to address such risk factors do not require a large financial input. There is a need for intersectoral actions between the health and other sectors to address food shortages and indoor air pollution due to indoor cooking using biomass fuel.

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• Factors Associated with Delayed Diagnosis among Patients with COVID-19 in Okinawa, Japan.

  Oiwake HY, Nonaka D, Toyosato T

  International journal of environmental research and public health ( International Journal of Environmental Research and Public Health )  19 ( 14 ) 8634 - 8634   2022.07 [ Peer Review Accepted ]

  Type of publication: Research paper (scientific journal)

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  The delayed presentation and diagnosis of COVID-19 can contribute to spread of the disease to others but can also cause severe conditions. This study examined factors associated with delayed diagnosis among patients with COVID-19 in Okinawa, Japan. We used the data from 7125 reported cases of people living in Okinawa prefecture with symptom onset between September 2020 and March 2021. The outcome variable was the number of days from symptom onset to diagnosis. The predictor variables included age, sex, occupation, residential area, presumed infection route, and the day of the week. Cox regression analysis was used to compare the outcome between categories for each predictor variable. The median number of days from onset to diagnosis was 3 days, with an interquartile range of 1 to 5 days. Significantly more time from onset to diagnosis was observed in patients in their 60s vs. those in their 20s (hazard ratio: 0.88; 95% confidence interval: 0.81–0.96); hospitality workers were compared to office workers (0.90; 0.83–0.97), patients with unknown infection routes to those with known infection routes (0.77; 0.70–0.84), and those with symptom onset on Sundays/national holidays to those with symptom onset on weekdays (0.90; 0.85–0.96).

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Grant-in-Aid for Scientific Research 【 display / non-display 】

Grant-in-Aid for Scientific Research 【 display / non-display 】

• Grant-in-Aid for Scientific Research(C)

  Project Year: 2019.04  -  2022.03 

• Grant-in-Aid for Scientific Research(C)

  Project Year: 2016.04  -  2019.03 

  Direct: 2,700,000 (YEN)  Overheads: 810,000 (YEN)  Total: 3,510,000 (YEN)

Preferred joint research theme 【 display / non-display 】

Preferred joint research theme 【 display / non-display 】

• Impacts of U.S. bases on the health of Okinawa people

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