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• Working in pairs: male-female village health volunteers supporting maternal health and community engagement in remote and ethnic communities of Lao PDR-a qualitative study.

  Uehara M, Vongphoumy I, Ahissou NCA, Pongvongsa T, Phongluxa K, Kobayashi J

  Tropical medicine and health ( Springer Science and Business Media LLC )  53 ( 1 ) 141   2025年10月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  Abstract Background Community health workers (CHWs) are vital for improving maternal and child health (MCH) in underserved settings; however, gender norms often influence their functioning. In the Lao PDR, Village Health Volunteers (VHVs) serve as frontline CHWs in rural areas. Xepon District is a remote border area with Vietnam, characterized by underserved conditions, limited health access, and predominantly ethnic minority populations. The VHV workforce in this district is largely male, which restricts culturally acceptable outreach to women and underscores the need to test a paired male–female model. To address this gender-related limitation, a provincial pilot program introduced male–female VHV/VHW pairs to strengthen MCH outreach. Objectives This study aims to explore how the male–female paired VHV model functions in remote ethnic minority communities and its contributions to maternal health promotion. Methods A qualitative descriptive study was conducted in 19 pilot villages in Xepon District, Savannakhet Province, from June to October 2024. Semi-structured interviews were held with 42 participants, including mothers, their partners, VHVs, village leaders, health center staff, and district/provincial health officials. Interviews were transcribed, translated, and analyzed using inductive thematic analysis based on Braun and Clarke’s six-phase framework. Results Four key themes emerged: (1) building trust and comfort through gender-matched interactions; (2) gender-specific responsibilities and task sharing between paired VHVs; (3) strengthening family support and health system linkages through female VHV/VHWs engagement; and (4) challenges and support needs for strengthening the VHV Program. Female VHV/VHWs played a crucial role in culturally sensitive maternal outreach, whereas male VHVs facilitated engagement with male household members and community leaders. Paired implementation enhanced service utilization and helped shift household norms. However, challenges persisted, including gender selection barriers, literacy gaps, and limited institutional support for paired training and supervision. Conclusion The male–female VHV/VHWs model may enhance access to MCH services by engaging men and women in complementary roles tailored to local contexts. To maximize its potential, institutional commitment is needed to formalize pair-based training, address gender barriers in recruitment, and strengthen community- and policy-level support systems for CHWs. Given the 2023 PHC policy, embedding gender-sensitive and context-specific approaches into guidelines and training manuals may be critical for aligning service delivery with sociocultural realities and ensuring responsiveness to the unique needs of remote communities.

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• Effect of trust in village health workers on the use of facility-based follow-up postnatal care services in two districts in the Lao People's Democratic Republic.

  Ahissou NCA, Uehara M, Nonaka D, Vongphoumy I, Pongvongsa T, Ounlienvongsack K, Phongluxa K, Kounnavong S, Kobayashi J

  Tropical medicine and health ( Springer Science and Business Media LLC )  53 ( 1 ) 61   2025年04月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  Abstract Background Despite high coverage of antenatal care services (89.8%) and facility-based deliveries (79.8%), delayed initiation or lack of follow-up postnatal care (PNC) visits remains a challenge in the Lao People's Democratic Republic (Lao PDR). Follow-up PNC encourages healthy lifestyles and monitoring mothers' and newborns' health to decrease postpartum complications and hospital readmissions. While village health volunteers and workers (VHVs/VHWs) are essential for health promotion in Lao PDR, the extent to which mothers' trust in VHVs/VHWs helps promote better service utilization has not been studied. Objectives We investigated the trust levels in VHVs/VHWs among ethnic minority mothers and the influence on the use of facility-based follow-up PNC. Methods We utilized cross-sectional data from July and August 2024, collected as a baseline survey for a quasi-experimental study conducted in 35 villages across the Sepone and Vilabuly districts. We compared the respondents' PNC usage and characteristics using chi-square tests and Fisher’s exact tests. Standard binary logistic regression analyses were conducted to estimate the effects of various factors on the utilization of facility-based follow-up PNC. Trust in VHVs/VHWs was a construct variable based on their provision of emotional support, relevant information, adequate discussion time, effective care, and the likelihood of future pregnancy-related care. Results The study enrolled 241 mothers (mean age 24 years, SD 5.7), including 110 from Sepone and 131 from Vilabuly. Overall, the follow-up PNC coverage rate was 19.0%, and there was no significant difference between Sepone and Vilabuly, despite variations in access to healthcare and engagement with VHVs/VHWs. High trust in VHVs/VHWs was linked to 12.25 times higher odds of utilizing follow-up PNC than low trust (95% CI 2.2–67.8). In addition, having an older child (9–12 months) and immediate PNC utilization were beneficial for subsequent PNC use. Unexpectedly, contact with VHVs/VHWs during prenatal and/or postnatal periods decreased the odds of utilizing follow-up PNC, with distance to health facilities and adherence to traditional gender norms also having a similar negative effect. Conclusions Facility-based follow-up postnatal care was critically low among respondents; however, increasing trust in VHVs/VHWs may foster improvements. Along with increasing contact frequency, offering quality support to mothers through VHVs/VHWs while emphasizing the complementary nature of community-based and facility-based care could be beneficial. Effective interventions may also include enhancing immediate PNC and tackling physical accessibility challenges, as well as restrictive gender norms through male involvement.

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• Effectiveness of Village Health Volunteers/Workers Working as Male-Female Pairs on Women's Use of Postnatal Care Services in Sepone District in Lao People's Democratic Republic: A Protocol for a Quasi-experimental Cluster Study.

  Ahissou NCA, Uehara M, Nonaka D, Vongphoumy I, Pongvongsa T, Ounlienvongsack K, Phongluxa K, Kounnavong S, Kobayashi J

  Cureus ( Springer Science and Business Media LLC )  17 ( 4 ) e82786   2025年04月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

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• Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People's Democratic Republic from 2006 to 2017: MICS data analysis.

  Ahissou NCA, Nonaka D, Takeuchi R, de Los Reyes C, Uehara M, Khampheng P, Kounnavong S, Kobayashi J

  Tropical medicine and health ( Springer Science and Business Media LLC )  51 ( 1 ) 56   2023年10月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

  　概要を見る

  Abstract Background Maternal mortalities remain high in the Lao People’s Democratic Republic (Lao PDR). Since 2012, to improve access to maternal health services for all women, the country implemented several policies and strategies including user fee removal interventions for childbirth-related care. However, it remains unclear whether inequalities in access to services have reduced in the post-2012 period compared to pre-2012. Our study compared the change in sociodemographic and economic inequalities in access to maternal health services between 2006 to 2011–12 and 2011–12 to 2017. Methods We used the three most recent Lao Social Indicator Survey datasets conducted in 2006, 2011–12, and 2017 for this analysis. We assessed wealth, area of residence, ethnicity, educational attainment, and women’s age-related inequalities in the use of at least one antenatal care (ANC) visit with skilled personnel, institutional delivery, and at least one facility-based postnatal care (PNC) visit by mothers. The magnitude of inequalities was measured using concentration curves, concentration indices (CIX), and equiplots. Results The coverage of at least one ANC with skilled personnel increased the most between 2012 and 2017, by 37.1% in Hmong minority ethnic group women, 36.1% in women living in rural areas, 31.1%, and 28.4 in the poorest and poor, respectively. In the same period, institutional deliveries increased the most among women in the middle quintiles by 32.8%, the poor by 29.3%, and Hmong women by 30.2%. The most significant reduction in inequalities was related to area of residence between 2006 and 2012 while it was based on wealth quintiles in the period 2011–12 to 2017. Finally, in 2017, wealth-related inequalities in institutional delivery remained high, with a CIX of 0.193 which was the highest of all CIX values. Conclusion There was a significant decline in inequalities based on the area of residence in the use of maternal health services between 2006 and 2011–12 while between 2011–12 and 2017, the largest decrease was based on wealth quintiles. Policies and strategies implemented since 2011–12 might have been successful in improving access to maternal health services in Lao PDR. Meanwhile, more attention should be given to improving the uptake of facility-based PNC visits.

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• Impact of village health volunteer support on postnatal depressive symptoms in the remote rural areas of Lao People's Democratic Republic: a cross-sectional study.

  Toyama N, Vongphoumy I, Uehara M, Sato C, Nishimoto F, Moji K, Pongvongsa T, Shirai K, Takayama T, Takahara M, Tamashiro Y, Endo Y, Kounnavong S, Kobayashi J

  Tropical medicine and health ( Springer Science and Business Media LLC )  49 ( 1 ) 28   2021年03月 [ 査読有り ]

  掲載種別: 研究論文（学術雑誌）

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  Abstract Background Village health volunteers (VHVs) are responsible for providing primary care in the communities of Laos. Unlike other districts, in Xepon more than 90% of VHVs are male and therefore experience difficulties interacting with pregnant women. To improve outreach to pregnant women, especially among ethnic minorities, a new project was implemented by local municipalities in 2017: newly selected female VHVs were paired to work with existing male VHVs. The objective of this study was to compare the postnatal depressive symptoms of ethnic minority mothers supported by pair-VHVs and single-VHVs in remote rural areas of Lao People’s Democratic Republic (PDR). Methods A cross-sectional study was conducted in March 2019. Mothers who had delivered a baby within 1 year preceding the study were recruited from 36 villages. Of the 305 mothers, 227 responded. The questionnaires included (1) demographic characteristics such as age, economic status, and birth experience; (2) self-decision to go to a health center/hospital to receive antenatal care; (3) type of VHVs (pair or single), support, and information from VHVs during pregnancy, support from husband and relationship with husband; (4) the Edinburgh Postnatal Depression Scale (EPDS). A Mann-WhitneyUtest, chi-square test, and multiple linear regression analysis were performed. Ethical approval was obtained from the University of the Ryukyus and National Ethics Committee for Health Research of Lao PDR. Results The average total EPDS score was 5.5 among mothers supported by pair-VHV and 7.0 among mothers supported by single-VHV. Results of the multiple linear regression analysis showed that the EPDS score was significantly lower among mothers supported by pair-VHV (β=−1.18,p<0.05) even after adjusting for economic and biological factors. Conclusions Mothers supported by pair-VHV had a significantly lower EPDS score than those supported by single-VHVs in this study area, suggesting that the support of male and female VHV pairs contributed to improving mental health status among ethnic minority mothers in remote rural areas of Lao PDR. Expanding the program to train female VHVs working with male VHVs is necessary for improving maternal and child health in a rural district of Lao PDR.

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• 遅寝である児の保護者の睡眠に関する自由記述の分析

  儀間 繼子, 上原 真名美, 辻野 久美子, 玉城 陽子, 遠藤 由美子

  日本看護科学学会学術集会講演集  1900年01月  -  1900年01月   

• 沖縄県5市における3歳児の早寝である保護者の児の睡眠に関する自由記述の分析

  儀間 繼子, 上原 真名美, 辻野 久美子, 遠藤 由美子, 玉城 陽子

  小児保健研究  1900年01月  -  1900年01月   

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• ラオス山岳少数民族の乳幼児を対象とした季節的栄養不足と健康への影響：縦断混合研究

  研究活動スタート支援

  課題番号: 25K24216

  研究期間: 2025年07月  -  2027年03月 

  代表者: 上原 真名美 

  直接経費: 2,000,000（円）  間接経費: 2,600,000（円）  金額合計: 600,000（円）

• アジアのCSE推進のための教育・研究人材養成プログラムの開発と国際ネットワーク構築

  基盤研究(A)

  課題番号: 25H00567

  研究期間: 2025年04月  -  2030年03月 

  代表者: 友川 幸, 竹内 理恵, 城川 美佳, ヤマモト ベバリーアン, 日達 真美, 杉田 映理, 上原 真名美, 小林 潤, 小笠原 理恵, MAWER Kim, 渋谷 文子 

  直接経費: 35,000,000（円）  間接経費: 45,500,000（円）  金額合計: 10,500,000（円）

• 低中所得国貧困僻地でのライフコースアプローチによる母子保健戦略策定の為の評価研究

  基盤研究(B)

  課題番号: 23K24659

  研究期間: 2024年04月  -  2027年03月 

  代表者: 小林 潤, 高橋 謙造, 野中 大輔, 友川 幸, 上原 真名美, 前田 縁子 

  直接経費: 13,100,000（円）  間接経費: 17,030,000（円）  金額合計: 3,930,000（円）

  　概要を見る

  ラオス人民民主共和国サバナケット県の2つの郡から選定された37村の比較対象研究計画を立案した。介入前後のサービス利用率の変化を推定するため、差分分析を実施する。その後、混合効果二項ロジスティック回帰分析を用いて、男女保健ボランティアのペアリングと施設ベースの産後ケア利用との関連性を、他の共変量と時間効果を調整して評価する内容である。このプロトコールは国際学術雑誌に論文として掲載された。今後このプロトコールにもとずいて、2025年11月にフォローアップ調査を行い評価を行う予定である。 また母子保健サービスの受け手としてパイロット村落の女性、サービスの提供側として保健センタースタッフおよび保健ボランティア、それぞれに対して深層インタビューとフォーカルグループディスカッションを行った。ラオス語および少数民族の言語によって行われたインタビューの逐語録を英語に翻訳した。逐語録を複数の研究者によって分析し、男女保健ボランティアのペアリングサービスの実施によって起こった現象を明らかにした。この結果、女性保健ボランティアはコミュニティメンバーから「親しみやすい相談役」として信頼され受け入れられていたが、男性保健ボランティアはリーダーシップを発揮し、コミュニティと保健専門家との調整役を果たしていた。さらに男性と女性の保健ボランティア間のタスク分担は、より多くのコミュニティメンバーへのアウトリーチを効果的に可能にしていることも明らかになった。