Introduction Neonatal jaundice occurs in about 60% of newborns. If not managed properly, it can progress to severe neonatal jaundice (SNNJ) leading to death or permanent disability. The incidence of SNNJ in Kuching District increased from 119.3 per 100,000 live births in 2005 to 123.3 per 100,000 live births in 2008, which was above the Standard National QAP Indicator of 100 per 10,000 live births. SNNJ can be prevented by early detection and proper management of neonatal jaundice. The objective is to increase the knowledge and practise of early detection of neonatal jaundice by nurses in Kuching District. Methods This was an interventional study covering a period of six months. The sample comprised 113 nurses of all categories working in urban and rural maternal and child health clinics in Kuching District. Tools used in the study were self-administered questionnaires in English and Bahasa Malaysia. The preintervention survey started in July 2009 while the post-intervention survey was done in January 2010. The interventions were done through Continuing Nursing Education sessions and included new nursing formats and new reporting procedures. New vehicles were also provided for home nursing. Data was collected and analyzed using MS Excel program. Results The pre-intervention survey on nurses showed that only 56.6% were able to identify the risk of factors causing jaundice; 94.6% able to define jaundice; 41.5% able to detect jaundice while 70.8% knew sign of Kernicterus. In term of recommended post natal nursing schedule only 40.7% able to practice the schedule while only 69.0% able to give advice on management of jaundice. Post intervention; 63.2% of nurses were able to identify the risk factors causing jaundice; 97.2% able to define jaundice while 97.2% were able to detect jaundice and 88.6% know sign of Kernicterus. On recommended post natal nursing schedule, 49.9 % practice the recommended schedule while 92.0% were able to give advice to mother on management of jaundice. The incident of jaundice of Severe Neonatal Jaundice dropped to 78 per 100,000
live births in 2010. Conclusions The study shows that the interventions taken helped to improve the
knowledge and practice of recommended measures to detect neonatal jaundice early. Stronger emphasis must be placed on using the new reporting procedures and new nursing sheets. Continuous monitoring through regular nursing audits by clinic supervisors is also essential to reduce the incidence of SNNJ. Provision of vehicles for all busy maternal and child health clinics for home nursing care is highly recommended.
Introduction Prolonged mechanical ventilation among cardiac surgery patient has been
found to be correlated with negative clinical outcome and increased
healthcare resources utilization. Prolonged mechanical ventilation (PMV)
was defined as the accumulative duration of 24 hours or more of
postoperative endotracheal intubation starting from transfer of the patient to
cardiac ICU. This study is aimed to identify the risk factors preoperative,
intra operative and postoperative for prolonged ventilation among cardiac
patients in AL-Thawra Modern General Hospital (TMGH).
Methods Observational study design was conducted during a two-month period (from
1 August 2014 to 30 September 2014). It was among 70 patients who were
admitted to cardiac surgery intensive care unit in Al-Thawra Modern General
Hospital and selected by convenient sampling. The soci-demographic
characteristic and clinical patient data were collected using short
questionnaire developed by researcher. All patients had the same anesthetic
and postoperative management. Statistical analysis was performed with SPSS
version 20 and using bivariate analysis and multivariate logistic regression.
The p-value of < 0.05 was found to be statistically significant.
Results Incidence of prolonged mechanical ventilator post cardiac surgery was 37.1%
(26/70) through bivariate analysis, multivariate logistic regression. Low
Ejection fraction of Left Ventricle was inversely related to mechanical
ventilation time (AOR= 0.872) with 95% confidence interval [0.790 - 0.963],
hemodynamic instability were associated with prolonged mechanical
ventilation time (AOR=16.35) with 95% confidence interval [2.558 -
Conclusion Low ejection fraction of Left Ventricle and Hemodynamic Instability post
operation were identified risk factors for prolonged mechanical ventilation
post cardiac surgery.
Introduction Married couples often do influence each other’s emotions and behaviors. The
effect of this interpersonal marriage relationship on emotional job demands
and job performance toward work-family conflict (WFC) is still under
research. This article aims to determine the effects of married couple’s job
factors (emotional job demands and job performance) on wife’s WFC.
Methods A total of 120 dyads in private sectors were recruited via private invitations
to social gatherings. Packets of self-administered questionnaires were given
included emotional domain of Demand-Induced Strain Compensation,
Spielberger Trait Anger Scale, work-family conflict and job performance
measures. Dyadic analysis using Actor-Partner Interdependence Model was
Results The emotional demand of wife significantly contribute higher effect (ES=
0.34 (95%CI: 0.23, 0.45); p
Introduction Overweight and obesity is a major public health problem in Malaysia. This
study aims to determine the prevalence of overweight and obesity among the
Malaysian adult population and their association with socio-demographic
characteristics (gender, ethnic, and age groups).
Methods A total of 17,257 adults aged 18 years and older (8,252 men, 9,005 women)
were assessed for BMI status, with a response rate of 97.8%, through a
household survey from the National Health and Morbidity Survey (NHMS),
conducted in all states of Malaysia in 2011.
Results All socio-demographic factors were consistently associated with higher
chance of being overweight (except gender and location) and obesity (except
location and household income). The identified risk of overweight were
Indian (aOR: 1.8, 95% CI: 1.2-2.8), aged 50-59 years (aOR: 2.8, 95% CI:
2.0-3.9), widower (aOR: 1.6, 95% CI: 1.3-2.0), subject with secondary
education (aOR: 1.2, 95% CI: 1.0-1.4), Homemaker/unpaid worker (aOR:
1.3, 95% CI: 1.1-1.4), and with high household income group (aOR: 1.3, 95%
CI: 1.2-1.6). The identified risk of obesity were women (aOR: 1.4, 95% CI:
1.2-1.6), Indian (aOR: 1.7, 95% CI: 0.9-3.2), aged 30-39 years (aOR: 3.6,
95% CI: 2.4-5.5), widower (aOR: 1.2, 95% CI: 0.9-1.6), subjects with
primary education (aOR: 1.2, 95% CI: 0.9-1.6), Homemaker/unpaid worker
(aOR: 1.3, 95% CI: 1.1-1.6), and with middle household income group (aOR:
1.3, 95% CI: 1.2-1.6).
Conclusions Our data indicate a high prevalence of overweight and obesity in the
population. Several sociodemographic characteristics are associated with
both overweight and obesity. This study highlights the serious problem of
overweight and obesity among Malaysia adults. Documentation of these
problems may lead to research and policy agendas that will contribute both to
our understanding and to the reduction of these problems.
Medication adherence is very important for the effective treatment or control of various health problems, including chronic disease like diabetes mellitus (DM). However, medication non-adherence among diabetic patients on follow-up treatment is still a global health problem. This study aimed to identify factors associated with medication adherence and to determine methods on how it could be improved. A cross-sectional study was conducted on medication adherence among Malays, Iban and Melanau ethnic groups in Kota Samarahan and Sarikei, Sarawak using the Health Belief Model framework. Interviews with questionnaires, which were tested for its validity and reliability using the Cronbach’s Alpha, were conducted to collect data on the respondent’s socio-demographic and economic characteristics, and health beliefs of 442 respondents. Data was analyzed using SPSS version 17.0 for frequency distribution, measures of central tendencies, significance testing and logistic regression. The medication adherence rates were low in terms of all the treatment indicators such as amount of medication (31.7%), frequency (38.9%), duration (26%), and follow-up treatment (24.2%). The respondent’s socio-economic and economic characteristics have statistically significant association with medication adherence. The respondents adhered towards medication because they believed in its benefits. They also took their medication because they believed in the severity of DM and their susceptibility to its serious complications. The cues to action (medication taking) such as worrying about their socio-economic well-being, effectiveness of medication, and health campaign on diabetic control have influenced medication adherence. However, forgetfulness, distance of clinic, and costs of transport have caused medication non-adherence. The respondent's health beliefs in the benefits of taking medication, perceived severity and susceptibility to DM and its serious complications have contributed towards medication adherence. Their concerns about the socio-economic well-being, effectiveness of medication, and health campaign on diabetic control were positive cues to medication taking behavior. Therefore, modifying the respondent's related health beliefs and reinforcing the positive cues to actions are the relevant intervention strategies that could be used in improving medication adherence among diabetic patients.
Introduction Hepatitis C Virus (HCV) recently was identified as a major cause of post transfusion hepatitis world wide. To evaluate the role of blood transfusion on the prevalence of HCV infection, by testing antibody and RNA as well as the genotypes of HCV .Also to detect if Blood transfusion acts as unconfounding risk factor for HCV infection.
Methods Sera from 3491 pregnant women were investigated for the presence of HCV antibodies (anti-HCV) by using third generation enzyme immunoassay (EIA-3) as screening test, followed by immunoblot assay (Lia Tek-III). In addition 94 sera of studied women were subjected to molecular analysis (at laboratories of Sorin BioMedica - Italy) for the detection of viral RNA and genotypes of HCV. Using RT-PCR & DNA Enzyme immunoassay (DEIA) method.
Results Our study revealed, that seroprevalence rate of HCV specific Ab & RNA were significantly higher (16.32 %, 80% respectively) among women with a history of blood transfusion, compared to those (2.53%, 56.5%) with no such history P=0.0001, P=0.01. And there is a significant direct linear correlation between number of blood transfused and the seropositive rate of anti-HCV (r=0.7, p=0.046). Based on multivariate analysis, interestingly, this study confirmed that, blood transfusion significantly acting as unconfounding risk factor for acquiring HCV infection (Adjusted OR=1.938,95% C.I=1.646-2.28). And the risk of exposure is increases with increased number of blood transfused. Although, we found no significant association between, HCV genotypic distribution and history of blood transfusion. However, high proportion of women with a history of blood transfusion were harboring HCV genotype -4 or 1b, 50%,40%, resepctively.
Conclusions Our study shows, evidence that, blood transfusion acts as unconfounding risk factor for acquiring and in a mode of transmission of HCV infection. Therefore strict screening of blood donor for HCV-Abs and / or RNA is highly recommended.
Introduction An Analysis of a Survey Questionnaire on health care workers’ knowledge
and practices regarding of infection control and complains them to apply
universal precautions. Health care workers are at substantial risk of acquiring
blood borne pathogen infections through exposure to blood or other products
of patients. To assess of infection control among health care workers in
Sana'a healthcare centers, Yemen.
Methods A cross-sectional study was conducted in the health center to assess
knowledge and practices regarding of infection control among 237 health
workers in Sana,a city. A structured self-administered questionnaires were
used and data was analyzed using SPSS version 20 and the associations were
tested with chi-square, with p-value of < 0.05.
Results The health care workers in public centers ware (51.1%) and (48.9%) of them
works in private centers. One hundred and seventeen (49.4%) respondents
had poor infection control knowledge, 113 (43.5%) had fair knowledge, and
17 (7.2%) had good knowledge. The knowledge was significantly associated
with type of center (P < 0.018), such that the public center had the highest
proportion with poor knowledge. And nurses and midwife having the highest
proportion with fair knowledge of infection control. Eight (3.4%) respondents
had a poor practice of universal precautions, 93 (39.2%) had fair practice, and
136 (57.4%) good practice. The practice was significantly associated with the
profession, level of education and work experience (P < 0.001), (P < 0.006),
(P < 0.001) respectively, and nurses and midwives as the profession with the
highest proportion with good practice.
Conclusion We conclude that the practices and knowledge of universal precautions were
low and that's need for intensive programmes to educate health care workers
on various aspects of standard precautions and infection control programmes
Clinical pathways have been implemented in many healthcare systems with mix results in improving the quality of care and controlling the cost. CP is a methodology used for mutual decision making and organization of care for a well-defined group of patients within a well-defined period. In developing the CPs for a medical centre, several meetings had been carried out involving expert teams which consist of physicians, nurses, pharmacists and physiotherapists. The steps used to develop the pathway were divided into 5 phases. Phase 1: the introduction and team development, Phase II: determining the cases and information gathering, Phase III: establishing the draft of CP, Phase IV: is implementing and monitoring the effectiveness of CP while Phase V: evaluating, improving and redesigning of the CP. Four CPs had been developed: Total Knee Replacement (TKR), ST Elevation Myocardial Infarction (AMI), Chronic Obstructive Airways Diseases (COAD) and elective Lower Segment Caesarean Section (LSCS). The implementation of these CPs had supported the evidence-based medicine, improved the multidisciplinary communication, teamwork and care planning. However, the rotation of posts had resulted in lack of document ownership, lack of direction and guidance from senior clinical staff, and problem of providing CPs prior to admission. The development and implementation of CPs in the medical centre improved the intra and inter departmental communication, improved patient outcomes, promote patient safety and increased patient satisfaction. However, accountability and understanding of the CPs must be given more attention.
Carpal tunnel syndrome (CTS) is a hand disorder which indicates the presence of symptoms such as pain, numbness, and muscle weakness among the patient. CTS is an occupational related disorder which can occur in any profession. However, it can be prevented and managed. The aims of the research were to determine the prevalence of acquiring CTS among nurses who worked in the wards and occupational risk factors involving the upper limbs during nursing tasks performance. The specific aims were to determine the relationship between the prevalence of acquiring CTS and individual factors (age, gender, race, educational level, duration of work and medical history), relationship between the prevalence of acquiring CTS and occupational risk factors in nursing tasks. Nurses profession was chosen as they are performing multitask involving upper limbs especially the wrist joints. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the level of severity in CTS. Occupational risk factors were assessed by using the Rapid Upper Limb Assessment (RULA). This research was a cross sectional mode which was carried out at a government university medical centre from November through December 2010. Eighty nurses were involved in the research. The respondents were required to fill in the socio-demographic information sheet. Those having CTS were required to fill in the BCTQ. Assessments were performed by observing of the job activity through RULA. The results showed that the prevalence for nurses acquiring CTS is 7.5%. The RULA assessment also indicated that the risk factor was in the highest level with a score of 7. No relationship was shown between the prevalence of CTS and race, gender, educational level and medical history. Significant relationship was indicated by the prevalence of CTS and occupational risk factors. In conclusion, a significant prevalence of CTS related to age of more than 30 years old, Malay races compared to Indian, working experience of more than 10 years and respondents with right hand dominant. Occupational risk factors also indicated among the active nurses. Therefore, it is important for us to modify the work environment, work flow, work methodology and ergonomic factors in order to prevent the nurses from acquiring CTS. Furthermore, education about the condition of CTS should be implemented and reinforced especially among the higher risk nurses.
Accepted 07 August 2011.
Introduction Chronic kidney disease (CKD) has emerged as a major medical illness that drew the attention of the community. This research focused on the prevalence of five contributing factors to the progression of CKD, namely blood pressure control, glycaemic control, lipid control, smoking and alcohol intake, and explored significant association between these variables. This was a crosssectional study that examined the progression of CKD based on the worsening of CKD stages.
Methods This study was conducted among CKD patients with type 2 diabetes mellitus who attended Nephorology Clinic, UKMMC from April to May 2011. The progression of CKD was observed for 3 consecutive visits with 3 months intervals between the visits. Information regarding demographic data and social history were obtained through face-to-face interview, followed by case note review of the blood results. Data collected was analysed using SPSS version 19.0.
Results A total of 201 respondents were investigated, which included 39.3% (n=79) female and 60.7% (n=122) male. The mean age for the respondents was 66.9 years old (±SD 9.00). Among the respondents, 71.5% had poor glycaemic control; 59.7% had poor blood pressure control; 65.2% had poor lipid control; 19.9% smoked and 3.5% consumed alcohol. There was poor correlation, there were statistically significant association between systolic blood pressure control with the glomerular filtration rate (GFR) (p=0.001; r=-0.229). From this research, high systolic blood pressure was associated with low GFR, which indicated poor kidney function and resulted in progression of CKD.
Conclusions This study has clearly demonstrated that the control of blood pressure was essential in delaying the progression of CKD.
Introduction Sleep has played a very important role in maintaining our health with good
living quality therefore the aim of this study is to determine the pattern of
sleep duration, especially short sleep and its associated factors among
workers in a tertiary institution.
Methods A cross-sectional study was conducted from January until May 2012 among
128 randomly selected Universiti Kebangsaan Malaysia Medical Centre
(UKMMC) staffs. Data was collected using a guided standardized data sheet
which consist of three sections; (1):sociodemographic &socioeconomic, (2):
lifestyle and, (3): anthropometric measurement and sleep diary. Data entry
and analysis were done using Statistical Package for Social Sciences (SPSS)
Results Majority of the staffs had normal sleep duration (67.2%) followed by short
sleep duration (26.6%) and long sleep duration (6.3%). Simple logistic
regression analysis indicated that late night snacking was significantly related
to short sleep (cOR=3.47, 95% CI: 1.12, 12.23, p=0.048).
Conclusions Adequate sleep is important to maintain one’s health. Steps can be taken to
limit late night snacking in order to improve the sleep pattern in this study
Introduction Drug abuse has been a global threat not only in Malaysia but worldwide,
especially among adolescents. This is alarming issue had been a serious
public health problem worldwide. The aim of the study is to access the
knowledge and attitude on drug abuse among Pahang Matriculation students
Methods A cross¬-sectional study was conducted involving 217 matriculation
students. A self-determined questionnaire was distributed among the students
regarding knowledge and attitude about drugs.
Results The prevalence of good knowledge on drug abuse was (82.03%). The
prevalence of students’ attitude on drug abuse has higher number of good
attitude with the sum of 182 (83.9 %). Only gender showed a significant
association with students’ knowledge (P= 0.046).
Conclusion The knowledge, attitude, and practice of drug abuse among Pahang
Matriculation students are good.
Rapid Rural Appraisal (RRA) is a systematic, semi-structured activity carried out in the field by a multidisciplinary team that is designed to obtain new information and hypotheses about rural life. This article reports the results of an RRA conducted in Kampung Paris 1 (KGP1), Kinabatangan, Sabah under the Annual Health Promotion Program of the School of Medicine, Universiti Malaysia Sabah. A systematic random sampling was used to recruit the villagers and data was obtained through compilation of pre-existing data, field observation, structured interviews with key informants and villagers. Cardiorespiratory diseases were prevalent in KGP1. Common water sources such as rain water collected in dug wells in KGP1 were unhygienic. Dangerous toxic fumes were produced by the burning of municipal wastes nearby village houses. The villagers of KGP1 were exposed to various farm animals, which may harbor zoonoses. Health care services are limited in KGP1. Villagers who were not poor (>RM897) represented 48% of the population, followed by the poor (RM503-897), 20% and the hardcore poor (1.00 person per bedroom. Poor water hygiene, polluted air from open burning, exposure to farm animals, poverty, poor education, overcrowding and inadequate health care services were among the few possible factors affecting the health of villagers in KGP1. Formal rigorous research should be conducted in the future to facilitate specific health interventions in areas of need such as KGP1.
Introduction The most effective and affordable public health strategy to prevent
hypertension, stroke and renal disease is by reducing daily salt consumption.
Therefore, this study aims to determine the association of knowledge, attitude
and practice on salt diet intake and to identify foods contributing to high
Methods Secondary data analysis was performed on MySalt 2016 data. It was
conducted from November 2015 until January 2016 which involving Ministry
of Health Staff worked at 16 study sites in Malaysia. Salt intake was
measured using 24 hours urinary sodium excretion. Food frequency
questionnaire was used to determine the sodium sources. Knowledge, attitude
and practice of salt intake were assessed using a validated questionnaire
adapted from WHO. Demographic data and anthropometric measures also
were collected. Sodium levels of more than 2400mg/day was categorised as
high sodium intake. Data were analysed using SPSS software version 21.
Results The mean sodium intake estimated by 24 hours urinary sodium excretion was
2853.23 + 1275.8 mg/day. Food groups namely rice/noodles (33.8%),
sauces/seasoning (20.6%), meat and poultry (12.6%) and fish/seafoods
(9.3%) were the major contributors of dietary sodium. In multiple logistic
regression analysis, being a male (aOR=2.83, 95% CI 2.02 – 3.96) and obese
(aOR=6.78, 95% CI 1.98 – 23.18) were significantly associated with high
urinary sodium excretions. In addition, those who were unsure that high salt
intake can cause hypertension (aOR=1.24, 95% CI 0.65 – 2.36), those who
think that they consumed too much salt (aOR=2.10, 95% CI 1.13 – 3.87) and
those who only use salt rather than other spices for cooking (aOR=2.07, 95%
CI 1.29 – 3.30) were significantly associated with high urinary sodium
Conclusions This study showed that the main sources of sodium among Malay healthcare
staff is cooked food. Poor knowledge and practice towards reducing salt
consumption among them contributes to the high sodium consumption. The
practice of healthy eating among them together with continuous awareness
campaign is essential in order to educate them to minimize sodium
consumption and to practice healthy eating.
Introduction There is an increasing trend of obesity in children and adolescent globally.
The objectives of this study were to identify the prevalence of overweight
and obesity among students from secondary schools and to determine the
mean random blood sugar (RBS) for the overweight and obese students.
Methods This was a cross sectional study. Two secondary schools that were scheduled
for visit by the School Health Team, Taiping in July 2016 were included. A
standardized data collection sheet was used to collect the data. Overweight
and obesity were defined based on WHO 2007 reference for BMI-for-age
criteria. Random blood glucose was checked for overweight and obese
Results A total of 184 school students consented and participated. 128 (69.6%) were
female and 90 (48.9%) were Malays. The mean weight and height were 56.21
kg and 1.61 m respectively with BMI of 21.49 kg/m2
. Overall, the prevalence
of obese and overweight were 12.5% and 10.9% respectively. Among the 4
BMI groups, there were no significant difference found in sex (p=0.849) and
races (p=0.536). However, there was significant difference (p=0.042) in
mean RBS for obese and overweight students between races. RBS readings
among overweight and obese students were within normal range with mean
of 5.95 (0.67) mmol/l (range between 4.60 – 7.70 mmol/l).
Conclusions The overall prevalence of overweight and obesity were comparable with
other studies done in Malaysia. Nevertheless, there was no prevalence of
Type II diabetes mellitus among them.
It all started with a SSM research. SSM, which is an abbreviation for ‘Special Study Module’ is a unique module in the curriculum of the Medical Faculty National University of Malaysia (UKM), where each students were required to do a medical research in the field that we have interest in. Being interested in the field of public health, 3 of my friends and I did a research on the prevalence of tuberculosis in Cheras using the graphic informational system (GIS) to map each case of tuberculosis on the map of Kuala Lumpur. Our supervisor was Associate Professor Dr Shamsul Azhar, who is himself an expert on the field of GIS study and has been doing his PhD research using the same system in Niigata University, Japan for almost 4 years. During one of our SSM meetings, he mentions that the post-graduate students in UKM has done several visits to Niigata University and brought up the idea that maybe the undergraduate students like us could do the same. (Copied from article).
Introduction In maternal healthcare, pre-pregnancy weight is used to predict pregnancy
outcomes. Since no recorded data on pre-pregnancy weight, perceived weight
is used alternatively. This study examines the relationship between perceived
and actual weight among non-pregnant urban Malaysian women of
childbearing age and identifies differences in perceived and actual weight by
selected socio-demographic characteristics.
Methods A cross-sectional study was conducted between April and June 2013 among
urban Malaysian women attending public health clinics in the Klang Valley.
Information on height, perceived current weight and time when their weight
was last taken were obtained and actual weight was the average of two
measurements (TANITA-HD-323-digital-scale). Socio-demographic data
collected were age, ethnicity, education level, marital and employment status
and total household income.
Results Mean age of 371 women in this study was 28.81±5.65, 82.2% were Malays,
62.8% had tertiary education, over 75% were married and employed, with
more than half from middle-income households. Overall, the mean perceived
and actual weight was 59.29±11.59 and 59.20±11.90 respectively. Pearson‟s
Correlation test showed a very strong positive correlation between perceived
and actual weight (r=0.957;p
Osteoporosis-related fractures have been recognized as a major health problem, particularly in the elderly with a high morbidity and mortality rate. The aims of the study were to identify knowledge and perception toward calcium intake among students at UiTM and to explore the differences between genders in dietary calcium intake. A cross sectional study was conducted through 336 students aged 18 to 34 years old. The participants were randomly chosen from the student’s enrolment list. A modified questionnaire was used to obtain the knowledge and perception of the participants. More than half of the participants have low knowledge regarding dietary calcium intake (58.6%), positive view towards the benefits of calcium intake and low perception towards the barrier of calcium intake. Chi square analysis showed a significant difference between male and female for knowledge (p=0.034) and barrier (p=0.002) for calcium intake. Intervention programs should be adopted to increase the knowledge among young adults to improve their health and prevent risk factors. So, health education specifically on calcium intake will be very useful to improve the knowledge and behavior of students.
In July 2010 Universiti Kebangsaan Malaysia (UKM) and Niigata University (NU) signed a memorandum of agreement to continue collaboration in joint planning and implementation of education, research and practice services in the field of medicine.This collaboration is also a good opportunity for Doctor of Public Health (DRPH) postgraduate candidates to gain experience on the practice of public health in handling public health issues, planning the healthcare facilities, delivering a quality public health services, enforcing public health policies/regulations and finally learn about the health systems in general at other countries especially from developed country like Japan. Experiencing Health Care and Culture in Niigata, Japan.