平成19年度専門課程特別研究論文要旨

389〈教育報告〉
平成19年度専門課程Ⅱ
国際保健分野Course Name: Master of Public Health

An Assessment of Knowledge, Skill, Perception and Practice of Community
Health Volunteer on Nine Key Family Practices for Health in Mondol Kiri
and Stung Treng on Community Intetrated Management Childhood Illness
in Cambodia
Teng SREY
Keywords:

knowledge, skill, perception, practice, CHV, training, 9 key family practices*

Thesis Advisors:

Kayoko HIRANO, Hiromitsu OGATA

Abstract
Introduction: The health status of Cambodian children

remains one of the lowests in the World. For example,
Under-five mortality rate is still very high, and maternalmortality ratio* (437 per 100,000 live births) is among thehighest in the South-Asia region. The preliminary result of
Cambodia Demographic Health Survey 2005 has shownthat under-five, infant and neonatal mortality rates were 83,
65, and 28 per 1,000 live births, respectively. Children are
suffering from the current four major causes such asneonatal condition (30%), acute respiratory illness (21%),and diarrhoea (17%), other diseases associated withmalnutrition. The third component of integrated
management of childhood illness (IMCI), which is called
community integrated management of childhood illness(CIMCI), is recently focused on improving family andcommunity practices. To do these tasks, community
practices based on strategy are needed, and community
health volunteers (CHVs) are the key-persons in thecommunity to promote public health, to support healthpractices and to follow-up all mothers and children to bereceived their needed preventive interventions. CHVs havebeen trained on CIMCI since 2005 by health centre staff toperform better jobs. The training program (12 key family
practices) was carefully designed to enrich knowledge,
skill, perception and practice of CHV with the necessary

topics related to common childhood illness and simple
interventions that are feasible and accessible at thecommunity levels.
Objectives: The aim of this study is to investigate

relationships among knowledge, skill, perception andpractice of CHV on 9 key family practices of CIMCI in 2
typical provinces in Cambodia: Mondul Kiri which has no
training program for CHV and Stung Treng which has ageneral training program for CHV. The results of this study
will contribute to improve the training activities and tostrength the current national child care program.
Methodology: A survey was conducted using questionnaires(by face to face interview) designed to know the situationof knowledge, skill, perception and practice of CHVs
related to 9 key family practices. 97 CHVs were randomly
selected (55 CHVs from Mondul Kiri and 42 CHVs from
Stung Treng) between 25 July to 4 October 2006. Data
were analyzed by using SPSS version 13.0. Descriptive
statistical methods were used for describing the actual
states about CHVs ’knowledge, skill, perception andpractices on 9 key family practices. And some analyticalmethods (Chi-square test, Mann-Whitney test andSpearman rank correlation test) were applied to analyse therelationship between some key variables on knowledge,
skill, perception and practice and socio-demographic.

*according to the definition of WHO, http://www.who.int/whois/indicators/maternalmortratio/en/
指導教官：

平野かよ子（公衆衛生看護部）
緒方裕光（研究情報センター）

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平成19年度専門課程特別研究論文要旨

Result: 1. Socio-demographic: The proportion of number offemales to total respondents was almost the same in
Mondul Kiri and Stung Treng (the proportion of females
was 57 percent). Ninety percent of CHVs completed firstyear grade of school. About 44 and 83 percent ofrespondents have been working more than one year in
Mondul Kiri and in Stung Treng, respectively. 69 percent ofrespondents in Mondul Kiri received technical support from
Ministry of Health while only 48 percent in Stung Treng.
69 percent of respondents in Stung Treng received technicalsupport from UNICEF. 46 and 95 percent of respondents
received financial support in Mondul Kiri and Stung Treng,respectively.
2. Knowledge, Skill, Perception and Practice: The
percentages of respondents who had good score to thequestions about knowledge in Mondul Kiri and Stung
Treng were as follows, respectively: 47 and 90 percent in
the question on“ breastfeeding ”, 26 and 70 percent on“ c o m p l e m e n t a r y f e e d i n g ”, 2 4 a n d 4 7 p e r c e n t o n“micronutrient”, 52 and 76 percent on“hygiene and safe
water”, 47 and 77 percent on“continued to feed and offer
more fluids”, 34 and 62 percent on“danger sign”, 79 and95 percent on“ give sick children appropriate hometreatment for infections”, 30 and 56 percent on“antenatalcare”, 7 and 44 percent on“malaria”. The percentages of
respondents who had good score to the questions about skill
on“hygiene, malaria and home care”in Mondul Kiri andStung Treng were 57 and 68 percent, respectively. The
percentages of respondents who had good score to thequestion about perception on“breastfeeding and ANC”in
Mondul Kiri and Stung Treng were 62 and 84 percent,respectively. 38 and 74 percent of respondents had goodpractice in Mondul Kiri and Stung Treng, respectively.
3. Relationship among knowledge, perception, practice andskill:
Mondul Kiri:-Knowledge on“children under six month need to drink
water along with breast milk”,“liquid (s) should give tochild after birth”,“recommend milk for healthy grow of
infant”and“breastfeeding”have significant relationshipwith perception on“hot breast milk after working outsideor doing heavy labour can cause a child to have diarrhoea
or fever”(p<0.01 and p<0.001 respectively).
-There were significant relationships between knowledge“on symptoms of vitamin A deficiency”and practice on“ specific issues ”(p<0.05), and between knowledge on“number of ANC visit for pregnant women”and practiceon“other activities”(p<0.05).
-There were significant relationships between skill on“ treatment malaria ”and practices on“ specific issues ”(p<0.01), between skill on“treatment intestinal parasites,
hygiene”and practice on“other activities”(p<0.05).
Stung Treng:-Knowledge on“recommended milk for healthy growth of
a n i n f a n t ”a n d“ b r e a s t f e e d i n g ”h a v e s i g n i f i c a n t
relationships with perception on“ hot breast milk afterworking outside or doing heavy labour can cause a child tohave diarrhoea or fever”(p<0.01 and p< 0.05, respectively).
-Knowledge on“how can prevent vitamin A deficiency”,“pregnant women should take vitamin A after giving birth”
and“ recommended time for post-partum vitamin A
supplementation ”have significant relationships withpractices of other activities (education on child illness,health centre referral, hygiene education, distribute to stop
mosquito larvae and collect information on women andnew-borns) (p<0.05).
-Skills on“ how to prevent intestinal parasite ”and“hygiene”have significant relationships with practices on“other activities”(p<0.05, p<0.05) and“specific issues(child immunization, tetanus toxoid vaccination for
pregnant, vitamin A for women who recently gave birth,
promotion of ANC visits, promote use of iodized salt inhousehold, delivery of insecticide treated bednets) ”(p<0.05, p<0.05).
-Perception on“hot breast milk after heavy labor or workoutside can make child have diarrhea or fever ”has asignificant relationship with the practice on“involvement
in community mobilization on other activities”(p<0.05).
4. Relationship between socio-demographic andknowledge, skill, perception, practice:
Mondul Kiri:-There were significant relationships between gender andknowledge on“ danger sign, ANC ”(p<0.05), between
education level and knowledge on“ breastfeeding,complementary feeding, and malaria”(p<0.05), between
education level and perception on“breastfeeding”(p<0.05),
between working year experience and knowledge on“malaria”(p<0.05) and between technical support from
MOH and practice on“ collaboration with local healthcentre”(p<0.05).
Stung Treng:-There were significant relationships between gender andpractice on“specific issues”(p<0.01), between educationlevel and knowledge“ on micronutrient ”(p<0.001),
between working experience and knowledge on“micronutrient”(p<0.05), and practice on“specific issues”(p<0.05), between financial support and skill on“ treat
malaria”(p<0.05), and practice on“specific activities”(p<0.05), between technical support from MOH andknowledge on“ breastfeeding ”, and practice on“ other7 48平成19年度専門課程特別研究論文要旨

activities ”(p<0.001), between technical support from
UNICEF and knowledge on“hygiene, continued to feed
and offer more fluids”(p<0.05), between technical support
from UNICEF and practices on“specific issues”(p<0.05).
Conclusion: CHVs in Stung Treng had higher level ofknowledge, skill, perception, and practice than CHVs in
Mondul Kiri on 9 key family practices for health. In Stung
Treng, there were relationships between: 1) knowledge andperception, 2) knowledge and practice, 3) skill and practice,and 4) perception and practice. In Mondul Kiri, there wererelationships between: knowledge and perception,knowledge and practice, and skill and practice. The training
on CIMCI for CHV is very effective, useful and essential to391

provide knowledge, skill, perception, and to enhance theircapacity in practice for playing major roles in healthpromotion for community people in their catchments areas,
to change behaviour and practices of caregivers forparticipating activities in reducing infant and childmorbidity/mortality and to improve child health anddevelopment in the country. In order to maintain theknowledge, skill, perception and practice of CHV, thefollow-up after training or the refreshment training areneeded. The selection of CHVs who have to attend thetraining should be done with considering gender, educationlevel and working experience. Technical support andfinancial support are essential to enhance the knowledge,
skill, perception, and practice of CHVs.

7 48平成19年度専門課程特別研究論文要旨

392〈教育報告〉
平成19年度専門課程Ⅱ
国際保健分野Course Name: Master of Public Health

Referral of High-risk Antenatal Clients from Community Health Centres
to the Victoria Jubilee Hospital: Kingston and St. Andrew, Jamaica
O’
Neil Anthony WATSON
KeyWords:

high-risk, antenatal clients, referral, early attendance, compliance

Thesis Advisor:

Hidemi TAKIMOTO

Abstract
Objective: The main purpose of this study was to assess thepromptness of the high-risk antenatal clients to get to thehospital after referral from the health centres, in theKingston and St. Andrew region, Jamaica, so as to improve
the referral system. This was achieved through thefollowing specific objectives:
1 ． Determining the high-risk profile of the clientsreferred
2 ． Determining the time taken for high risk clients tovisit the tertiary hospital after being referred
3 ． Determining if early attendance to high-risk clinics
bears any relationship with demographic features,
medical conditions, past obstetric history orcomplications of this pregnancy and
4 ． Determining if clients’compliance to referral advice
to get to the high-risk clinics bears any relationshipwith demographic features, medical conditions, pastobstetric history or complications of this pregnancy.
Study design and method: A cross-sectional study was
conducted using records (dockets) from the community
health centres and the specialist hospital, Victoria Jubilee
Hospital (VJH). The sample consists of 105 matchingrecords between 17 health centres and VJH of high-risk
antenatal clients referred during the period January 1, 2006
to February 28, 2006. Overall 80.2% of records matchedbetween primary care and the specialist institution. Clientswere stratified into two groups based on the number of days
taken to get to the hospital after being referred from thehealth centre. They were classified as early if they attended
指導教官：

瀧本秀美（生涯保健部）

obstetric care within 7 days while late if they attended afterthat period. Women who were admitted to the hospital after
this seven-day period for the sole purpose of delivery andwithout any prior assessment at the high-risk clinic weretermed non-compliant.
Results: Seventy-six (72.4%) of the clients had single
referral indications. There were a total of 140 high-risk
conditions among the 105 clients of which: anaemia 17.9%(n=25), previous caesarean section 13.6% (n=19), grandmultiparas 11.4% (n=16), young teenagers 9.3% (n=13) andunsure of dates 8.6% (n=12) were the most frequent
referred conditions. The mean age was 25.3+/- 7.6 years(range 13-41 years, median 25 years). The average timethat the clients took to get to the specialist hospital afterreferral from the health centre was 31.5+/- 31.6 days (range
0-139 days, median 25 days). Only 30.5% (n=32) of them
arrived at the Victoria Jubilee Hospital within seven days,
but remarkably, patients having pre-eclampsia (p<0.01) andpatients referred at or after 37 weeks of gestation (p <0.01)
were early. On the contrary, the greater proportion of clientsreferred with demographic features, past obstetric history
and anaemia were late. Only 8% (n=2/25) of clientsreferred from Zone 2 were early (p=0.01). The compliance
rate to referral advice was 84%. The mean time to hospitalfor the non-compliant patients (n=17) was 58.0+/- 32.7
days (range 21-139 days, median 48 days).
Conclusion: Clients with pre-eclampsia arrived early in thisstudy. This type of focused antenatal care and referral tospecialized care is important to reduce maternal morbidity
and mortality. The current guidelines for management andreferral of clients with this condition should be maintained
and supported. However, the punctuality of high-risk clients
especially with anaemia, demographic features and past

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平成19年度専門課程特別研究論文要旨

obstetric conditions needs to be improved. Health education
among clients with high-risk conditions may need to bestrengthened. The impact of social and economic factors on
antenatal clients will require further study. Alternatively,
the skill and competency of human resource personnel at393

the health centre can be gauged so that non-emergency
high-risk clients can be managed longer in the community.
However, the sample size and other limitations of this study
may not be sufficient to make such recommendations.

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平成19年度専門課程特別研究論文要旨

394〈教育報告〉
平成19年度専門課程Ⅱ
国際保健分野Course Name: Master of Public Health

A Descriptive Case Study of Wait House Concept Provided at
Malalua Health Centre for Pregnant Mothers in Kerema District,Gulf Province, Papua New Guinea
Bernard Maima BAL
Keywords:

accessibility, decision, wait house, midwives, maternal and child health services

Thesis Advisor:

Nobuyuki HYOI

Abstract
Introduction
The Maternal Mortality Rate for Gulf Province is 790 per
100 000 live births and that was recorded as the second
highest maternal deaths by province in PNG. Of allmaternal deaths, an average of 45% was from obstetriccauses. These statistics posed a major challenge for thedivision of Health in the Province.
Among the many problems, the core problem that
contributed to the high MMR was poor access by pregnant
women to health facilities for ante-natal screening anddelivery under the supervision of skilled health workers(doctors/midwives/nurses). Having realized that, theMaternal and Child Health Services in its endeavor toaddress the high MMR has initiated the Wait House. The
goal of WH concept was to improve the MCH services inorder to reduce the high MMR in the province as theultimate outcome.
Objectives

1) To assess the factors associated with the decision for theutilization of the wait house; and 2) to assess the utilizationand outcome of the wait house and determine if it isbeneficial to the users from the view points of the users andservice providers.
Method/Design

A descriptive case study by using questionnaires that had
four parts: information on socio-demographic factors,socio-economic and cultural factors, accessibility factors
指導教官：

兵井伸行（人材育成部）

and health service factors. The target population was theusers of the WH selected among the five main catchment
villages served by Malalaua Health Centre. The data werecollected in December 10th to 13th, 2007.
Results/Discussion
Socio-demographic factor

The characteristics of the respondents: 50 mothers who
have used the wait house and delivered at Malalaua healthcentre were interviewed. The mean age was 37 ± 34.7 years.
86.0 % (n=43) were married and 72.0 % had primary school
education.
Socio- economic and cultural factor

All (n=50) respondents were subsistence farmers withmean monthly income of 203 kina from subsistence
farming which enabled them to meet the transport costwhen they went to use the WH. 94.0 % respondents (n=47)
reason for the use of WH was to have easy access todelivering at the health centre under the supervision of the
midwives and nurses. Nearly all (n=49) respondents madethe decision for the use of WH a week to two weeks prior
to their arrival at WH. 64.0 % (n=32) respondents made thedecision themselves to use the WH while 36.0 % (n=18)
decided together with their husbands. The study found thatthe higher the level of education, the more freely the
respondents discussed with their husbands, and the moreconsiderate they were of the importance of utilization of theWH they perceived. The study also found that more thanhalf (54.0 %) of the respondents encountered objections totheir decision for the use of WH. The respondents who
made the decision by themselves encountered moreobjections than those decided together with their husbands.
The study also found statistical significance (p=0.04) that

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平成19年度専門課程特別研究論文要旨

the more the objections encountered the more reluctant anddiscouraged they were to using the WH and attending ANC
clinics.
Accessibility factor

For 94.0 % (n=47) respondents, it was not easy for themto travel to the health centre when they were pregnant.
Distance, therefore, was one of the factors they consideredin their decision for the use of WH. For those who
considered distance as a factor also rated cost as expensive.
This finding indicates that for those who lived far away it
was very difficult to get to the health centre to deliver. The
mean travel time taken to reach the WH was 3.3 ± 1.16
hours and 38.0 % respondents took more than four hours toarrive at the WH. This finding illustrates the difficulties one
had to endure particularly when pregnant to reach the WH.
It was found statistically significant (p=0.001) that those
who used land transport took longer time to reach the WH
than river/sea transport. 92.0 % (n=46) respondents
considered weather as one of the factors in their decisions
for using WH. Statistical significance was found (p=0.002)
that those who considered weather as a factor rated cost as
expensive. It is speculated that changes in the weather
pattern inflated travel cost. Transportation problem wasanother factor considered by 90.0 % (n=45) respondents intheir decision to use the WH.
Health service factor

The study found that there were no midwives available inthe village. It was one of the influential factors respondents

395

considered for the use of WH. The non availability of
midwives was due to not enough midwives positions
available in the province. The study found that
dissemination of information was an enabling factor. 98.0
% (n=49) respondents received information about theavailability of the WH via their friends and have turned up
to use the WH. Radio doctor program and monthly healthbroachers were found to be not the suitable means ofsending out information. This indicate that appropriate
means of sending out information that the majority of the
population can easily have access to needed to be
identified and used for disseminating information. The
study further found that WH was beneficial to the users as
indicated by all (100 %) respondents.
Conclusion

It is concluded through the interview conducted among
the women who used the WH that the non availability ofthe midwives in the villages, distance, travel time, theweather and transportation problems were the main factors
mothers considered in their decision for using the WH.
In all, it can be deduced that WH is beneficial to the users
and has increased the number of health centre deliveries.
Therefore, there is a need for the district healthmanagement team to carry out more awareness on theavailability of WH, promote male partnership and get moremale leaders to actively participate in the awarenessprograms and extend the concept to other major healthcanters in the district.

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平成19年度専門課程特別研究論文要旨

396〈教育報告〉
平成19年度専門課程Ⅱ
国際保健分野Course Name: Master of Public HealthAccessibilty of Drugs in Mtwara Regional Hospital,
What is the Challenge Ahead?
Florah B. MAKENYA
Keywords:

essential drugs, accessibility of essential medicines, affordability of drugs, rational utilization of drugs,
Tanzania

Thesis Advisor:

Ken- Ichiro TANEDA

Introduction:
Good health is an important element required for national
development, poverty alleviation and other healthdevelopment gain needed by all. It is acknowledged that,most leading causes of death and disabilities in developing
countries can be prevented, treated or at least alleviatedwith the use of cost effective essential drugs. Scaling up
access to essential medicines is critical to global efforts toprevent millions of death a year, to reduce suffering and tolessen burden of illness. It is estimated that by improving
access to existing essential medicines and vaccines about
10 million lives per year could be saved (WHO 2004). The
study intended to assess drug access and utilization in
Mtwara regional hospital.

doses as indicators.

Study Design and Methods:
The study was a cross sectional descriptive study basedon methodology developed by INRUD/WHO as well as
focused on Level II Indicators. Access in this study was
expressed as the availability of affordable, good quality,
appropriate and efficiently use of drugs. The study site
comprised two private pharmacies, a government warehouse and an out patent department at a public hospital.
The study involved 16 key drugs to treat common illnesses,
100 patients encountered in dispensing area, 152 patients’prescriptions and pharmacy inventory books. The study
utilized retrospective and prospective methods. The data
were collected in July-August 2007.

Objectives:

Results:

General objective was to examine the access of essential
drugs in the hospital and thereafter to identify problems anddefine areas which needed improvement. The specificobjectives were to assess (1) Facilities factors using
availability of key drugs, stock out duration, average
medicine cost per encounter, presence of treatment
guidelines (STGs) and adequacy of storage conditions as
indicators. (2) Prescribers factors employing average
number of drugs per prescription, percentage of patients
receiving injections and antibiotics, tracer cases treatedaccording to STGs. (3) Pharmaceutical dispensing factors
using percentage of drugs actually dispensed, drugs
adequately labelled and patients with knowledge of correct

Facilities indicators: Availability of key drugs surveyed was

指導教官：

種田憲一郎（政策科学部）

81.25% in the public hospital, 87.5% in the private
pharmacies and 93.75% in the government warehouse. The
median stock-out duration in the public hospital was 53days(mean 68 ± 79 days). The mean cost for each prescription
surveyed (n=70) required 4.4 working hrs for the least paid
government employee (equivalent to 11.5 ± 12.9% of theweekly salary). Storage condition in dispensing area of
public hospital was inadequate (score 5 out of 11), which
implies the quality of medicine may be doubtful.On theother hand, the warehouse storage condition was adequate(score 10 out of 11) and hence drugs were of good quality.
Prescriber’s indicators: Average number of drugs prescribed
per patient was 2.7 ± 0.99. There was no correlation(R=0.0132) between number of drugs prescribed with age

7 48平成19年度専門課程特別研究論文要旨

of patients. Percentage of patients received injection andantibiotics were 34 ± 4.3% and 68 ± 2.8% respectively.
Utilization of antibiotics to children with diarrhea was
100%, while in ARI (non pneumonia) was 85%. 84.2% of
patients diagnosed with mild/ moderate pneumonia weretreated with antibiotics, out of which 81.25% wereprescribed more than one kind of antibiotics. Use of ORS(Oral Rehydration Salt) to children presented with diarrhea
was 85%. In treatment of uncomplicated malaria, six
regimens were found, only 50% of the cases were treatedwith first line mediations (Artemether/Lumefantrine – ALutabs/Coartem®).
Pharmaceutical dispensing indicators: Percentage of drugs
actually dispensed to patients encountered (n=100) was
85.5%. The main reason for un-supplied drugs was out ofstock (83.3%). 90.2% of drugs dispensed were adequately
labeled while 66% of patients under stood how to take theirdrugs correctly. There was no association in number of397

drugs dispensed and patients’knowledge of correct doses.
(x2, p>0.05, R=0)

Conclusion:
Nearly all indicators showed disquieting results. Thoughavailability of drugs both in the medical store and the
public hospital was reasonable, stock-outs duration was
irrational. The facility prescribed average of three drugs per
patient slightly higher to recommendation of INRUD/WHOof less than two drugs per prescription. In order tounderstand specific causative factors, it is necessary toundertake detailed assessment in areas which showed
inadequate results such as stock-out duration, tracer cases
treated according to guidelines, patients’knowledge andhigh utilization of injections and antibiotics.

Drugs and medicines have the same meaning.

7 48平成19年度専門課程特別研究論文要旨

398〈教育報告〉
平成19年度専門課程Ⅱ
国際保健分野Course Name: Master of Public Health

Factors affecting the successful TB treatment of TB/HIV cases under a community
TB/ART DOT program in Zambia
Kuniko MURAKAMI
KeyWords:

community DOT, tuberculosis, HIV/AIDS, treatment success, Zambia

Thesis Advisors:

Tomoko KODAMA, Norio YAMADA

BackgroundA rapid increase of tuberculosis (TB) cases is largely due
to the Human Immunodeficiency Virus and Acquired
Immunodeficiency Syndrome (HIV/AIDS) epidemic and50-70% of TB patients are estimated to be co-infected with
HIV/AIDS in Southern African countries. The Directly
Observed Treatment Short-course (DOTS) has been aninternationally accepted strategy for TB control since 1995.
DOT is one of five components of DOTS. Several previous
studies focused on the health center based DOT to assess
the factors affecting the TB treatment outcome; however,few studies examined the effectiveness of the communitybased DOT. As antiretroviral therapy (ART) expands, thecommunity DOT approach is recognized as one of the entry
points to ART. It is important to assess the factors affecting
TB treatment outcome in the settings of the community
DOT.

Objective
To determine the factors affected TB treatment outcomesof TB/HIV cases under the community TB/ART DOT
program.

Methods
Study design Observational case-series study of TB/HIV

patients (Part I) and combined analysis with semi-structured
questionnaire for health volunteers (Part II) Study settings
Kamanga Operational Research (Kamanga-OR) of
community-based TB/HIV/AIDS organization (CBTO)
指導教官：

児玉知子（政策科学部）
山田紀男（結核研究所）

which is a nongovernmental organization in Kamangacompound, Lusaka, Zambia. Inclusion criteria Adults over
20 years of age with pulmonary tuberculosis, HIV positive,
and no history of ART. Participants A total of 91
participants out of 138 applicants met the criteria andenrolled to the study from August 2004 to August 2005.
Data Collection and Measurements Part I data were utilized
from the Kamanga-OR database, such as sociodemographics, TB history, initial symptoms, sputum smear
results, and initial CD4 counts. Those data were collectedduring the period of August 2004 and August 2007 byinterview from 91 participants and laboratory examination.
Part II data were collected by 10 trained health counselors
using a semi-structured questionnaire from 47 healthvolunteers who followed 91 participants during the periodof the 20 th and 29 th August 2007. The variables in thequestionnaire were the existence of side-effect, its severity,and its management during treatment including ART,
family support, and patient attitude. Analysis A total of 91
participants were classified into two groups in terms of the
TB treatment outcome,“ treatment success ”and“ nontreatment success.”We obtained the Odds Ratios of eachvariable of socio-demographic and laboratory data fortreatment outcome (Part I). We examined the association
between treatment outcome and side-effect, family support,
and patient attitude using the chi-square test (Part II).

Results
Among the total participants, 62.6% had treatment
success (8.8% were“cured”and 53.8% were“treatmentcompleted ”) and the 37.4% belonged to non-treatment
success (15%“died”, 10% were“defaulter”and 12% were“ transfer out ”). There was no statistically significant

7 48平成19年度専門課程特別研究論文要旨

difference between the TB treatment outcome and gender,
age, marital status, employment status, annual income,drinking habit, and smoking habit. There was a significant
difference between TB treatment outcome and the facilities
where the participants consulted first. (OR: 2.77, 95%CI:
1.15-6.65). ART commencement was statisticallysignificant for treatment success (OR: 5.47, 95%CI:
2.16-13.83). The severity of the side-effects from TB/HIV
treatment, and the level of management after consultation
were not significantly related to the treatment success(p =0.10, p =0.09, respectively), however, the course of thesymptoms after consultation was strongly related to thetreatment outcome (p <0.001).Cooperative family support
and positive patient attitude were significantly associatedwith treatment success (p =0.03, p <0.001, respectively).

Discussion and Conclusion
The participant ’s first contact with a referral TB
diagnostic centre was strongly associated with treatment399

success compared to the contact with other facilities.
Further analysis is needed regarding the influence of ART
on TB treatment outcome. We found positive relationships
between cooperative family support and treatment success,and patient positive attitude and treatment success. The
positive attitude would lead to proper treatment adherence,
which is crucial, especially for ART, to avoid drug
resistance. Compared with a health center based approach,the community-based approach could be more affected bystigma and discrimination regarding TB and HIV/AIDS.
CBTO is regularly offering“therapeutic meetings”for all
persons with an interest in TB/HIV issues to tackle suchstigma.
The collaboration program between TB and HIV/AIDS
treatment has been strengthened as ART has been expandedin Zambia. This study suggested that a community
approach could an important approach to encourage
patients and family members, which would lead them to a
successful treatment outcome.

7 48平成19年度専門課程特別研究論文要旨

400〈教育報告〉
平成19年度専門課程Ⅱ
健康危機管理分野

レプトスピラ症の診断と報告に関する研究
宮崎県における医師・獣医師を対象とした KAP 調査
高橋亮太

Cross Sectional Study About Diagnoses and Reports of Leptospirosis ;Knowledge, Attitude and Practice Survey of Physicians
and Veterinarians in Miyazaki Prefecture.
Ryota TAKAHASHI
Abstract
Objective: Perform a cross sectional questionnaire survey about Leptospirosis to reveal the relationship between diagnoses

and reports by physicians and veterinarians in infectious disease surveillance.
Materials and methods: Knowledge, attitude and practice survey was conducted among 471 physicians and 74 veterinarians
in Miyazaki Prefecture.
Results: Totally, 205 physicians (43.5%) and 57 veterinarians (77.0%) reported the questionnaires. We observed a lack ofessential epidemiological information among the physician group. On the other hand, among the veterinarian group, we
observed that it was difficult for veterinarians to make diagnoses because of an inadequate laboratory system.
Conclusion: To improve the Leptospirosis surveillance system in Miyazaki Prefecture, we recommended they provided
epidemiological information to physicians regularly and developed an effective laboratory test system.
Keywords: Leptospirosis , zoonosis, surveillance, questionnaire survey, Miyazaki Prefecture
Thesis Advisor:

Tomoko TACHIBANA, Takaaki OHYAMA

Ⅰ．目的
感染症サーベイランスの問題点として，診断された症例数よりも，過少報告されている可能性が指摘されている．
すなわち，報告は診断した医師・獣医師の知識，態度，行動により異なっている可能性がある．今回，医師・獣医師による診断と報告の詳細を検討するために人獣共通感染症であるレプトスピラ症に注目した．
レプトスピラ症の確定診断には臨床検査が必要である．
特に，イヌのサーベイランスの届出基準は 7 種類の血清型に限られているため臨床検査による血清型の判定が必要
不可欠になっている．また，ヒトとイヌの症例の発生動向や国立感染症研究所実地疫学専門家養成コース（FETP）の疫学調査結果から1），宮崎県における対策が必要と考え指導教官：

橘とも子（人材育成部）
大山卓昭（国立感染症研究所感染症情報センター）

られている．
本研究では 1）医師・獣医師を対象としたレプトスピラ症認知度を把握すること，2）診断と報告について考察すること，3）宮崎県における今後のレプトスピラ症対策に役立つような情報提供を行なうこと，を目的として調査を
実施した．

Ⅱ．方法
宮崎県医師会の内科医会に所属する医師471人全数および宮崎県獣医師会に所属し動物病院に勤務する獣医師74
人全数を対象として，無記名による自記式質問票調査を郵送法により実施した．調査期間は，医師が2007年11月から12月にかけて，獣医師が同年10月から11月にかけて実施した．集計は，医師，獣医師別々に実施し単純集計にて分析を行った．
調査票は KAP 調査の手法に基づき2），属性，レプトス
ピ ラ 症 の 認 知 度・ 情 報 源， 診 断 と 報 告 等 の 知 識（K:7 48平成19年度専門課程特別研究論文要旨

Knowledge），態度（A: Attitude），行動（P: Practice）を問う質問項目を設定した．

Ⅲ．結果
1 ．医師アンケート結果
有効回答数および有効回答率は205人（43.5％）であった．認知度は，「レプトスピラ症を知っている」が205人
中183人（89.3%）であった．その場合に，「知っている項
目」については，「典型的な症状」183人中175人（95.6%），「検査方法」125人（68.3%），「治療」111人（60.7%），「感
染 リ ス ク 集 団 」111人（60.7%），「 疫 学 的 な 知 識 」47人
（25.7%）の順であった．診断と報告については，「レプトスピラ症を診断したことがある」という質問に，「はい」
205人中20人（9.8%），「いいえ」177人（86.3%）であった．「報告を行なったことがある」という質問に，「はい」
7人（3.4%），「いいえ」188人（91.7%）であった．この「いいえ」の188人に，「未報告の理由・原因」について聞いたところ，「疑うような患者を診たことがない」が134人（71.3%）と最も多かった．「宮崎県の対策への要望」
は，「医療従事者に対して発生状況や対策等の情報提供を行って欲しい」が165人（80.5%）と最も多かった．
2 ．獣医師アンケート結果
有効回答数および有効回答率は57人（77.0 ％）であった．認知度は，「イヌのレプトスピラ症を知っている」が57人中56人（98.2%）であった．診断と報告については，「イヌのレプトスピラ症を診断したことがある」という質問 に，「 は い 」57人 中42人（73.7%），「 い い え 」12人
（21.1%）であった．「報告を行なったことがある」という質問に，「はい」22人（38.6%），「いいえ」32人（56.1%）であった．この「いいえ」の32人に「未報告の理由・原因」について聞いたところ，「確定診断のための検査をしなかった」18人（56.3%），「重症例が多く，確定診断をつけることがなかった」13人（40.6%），「検査を提出する手段がなかった」8 人（25.0%）等の順であった．「宮崎県の対策への要望」は，「疑い症例に対する検査診断の支援を行って欲しい」が47人（82.5%）と最も多かった．

Ⅳ．考察
1 ．医師結果の考察
認知度については，回答した医師の89 ％が知っているという結果であり，ある程度の認知度はあると考えられた．しかし，知っている項目の結果から，「感染リスク集

401団」や「疫学的な知識」等の診断に必要な疫学情報が不足していることが示唆された．また，報告をしない理由として，「疑い例を診たことがない」が最も多かったことから鑑別診断に挙げるための知識の不足が背景にある可能性が考えられる．
調査の背景となる，宮崎県におけるレプトスピラ症の流行1）と今回の調査結果を踏まえて，診断と報告の効率化を図るためには，医療機関等で勤務する医師に対して積極的な情報提供を行っていくことが必要であると考えられた．
2 ．獣医師結果の考察
認知度については，回答した獣医師の98 ％が知っているという結果であり，かなりの認知度があると考えられた．報告をしない理由として，検査関連の項目が多くあげられていたことから，検査体制が整備されていないこと
が，報告に影響を与えていた可能性が考えられた．
イヌのレプトスピラ症についても宮崎県における地域流行が示唆されており1），今回の調査結果を踏まえて，今後の診断と報告の効率化を図るためには，動物病院における検査診断支援を行っていくことが必要であると考えられ
た．

Ⅴ．まとめ
本研究では宮崎県の医師・獣医師に対してアンケート調査を実施し，その認知度や診断と報告に影響する因子の考察等の結果から今後のレプトスピラ症対策への提言を行った．
医師については診断につながる疫学情報の不足が背景にあり，積極的な情報提供を行っていくことが必要であると考えられた．獣医師については検査体制の整備が十分ではないことが推測され，動物病院における検査診断支援が必要であると考えられた．

文献1 ） 鈴木智之，高橋亮太，中島一敏，大山卓昭，谷口清洲，岡部信彦．宮崎県におけるヒトのレプトスピラ症発生事例に対する疫学調査．第66回日本公衆衛生
学会総会；2007.10.24-26；愛媛．同抄録集．愛媛；
2007．P. 579.

2 ） Maswanya E, Moji K, Aoyagi K, Yahata Y, Kusano Y,
Nagata K, et al. Knowledge and attitudes toward AIDS
among female college students in Nagasaki, Japan.
Health Educ Res 2000;15:5-11.

7 4

8平成19年度専門課程特別研究論文要旨

402〈教育報告〉
平成19年度専門課程Ⅱ
健康危機管理分野

男性淋菌感染症に関する性感染症定点サーベイランス評価
五十嵐正巳

Evaluation of the Sentinel Surveillance in Japan, concerning MaleN. Gonorrhoeae Infection
Masami IKARASHI
Abstract
Objectives: To review Japanese male gonorrhea reports from the nationwide sentinel surveillance system, and Kochi

prefecture medical facilities Perform better surveillance site selection in Kochi prefecture to improve gonorrhea reporting.
Methods: I. We surveyed all 977 sentinels in Japan, and determined how many male gonorrhea cases each sentinel diagnosed
from Apr. to Oct. 2006. We determined whether the site was a hospital or a clinic, the primary medical specialty provided,
and the population aged 15-64 years in the district where the site was located. II. In Kochi prefecture we reviewed
surveillance in all the medical facilities providing‘obstetrics and gynecology,’‘urology,’‘dermatology,’and‘venereal
disease.’Results: I. In the 977 sentinel settings, clinics reported more cases than hospitals. Sentinels providing mainly
urologic services reported the most cases. Sites in administrative districts with higher populations reported more cases. II. In
Kochi, surveillance could be improved when two sentinels having more cases were selected. Conclusion: If prefectures selectclinics which mainly provide urologic services as surveillance sites, they can improve surveillance of male gonorrhea. In
Kochi, sentinel surveillance is more representative when two clinics in Kochi city providing urologic services are included.
Keywords:

Neisseria gonorrhoeae, sexually transmitted diseases, surveillance, sentinel medical settings,
national surveillance system for infectious diseases in Japan

Supervisors:

Hirohisa IMAI, Tamano MATSUI

Ⅰ．目

的サーベイランスとは，継続的，系統的に情報収集することであり，その情報を対策につなげることが理想である1）．
我が国では，感染症法に基づき，感染症発生動向調査が実施されている2）．同調査では，診断した全医師から届け出を求める全数把握疾患と，予め指定された定点医療機関（以下，定点という）に受療した患者情報を集める定点把握疾患がある．
しかし，定点配置を議論した研究は少なく3），都道府県が定点を選定する際には，医療機関の規模や診療科目を考慮する必要がある3）が，十分に検討されていない．
男性では，性感染症定点疾患の中で淋菌感染症が31.2%を占め，男性淋菌感染症の発生動向は定点疾患全体の推移
指導教官：

今井博久（疫学部）
松井珠乃（国立感染症研究所感染症情報センター）と概ね一致している．
そこで，男性淋菌感染症患者を的確に把握するために都道府県が定点設定の際に有効な指針を示すこと，2006年 4
月から10月までの定点当り男性淋菌感染症報告数が最低であった高知県において男性淋菌感染症患者の受診動向を反映したサーベイランスとなるために定点設定を見直すことの 2 つを本研究の目的とした．

Ⅱ．方法

1 ．男性淋菌感染症を多く報告した定点の特徴
全国977定点それぞれの病院／診療所，主な医療を提供している診療科目（産婦人科系，泌尿器科，皮膚科，性病科），所在地生産年齢（15-64歳）人口について2006年 4
月から10月までの男性淋菌感染症報告数を記述した．
2 ．高知県全数調査による定点の見直し
高知県内の産婦人科，産科，婦人科（産婦人科系），性病科，泌尿器科，皮膚科（泌尿器科・皮膚科系）を標榜す

7 4

8

平成19年度専門課程特別研究論文要旨
る全140医療機関を対象にした調査票による調査を行った．男性淋菌感染症報告数が多かった属性を代表する医療機関を優先的に定点とすることで見直した．高知県の泌尿
器科・皮膚科系現定点 3 つをそれぞれ A, B, C とし，見直した後の 3 定点を A’，B’，C’とした．見直し前後の定点から得られた患者の年齢分布を全数調査で得られた全患者の年齢分布と比較した．

Ⅲ．結

果

=ੱ?
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図 3 ．見直し前の現 3 定点からの患者報告（n=6）

察

1 ．男性淋菌感染症を多く報告した定点の特徴
病院よりも診療所で有意に報告数が多く，中でも泌尿器科医療を主に提供している診療所で有意に報告数が多かった．そのため，都道府県が定点を選定する際には，病院よりも診療所を優先し，さらに泌尿器科医療を主に提供している診療所を優先することで男性淋菌感染症患者を効果的に把握することができることが示唆された．
2 ．高知県全数調査による定点の見直し
高知では，現在の定点によって報告された患者（n=6）の年齢分布からは，高知県での全数調査で得られた全133
患者の年齢分布を類推することは不可能であった．そのため，現在の定点設定では，代表性のあるサーベイランスとなっていなかったことが分かった．しかし，定点設定を見直した後に得られた男性淋菌感染症患者の年齢分布は，患者総数133の年齢分布と相似していたため，この見直し後の定点からは，男性淋菌感染症患者の全体像を反映した分布を把握することができる．つまり，高知県では，生産年
齢人口10万人以上の地（高知市）に所在する泌尿器科標
榜の診療所である属性の中から優先的に定点を選ぶことによって，代表性のあるサーベイランスを実施することができると考えられた．

Ⅴ．まとめ

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図 1 ．高知県全数調査での全患者（患者総数133）=ੱ? 
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Ⅳ．考1 ．男性淋菌感染症を多く報告した定点の特徴
全国977定点において，男性淋菌感染症報告数が病院よりも診療所で多かった（p<0.01）．報告数が産婦人科系よりも泌尿器科，皮膚科，性病科で多かった（p<0.01）．中でも泌尿器科は皮膚科よりも報告数が多かった（p<0.01）．
所在地生産年齢人口が大きくなる程，報告数が多い傾向を認めた．
2 ．高知県全数調査による定点の見直し
有効回答医療機関数は56（40.0％）であった．全数調査で得られた2006年 4 月から10月までの男性淋菌感染症患
者総数は133であった（図 1 ）．
男性淋菌感染症を多く報告した属性は，生産年齢人口10万人以上の地（高知市）に所在し，標榜科目に泌尿器科がある診療所であった．
見直し後の 3 定点から得られた患者（n=22）の年齢分
布（図 2 ）は，全133患者の年齢分布（図 1 ）と相似したが，見直し前の現 3 定点から得られた患者（n=6）の年齢分布（図 3 ）は，全133患者の年齢分布（図 1 ）と相似し
なかった．

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403

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・都道府県が男性性感染症に対する定点を選定する際には，病院よりも診療所を優先し，さらに泌尿器科医療を主に提供している診療所を優先することで男性淋菌感染症患者を効果的に把握することができる．
・高知県では，高知市内の泌尿器科を標榜する診療所を優先的に定点とすることによって，男性淋菌感染症患者の全体像を反映した代表性のあるサーベイランスとなる．

文
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図 2 ．見直し後の 3 定点からの患者報告（n=22）

献1 ） Centers for Disease Control. January 1988. CDC
Surveillance Update. Atlanta, Ga.: CDC
2 ） 岡部信彦．感染症発生動向調査について．厚生の指標 2001年；48（6）：1-7.
3 ） 村上義孝，橋本修二，谷口清州，永井正規．感染症
発生動向調査における定点配置の現状評価．日本公衛誌 1999年；46（12）：1060-1067.

7 48平成19年度専門課程特別研究論文要旨

404〈教育報告〉
平成19年度専門課程Ⅱ
健康危機管理分野

腸管出血性大腸菌の家族内二次感染防止に関する検討
徳田浩一

Prevention of Secondary Household Transmission Associated withEnterohemorrhagic Escherichia Coli Outbreaks
Koichi TOKUDA
Abstract
Objectives: To investigate secondary household transmission (SHT) due to EHEC outbreaks in day-care centers (DCCs). To
recommend appropriate interventions for local health centers (LHCs) to prevent the spread of infection. Methods: Suspected

outbreaks of EHEC infection in DCCs were identified from the National Epidemiological Surveillance of Infectious Disease(NESID). Questionnaires were sent to LHCs that may have responded to the outbreaks. Based on the results of questionnaires
and the data in NESID, the rates of SHT were calculated and factors affecting the rate of SHT were analyzed by multiple
regression analysis. Results: Sixteen outbreaks were detected by questionnaires. The rates of SHT ranged from 0.0 through34.4%. The highest rate was 23.0% among children aged 6-9 years. Infection rate of mothers were significantly higher thanfathers and grandparents. By multiple regression analysis, five independent variables such as“the way of providing information
to families with EHEC”,“type of EHEC”,“days taken to provide information”, etc. were selected in the best model. Conclusion:
Early response and hygiene education through visiting LHC staff may be effective measures to prevent secondary spread in
EHEC outbreaks. Hygiene education should be emphasized for children 6-9 years old as well as younger children.
Keywords:

EHEC, day-care centers, secondary household transmission, prevention of the spread of EHEC infection,
multiple regression analysis

Supervisors:

Tomoko TACHIBANA, Tomimasa SUNAGAWA

Ⅰ．目的
腸管出血性大腸菌（EHEC）感染症の年間報告数は，
1999年以降3,000 ～ 4,000人にのぼっている．毎年，流行期には高齢者施設や飲食店などの施設における集団感染事例が報告されるが，保育所や託児所からの報告も少なくな
い1）．本研究は，保育所および託児所（以後，保育施設）
から家庭内への EHEC 持ち込みによる家族内二次感染の実態を把握すること，さらに家族内二次感染に影響を及ぼす要因を検討し，感染拡大防止に有効な対策を提言することを目的とした．

Ⅱ．調査対象と方法
1 ．家族内二次感染の実態把握
指導教官：

橘とも子（人材育成部）
砂川富正（国立感染症研究所感染症情報センター）

2006年第 1 週～第52週に，保育施設における入所児10人以上の感染者が報告された EHEC 集団感染事例を調査した．まず，感染症サーベイランスシステム（NESID）
を用いて，調査対象期間に 0 ～ 6 歳の EHEC 感染者を10名以上報告した地域を探索した．次に，当該地域を管轄す
る保健所に対して質問紙を郵送し，調査を実施した．調査
内容は，①保育施設における入所児10名以上の EHEC 集団感染事例の有無② EHEC 陽性入所児の情報［年齢，症状の有無等］③ EHEC 陽性入所児の家族情報［家族構成，感染者の有無等］④家庭への感染対策指導実施日⑤指導方法［文書，個別訪問等］，などとした．また，調査で得た感染者の NESID 上の登録番号から，①各事例の発端者の医療機関診断日②医療機関から保健所への報告日③感染者の情報［EHEC 血清群・毒素型等］を NESID より抽出した．家族内二次感染率の算出は，当該施設の入所児が家庭
内に 1 人のみであった家族員を対象とした．差の検定にはχ2検定（あるいは Fisher の正確な検定）を，傾向性の7 48

平成19年度専門課程特別研究論文要旨
検定にはコクラン・アーミテージ検定を行った．統計学的な有意水準は 5 ％とした．
2 ．家族内二次感染に寄与した要因の分析
目的変数を家族内二次感染率とし，また説明変数を，①
医療機関診断から家庭への情報提供までに要した日数②
EHEC 陽性入所児の平均年齢③ EHEC 陽性入所児の有症率④ EHEC 血清群・毒素型⑤ EHEC 陽性入所児家庭への情報提供方法（初動時）⑥他入所児家庭への情報提供方法（初動時）⑦他入所児家庭への情報提供方法（初動後）⑧
平時における家庭への感染対策指導の有無，として重回帰分析を実施した．回帰分析には SPSS 10.0J（Windows）
を用いた．

表1

405

回帰分析に用いた変数⋡⊛ᄌᢙኅᐸౝੑᰴᗵᨴ₸ ⺑᣿ᄌᢙ ㅪ⛯ᄌᢙ㧕ᖱႎឭଏߦⷐߒߚᣣᢙ ᣣ'*'%㓁ᕈ౉ᚲఽᐕ㦂 ᱦ'*'%㓁ᕈ౉ᚲఽ᦭∝₸ ⺑᣿ᄌᢙ ⾰⊛ᄌᢙ㧕'*'%ဳ186
18686'*'%㓁ᕈ౉ᚲఽኅᐸ߳ߩᖱႎឭଏᣇᴺ ೋേᤨㅢ⍮୘೎⸰໧ઁ౉ᚲఽኅᐸ߳ߩᖱႎឭଏᣇᴺ㧔ೋേᤨ㧕ㅢ⍮ߘߩઁ ୘೎⸰໧‫⼔଻ޔ‬⠪⺑᣿ળઁ౉ᚲఽኅᐸ߳ߩᖱႎឭଏᣇᴺ ೋേᓟߩኻᔕ
ㅢ⍮ߘߩઁ ୘೎⸰໧‫⼔଻ޔ‬⠪⺑᣿ળᐔᤨߩኅᐸኻᔕ
ኅᐸ߳ߩᗵᨴኻ╷ᜰዉ޽ࠅኅᐸ߳ߩᗵᨴኻ╷ᜰዉߥߒ

ᦨዊ୯

ਛᄩ୯





ᦨᄢ୯



ᦨዊ୯

ਛᄩ୯

ᦨᄢ୯




0








































Ⅲ．結果と考察
1 ．家族内二次感染の実態把握疑いを含む18事例の EHEC 集団感染が NESID より探知され，18保健所に対して質問紙を送付した．全保健所から回答があり（回収率100 ％），16事例の発生が確認された．家族内二次感染率算出の条件を満たした家族員は751人であり，感染率は事例により0.0％から34.4％であった．性別の感染率は男性7.8 ％，女性10.7 ％で有意差はな
かった．年齢群別の感染率は 6 － 9 歳が23.0 ％で最も高く，次いで 0 － 5 歳15.4％の順であった．全体的な傾向として低年齢であるほど感染率が高値であった（p<0.001）．
続柄別の感染率は兄弟が21.3 ％で最も高く，次いで姉妹
18.3％，母親10.0％の順であった．兄弟の感染率は母親と比較して有意に高く，母親の感染率は父親および祖父母と比較して有意に高かった．これは家庭において子供に最も接触機会の多い養育者が通常は母親であることと関連した結果と考えられた．EHEC 陽性入所児年齢別の感染率は，低年齢であるほど家族員の感染率が高い傾向がみられたが，4 歳以上では逆に年長であるほど家族員の感染率が高かった．要因として，4 歳以上の年長児における日常衛生面（排泄・手指衛生など）での不完全な自立との関連が推察される．EHEC 陽性入所児の胃腸炎症状の有無でみた感染率は有症群8.2％，無症群9.9％であり，微量の菌数で感染が成立するという EHEC の特徴が関連していると思われた．原因菌は O26VT1あるいは O157VT1 VT2の 2つに大別され，感染率は O26VT1群8.7%，O157VT1VT2
群10.8％で有意差はなかった．
2 ．家族内二次感染に寄与した要因の分析
各変数の記述統計量を表 1 に，重回帰分析で最適モデ
ルとして選択された変数を表 2 に示す．

表2

重回帰分析結果⺑᣿ᄌᢙ(+(&㓁ᕈ౉ᚲఽኅᐸ߳ߩ
ᖱႎឭଏᣇᴺ ೋേᤨ(+(&ဳ(+(&㓁ᕈ౉ᚲఽ᦭∝₸ᖱႎឭଏߦⷐߒߚᣣᢙ
ઁ౉ᚲఽኅᐸ߳ߩᖱႎឭ
ଏᣇᴺ㧔ೋേᤨ㧕
5 

࿁Ꮻଥᢙ

ᮡḰ⺋Ꮕ

ᮡḰൻଥᢙ

S୯

























⥄↱ᐲୃᱜᷣ5 

重回帰分析から，感染率がより低下する要因や対策として以下の結果を得た．① EHEC 陽性入所児のいる家庭への情報提供方法（初動時）として通知のみでなく，個別訪問を行った場合②起因菌が O157VT1VT2でなく O26VT1であった場合③ EHEC 陽性入所児の有症率がより高かった場合④情報提供までに要した日数がより短期間であった
場合⑤他入所児家庭への情報提供方法（初動時）として通知のみでなく，その他（個別訪問あるいは保護者説明会）を行った場合IV．まとめ
家庭への感染対策指導に際しては，家族員による感染率の違いを考慮すべきと考えられた．6 ～ 9 歳の小児における感染率と，持ち込んだ児が 6 歳であった場合の家族員の感染率が最も高いことから，就学前から小学生相当の小児に対する衛生教育が強化すべき課題であると思われた．
集団感染事例発生の可能性が探知された場合，通知のみ
でなく，個別訪問あるいは保護者説明会による早期対応と感染対策指導が，家族内二次感染による感染拡大防止に有効と考えられた．

文献1 ） 国 立 感 染 症 研 究 所． 病 原 微 生 物 検 出 情 報 2007；
28：p. 131-42．

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