The growing prevalence of gaming disorder (GD) in adolescents is a global concern. Despite parents' critical role in addressing GD, how dysfunctional parenting practices are associated with adolescent GD remains understudied. This study assessed the association between dysfunctional parenting practices and adolescent GD among Japanese male junior high school students. Data were collected in 2024 via web-based, self-administered questionnaires from 300 parents (183 fathers and 117 mothers), each reporting on one male junior high school student. Suspected GD was assessed using a validated parent report measure (i.e., the Gaming Disorder Scale for Parents). Dysfunctional parenting practices were measured using the Parenting Scale, comprising two dimensions: Overreactivity and Laxness. Mean factor scores of Overreactivity and Laxness were compared between the suspected and non-suspected GD groups using a t-test. Logistic regression models assessed the association of Overreactivity and Laxness with suspected GD, controlling for covariates. The mean score of Overreactivity was significantly higher in the suspected GD group than in the non-suspected group, whereas that of Laxness was not. After adjustment, overreactive parenting was significantly associated with suspected GD (adjusted odds ratio: 1.89, 95% CI [1.31, 2.74]). This study showed that overreactive parenting was independently and significantly associated with increased odds of suspected GD.

INTRODUCTION:Malaria is a parasitic disease caused by Plasmodium parasite and transmitted to humans by infected female Anopheles mosquito. Several studies have explored community knowledge of malaria. However, despite the remarkable proportions of asymptomatic malaria, its awareness remains relatively understudied among the affected communities. Hence, this study aimed to determine the proportion of people with knowledge of asymptomatic malaria in endemic countries and describe their perspective towards malaria control interventions. The findings from this study could contribute to developing tailored interventions in both low and high-transmission settings. METHOD:The systematic review protocol was deposited in protocols.io and registered at PROSPERO (ID: CRD42024508104). A systematic literature review was conducted searching for peer-reviewed articles on knowledge of asymptomatic malaria published from 2010 to 2024. Three databases (PubMed (MEDLINE), Google Scholar, and Web of Science) were searched. The risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool and the Mixed Methods Appraisal Tool (MMAT). A thematic analysis and a narrative synthesis were conducted to synthesise the results. The research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS:In total, 483 articles were retrieved, and 11 relevant articles were included in the analysis. According to four studies conducted among the general public, the proportion of individuals knowledgeable of asymptomatic malaria ranged from 14.2% to 79.8%. The proportion among health personnel was 88% (one study). The qualitative studies showed varied and lacking knowledge of asymptomatic malaria among the participants, as well as refusal and reluctance to adhere to interventions targeting asymptomatic Plasmodium carriers. CONCLUSION:This review showed a lack of knowledge of asymptomatic malaria among endemic communities and a remarkable shortage of studies on related topics. For better malaria control and to accelerate disease elimination, education on asymptomatic malaria would be necessary. Given the limited number of studies, further research on knowledge of asymptomatic malaria would be crucial in various malaria-endemic areas to provide evidence for tailored interventions.

In the fight against malaria, control measures mainly focus on symptomatic infections with available diagnostic tools such as rapid diagnostic tests and microscopy in urban and remote areas. Individuals having malaria symptoms are likely to be aware of their condition and seek treatment at healthcare facilities. Furthermore, many studies have assessed community’s knowledge of malaria. These studies often focus on people’s awareness of the disease’s symptoms, their attitude in seeking treatment and protective measures they use. On the other hand, asymptomatic malaria, which is defined as malaria infection with Plasmodium parasites of any density without symptoms related to the disease, constitutes one of the challenges to malaria elimination, and awareness of this asymptomatic Plasmodium infection remains relatively understudied among the affected communities. Moreover, not only asymptomatic individuals do not necessarily seek treatment, but they also constitute the disease reservoir that contributes to malaria relapses and transmission through mosquito bites. To present, few studies reported community knowledge of asymptomatic malaria. Hence, it is crucial to explore and raise awareness on asymptomatic malaria as this knowledge may determine community level of engagement in malaria control interventions. Therefore, this systematic review aims to determine the proportion of people who have knowledge of asymptomatic malaria in endemic countries and describe their perceptions and beliefs about malaria control.

BACKGROUND:Despite substantial improvements in antenatal care and skilled birth attendance coverage, postpartum service uptake lags in the Lao People's Democratic Republic (Lao PDR). The 2019 Lao Primary Health Care Policy emphasizes the importance of village health volunteers/workers (VHVs/VHWs) working as groups or pairs to promote primary care services, including obstetric care. However, little is known about whether or how the pairing of male and female VHVs/VHWs may encourage better uptake of postpartum care in communities with solid gender norms. OBJECTIVE:Therefore, the study aims to assess the effectiveness of male-female VHVs/VHWs working in pairs on women's uptake of facility-based follow-up PNC visits in rural Sepone, Lao PDR. METHODS:A quasi-experimental cluster study will be conducted between July 2024 and October 2026 in 37 selected sites from two districts in the southern Lao PDR. In 19 selected intervention villages in the Sepone district, trained female-male VHVs/VHWs pairs will promote postpartum services, whereas in 18 similar control villages in the Vilabuly district, VHVs/VHWs will implement standard activities for obstetric care promotion. The study obtained ethical approvals from the University of the Ryukyus and the Lao Tropical and Public Health Institute. DATA ANALYSIS:Difference-in-difference analyses will be conducted to estimate service coverage pre-post intervention changes in study sites. Then, using mixed-effect binary logistic regressions, we will assess the association between pairing VHVW/s and facility-based follow-up PNC use, which will be adjusted for other covariates and time effects. Finally, we will analyze the context of pairing VHVs/VHWs implementation using coded transcripts of interviews and focus group discussions. RESULTS:At the end of the study period, we anticipate at least a 10% increase in follow-up PNC visits at intervention sites compared to control sites. The improvement is expected to result from improved mothers' trust and satisfaction with VHVs/VHWs, and enhanced husband support. CONCLUSION:The findings of this study will guide the Lao government's strategy to involve both male and female VHVs/VHWs in primary healthcare according to the 2019 Primary Health Care Policy.

A considerable number of people are exposed to noise from military aircraft daily, but its health effects have not been sufficiently examined. This study assessed the association of exposure to such noise with mental well-being and sleep disturbance among people living in Okinawa prefecture, where there are two U.S. military air bases. In 2024, data were collected from 394 residents in high-, low-, and no-exposure communities using the WHO-5 Well-being Index and the Athens Insomnia Scale. Among respondents, 55.8% were female; the largest age groups were 70's (25.4%) and 60's (23.6%). Poor mental well-being and sleep disturbance were most prevalent in the high-exposure community (poor mental well-being: 38.2%, sleep disturbance: 46.6%), followed by low-exposure (36.1%, 46.3%) and no-exposure (21.9%, 29.0%) communities. Multivariate logistic regression analyses showed that compared to no-exposure community, the high-exposure and low-exposure communities were significantly more likely to have poor mental well-being (odds ratio (OR): 1.84, 95% confidence interval (CI): 1.05-3.23; OR: 1.94, 95% CI: 1.05-3.56), as well as sleep disturbance (OR: 1.98, 95% CI: 1.17-3.35; OR: 2.04; 95% CI: 1.16-3.59, respectively). The results suggest that there is a substantial need to address the noise from military aircraft in Okinawa.

Abstract Background As the Lao People’s Democratic Republic is nearing malaria elimination, asymptomatic malaria infections remain a challenge to address. Control measures focusing on symptomatic persons do not effectively work for asymptomatic infections which often go undetected by conventional diagnostic tools. It is therefore crucial to understand the burden of asymptomatic malaria for tailored interventions to eliminate the disease. This study assessed the prevalence of asymptomatic malaria infections with associated risk factors in an endemic district of Savannakhet province. Methods In March 2024, a cross-sectional study was conducted in three villages of Nong District. Blood samples were collected from the fingertips of the participants for Plasmodium parasite identification using microscopy and Loop-mediated Isothermal Amplification (LAMP); those aged 13 years and above were also interviewed. Mann–Whitney U test and Fisher’s exact test were performed to compare the medians of different age and temperature groups and determine the association between predictor variables and outcome variables respectively. Results A total of 622 individuals participated in this survey; Plasmodium parasites were detected in 2.1% (13/622) of participants. The prevalence of asymptomatic malaria was 1.8% (11/622). Plasmodium vivax accounted for 15.4% (2/13) of all positive cases. The remaining species could not be identified. Farmers aged 15 years and above accounted for 81.8% of the asymptomatic infections. Ninety percent (90%) of the participants used bed nets in the village. Among interviewed participants, 23.6% reported not using mosquito bed nets in the forest; 21.3% of the participants who had been to the forest were nighttime forest workers. Conclusions This study revealed a prevalence of 1.8% of asymptomatic malaria infections in the study areas with the majority of the infections clustered among farmers, and an important proportion of these populations not using protective measures in the forest. These findings showed that malaria reservoirs are notable with a lack of use of protective measures, which could threaten malaria control and elimination efforts. Therefore, malaria elimination in Lao PDR by 2030 would need interventions targeting high-risk adult populations for screening with sensitive tools coupled with sensitization on protective measures and asymptomatic malaria.

Despite high coverage of antenatal care services (89.8

The Ministry of Health, Lao People's Democratic Republic (Lao PDR), surveyed health centers using the Quality Performance Scorecard (QPS) tool in 2021 to assess the quality of healthcare services at health centers. To validate the QPS tool, this study assessed the association between the QPS scores obtained from each health center and outpatient department (OPD) visits, antenatal care (ANC) coverages, and under-five mortality rates (U5MR) in the health centers' catchment area. This ecological study assessed the association between the QPS scores as an independent variable and OPD visits, coverage of ANC at least one visit (ANC1), coverage of ANC four or more visits (ANC4) and U5MR as a dependent variable, using secondary data collected from the 234 health centers and 31 district health offices in the four northern provinces, such as Huaphan, Xiengkhuang, Oudomxay and Phongsaly. Mixed-effect linear regression was used to assess the association between the independent variable and dependent variables while adjusting for covariates. The mean value (standard deviation) was 64.9/100 (14.3) for QPS score, 3.3 (3.6) for U5MR (per 1,000 under-five population), 0.7 (0.5) for OPD visits (per population), 9.6 (6.0) for ANC1 coverage (per estimated number of reproductive-aged women) and 5.7 (4.4) for ANC4 coverage. The QPS scores were significantly independently associated with U5MR (unstandardized regression coefficient: −0.225 and standardized regression coefficient: −0.894), OPD visits (−0.004 and −0.114) and ANC4 coverage (−0.036 and −0.117). This study shows that with increasing level of quality of healthcare services as measured by QPS, the U5MR was decreasing. The association demonstrated the ability of the QPS tool to capture the quality of healthcare services at health centers. Although the QPS scores were also negatively associated with OPD visits and ANC4 coverage, these associations were weak and likely confounded by unmeasured factors, or explained by quality care potentially reducing patients’ perceived need for frequents visits. To further validate the QPS tool, a longitudinal study is recommended to confirm the findings and address unmeasured factors.

Background To provide better quality healthcare services to patients with different linguistic and cultural backgrounds, the cross-cultural competence of medical professionals is important. However, assessing and improving the cross-cultural competence of healthcare professionals is difficult in Japan, as there is no standardized scale to measure the competence. This study’s purpose was to translate the Cross-Cultural Competence instrument for Healthcare Professionals (CCCHP), which was developed and used in Europe, and to examine its reliability and validity among Japanese nurses. Methods During June and July 2021, nursing staff were invited to take web- and paper-based surveys in Okinawa Japan. The CCCHP (five-factor model with 27 items across motivation, attitude, skills, emotion, and knowledge) was translated using a combination translation method, and a five-point Likert scale was used for responses. Exploratory and confirmatory factor analyses and known-group method were used to examine structural validity, while Cronbach’s alpha coefficient was used to test reliability. Results A total of 294 responses were analyzed; 77.2% had more than five years of experience. Since the fit index indicated that the five-factor model was not a good fit, it was modified to a four-factor model (J-CCCHP24) by moving three variables, removing the knowledge factor, and using the error covariance of the variables. The fit index after the modification was improved to comparative fit index (CFI) = 0.92, Tucker-Lewis index (TLI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, and standardized root mean square residual (SRMR) = 0.06, and Cronbach’s alpha was 0.85. The mean scores of J-CCCHP24 were significantly higher in the group with a history of overseas travel, higher foreign language skill, training in intercultural care, experience of foreign patient care, and intercultural interactions outside the workplace than in the group without these characteristics. Conclusion This study confirmed the validity and reliability of the modified Japanese version of the CCCHP (four-factor model with 24 items). The results suggest that the exposure to different cultures on a personal level may help improve nurses' cross-cultural competence. Further refinement of this scale for practical use would encourage the implementation of necessary countermeasures to improve the cross-cultural competence of Japanese healthcare professionals.

Background Hypertension is responsible for many premature deaths worldwide. However, many individuals with hypertension remain undiagnosed. Tonga is one of the countries that has had a steep increase in hypertension, thus undiagnosed hypertension could also be increasing. Purpose of this study was to assess the prevalence and factors associated with undiagnosed hypertension among Tongan adults. Methods This cross-sectional study used data collected from conveniently sampled 473 participants using electronic questionnaire and digital sphygmomanometer through household visits between February and March 2023. Inclusion criteria were age of 18–65 years, residence in the villages for at least six months, and not being pregnant. Fisher’s exact test and mixed-effect logistic regression were performed using the EZR software to assess the association between undiagnosed hypertension and predictor variables. Results The prevalence of undiagnosed hypertension was 22.4% (106/473). Five variables that were significantly associated with undiagnosed hypertension in Fisher’s exact test were included in the multivariate logistic regression. Overall, only three variables remained significant. First, participants who never had their blood pressure measured had higher prevalence compared to those who had it checked recently (33.3% vs. 19.1%); odds ratio: 2.24). Secondly, participants who were not aware of the risk of developing hypertension were significantly more likely to have undiagnosed hypertension compared to those who were aware (27.9% vs. 16.7%; odds ratio: 1.81). Lastly, middle-aged participants (30–49 years) and older (50–65 years), were significantly more likely to have undiagnosed hypertension compared to those who were 18–29 years old (30.0% and 23.7% vs. 11.8%; odds ratio: 3.58 and 3.38 vs. 1.00). Conclusion The prevalence of undiagnosed hypertension could be substantial among Tongan adults, implicating a need to address this issue by doing further research and review current public health work to address hypertension in Tonga. Undiagnosed hypertension was associated with having no experience of blood pressure measurement, lack of awareness about hypertension, and age. Tongan government should provide people with more opportunities to have their blood pressure measured and to improve their awareness.

Background For safe drinking water, household water treatments (HWT) is important to reduce the risk of diarrhea in low-and-middle countries including Lao People's Democratic Republic (Lao PDR). However, the measurement of HWT relies chiefly on self-report in most nationwide surveys. Thus, the validity of self-reported measurement is of concern. The objective of this study was to determine the proportion of households with the presence of boiled water among households that report boiling practices in a rural area of the Lao PDR. Methods This study was conducted with randomly selected 108 households in the four villages in the catchment area of the two health centers, in Xepon district of the Savannakhet province, between September and October 2023. The inclusion criterion of the households was the households that report boiling as HWT. Surveyors conducted interviews with an adult household member and observations on boiled water through household visits, using a questionnaire. Descriptive statistics were conducted to summarize the collected information using the frequency with proportion for categorical variables and the median with interquartile range for continuous variables. Bivariate analyses were conducted to assess an association between each of the factors and the presence of boiled water, using Fisher's exact test. Results Among the 108 households that reported boiling practice, 91 households were able to show the surveyor self-reported boiled water. Thus, the proportion of households with the presence of boiled water was 90.1% (95% confidence interval: 82.5-95.1%). Households with a fixed schedule of boiling were significantly more likely to present boiled water, compared to households without (94.5% vs. 50.0%). Not all household members do not necessarily drink boiled water: approximately a quarter (25.7%) of the participants reported that some household members drink unboiled water. Conclusions This study showed that among households that reported boiling drinking water, 90.1% were able to present a container with self-reported boiled water. It suggests that the self-reported measure of boiling practices can be valid in the study villages.

BackgroundThere are various impacts of COVID-19 on health systems of the world. The health systems of low- and middle-income countries are less developed. Therefore, they have greater tendencies to experience challenges and vulnerabilities in COVID-19 control compared to high-income countries. It is important to contain the spread of the virus, and likewise strengthen the capacity of health systems in order for the response to be effective and swift. The experience from 2014 to 2016 Ebola outbreak in Sierra Leone served as preparation for COVID-19 outbreak. The aim of this study is to determine how control of COVID-19 outbreak in Sierra Leone was enhanced by the lessons learned from 2014 to 2016 Ebola outbreak, and health systems reform.MethodsWe used data from a qualitative case study conducted in four districts in Sierra Leone through key informant interviews, focus group discussions, document, and archive record reviews. A total of 32 key informant interviews and 14 focus group discussions were conducted. A thematic analysis was used to analyze the data, and all transcripts were coded and analyzed with the aid of ATLAS.ti 9 software program.ResultsThe six themes obtained were composed of categories that connect with each other and with codes to form networks. The analysis of the responses demonstrated that "Multisectoral Leadership and Cooperation", "Government Collaboration among International Partners", and "Awareness in the Community" were among the key interventions used during the control of 2014-2016 Ebola virus disease outbreak, which were applied in the control of COVID-19. An infectious disease outbreak control model was proposed based on the results obtained from the analysis of the lessons learned during the Ebola virus disease outbreak, and health systems reform.Conclusions"Multisectoral Leadership and Cooperation", "Government Collaboration among International Partners" and "Awareness in the Community" are key strategies that enhanced the control of the COVID-19 outbreak in Sierra Leone. It is recommended that they are implemented in controlling COVID-19 pandemic or any other infectious disease outbreak. The proposed model can be used in controlling infectious disease outbreaks, especially in low- and middle-income countries. Further research is needed to validate the usefulness of these interventions in overcoming an infectious disease outbreak.

BackgroundDengue remains a major public health problem in the Philippines, particularly in urban areas of the National Capital Region. Thematic mapping using geographic information systems complemented by spatial analysis such as cluster analysis and hot spot detection can provide useful information to guide preventive measures and control strategies against dengue. Hence, this study was aimed to describe the spatiotemporal distribution of dengue incidence and identify dengue hot spots by barangay using reported cases from Quezon City, the Philippines from 2010 to 2017.MethodsReported dengue case data at barangay level from January 1, 2010 to December 31, 2017 were obtained from the Quezon City Epidemiology and Surveillance Unit. The annual incidence rate of dengue from 2010 to 2017, expressed as the total number of dengue cases per 10,000 population in each year, was calculated for each barangay. Thematic mapping, global cluster analysis, and hot spot analysis were performed using ArcGIS 10.3.1.ResultsThe number of reported dengue cases and their spatial distribution varied highly between years. Local clusters were evident during the study period. Eighteen barangays were identified as hot spots.ConclusionsConsidering the spatial heterogeneity and instability of hot spots in Quezon City across years, efforts towards the containment of dengue can be made more targeted, and efficient with the application of hot spot analysis in routine surveillance. This may be useful not only for the control of dengue but also for other diseases, and for public health planning, monitoring, and evaluation.

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.

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.

Background The World Health Organization (WHO) estimated that 29% of global tuberculosis (TB) and almost 47% of childhood TB cases were not reported to national TB programs in 2019. In Cambodia, most childhood TB cases were reported from health facilities supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria in 2019. This study aimed to compare the healthcare providers' knowledge, attitude, and practices (KAP) on childhood TB case detection in operational districts (ODs) with high and low childhood TB case detection in Cambodia. Methods We conducted a cross-sectional study between November and December 2020 among healthcare providers in 10 purposively selected ODs with high childhood TB case detection and 10 ODs with low childhood TB case detection. A total of 110 healthcare providers from referral hospitals (RHs) and 220 from health centers (HCs) were interviewed. We collected information on socio-demographic characteristics, training, and KAP on childhood TB. Pearson's Chi-square or Fisher's exact and Student's t -tests were performed to explore the differences in KAP of healthcare providers from ODs with low vs. high childhood TB detection. Results Of the 330 respondents, 193 were from ODs with high childhood TB case detection, and 66.67% were from HCs. A significantly higher proportion (46.11%) of respondents from ODs with high childhood TB case detection received training on childhood TB within the past two years than those from low childhood TB case detection ODs (34.31%) ( p = 0.03). Key knowledge on childhood TB was not significantly different among respondents from ODs with high and low childhood TB case detection. A significantly higher proportion of respondents from ODs with high childhood TB case detection had a good attitude (98.96 vs. 97.08%, p = 0.002) and performed good practices (58.55 vs. 45.26%, p = 0.02) on contact investigation in the community than those from low childhood TB case detection ODs. Conclusions Healthcare providers from ODs with high childhood TB detection had better attitudes and practices towards childhood TB. The attitudes and practices need to be improved among healthcare providers in ODs with low case detection. Further investment in training and experience sharing on childhood TB case detection among healthcare providers is needed to improve childhood TB case detection.

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).

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.

Handwashing with soap is effective in preventing communicable diseases including diarrhea,1 but many households do not use soap for handwashing. A report from WHO/UNICEF showed that while water is available, soap tends to be unavailable for handwashing in rural households.2 For example, in the Lao People’s Democratic Republic (Lao PDR), only 1.0% of households lacked water for handwashing but 34.7% lacked soap.3 Survey data suggest that socio-economic status (SES) is associated with the presence of soap for handwashing. A descriptive study on handwashing in 51 countries reported that households in lower wealth quintiles or in rural areas were less likely to have soap in their handwashing facilities than households in higher wealth quintiles or in urban areas.4 According to a study that used nationally representative data of 16 sub-Saharan African countries, there were remarkable inequalities in access to water and soap for handwashing by place of residence and wealth quintile.5 The Lao Social Indicator Survey II (LSIS II)—a household-based nationwide survey in 2017—showed that households whose heads have lower educational attainment, rural households, households of minority language group, and households of lower wealth quintiles were less likely to have soap for handwashing, compared to their counterparts.6 However, these studies failed to examine the association between SES and the presence of soap for handwashing while considering confounding factors and thus the association remains unclear. Therefore, this study examined the association between SES and the presence of soap for handwashing facility in Lao PDR while controlling for potential confounding factors.

Diarrhea is a leading cause of death among children under five (U5) in Lao People’s Democratic Republic (PDR). This study assessed the association between the presence of household hand-washing facilities with water and soap and diarrhea episodes among children U5 in Lao PDR. Data from the Lao Social Indicator Survey II were used. The outcome variable was diarrhea episodes in the two weeks preceding the survey. The main predictor variable was the presence of household hand-washing facilities with or without water and/or soap. Mixed-effect logistic regression analysis was used to assess the association, controlling for clustering, and other predictor variables. Of the 8640 households surveyed with 11,404 children, 49.1% possessed hand-washing facilities with both water and soap and 34.7% possessed hand-washing facilities with water alone. Children whose households possessed hand-washing facilities with water alone were significantly more likely to have a diarrhea episode compared to children whose households possessed hand-washing facilities with both water and soap (8.1% vs. 5.9%; odds ratio, 1.49; 95% confidence interval, 1.22–1.81). The association remained significant even after adjusting for other predictors. The absence of soap in hand-washing facilities was associated with higher odds of having a diarrhea episode among children U5 in Lao PDR.