Revisiting the tsunami: health consequences of flooding.
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Africa↗
Biomedical subjects
Sandy Cairncross
Publications and source records attributed to Sandy Cairncross.
Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe.
Unless strategies are found to galvanise rural communities and create a demand for sanitation, we cannot achieve the United Nations Millennium Development Goal of halving the 2.4 billion people without sanitation by the year 2015. This study describes an innovative methodology used in Zimbabwe--Community Health Clubs--which significantly changed hygiene behaviour and built rural demand for sanitation. In 1 year in Makoni District, 1244 health promotion sessions were held by 14 trainers, costing an average of US dollars 0.21 per beneficiary and involving 11,450 club members (68,700 beneficiaries). In Tsholotsho District, 2105 members participated in 182 sessions held by three trainers which cost US dollars 0.55 for each of the 12,630 beneficiaries. Within 2 years, 2400 latrines had been built in Makoni, and in Tsholotsho latrine coverage rose to 43% contrasted to 2% in the control area, with 1200 latrines being built in 18 months. Although Zimbabwe has historically relied on subsidies to stimulate sanitation, this intervention shows how total sanitation could be achievable. The remaining 57% of club members without latrines in Tsholotsho all practised faecal burial, a method previously unknown to them. Club members' hygiene was significantly different (p<0.0001) from a control group across 17 key hygiene practices including hand washing, showing that if a strong community structure is developed and the norms of a community are altered, sanitation and hygiene behaviour are likely to improve. This methodology could be scaled up to contribute to ambitious global targets.
Community Health Planning↗
What causes sustainable changes in hygiene behaviour? A cross-sectional study from Kerala, India.
This study was designed and the field work carried out by a non-governmental organisation (NGO) responsible for implementing hygiene promotion. The sustainability of changed hygiene behaviour was studied at various periods up to nine years after the conclusion of a multifaceted hygiene promotion intervention in Kerala, India. Various methods including a questionnaire to assess knowledge, spot observation, demonstration of skills on request, and household pocket voting were used and compared for the measurement of the hygiene outcome. Pocket voting gave the lowest prevalence of good practice, which we infer to be the more accurate. Good handwashing practice was reported by more than half the adults in intervention areas, but < 10% in a control area. Handwashing prevalence showed no association with the elapsed time since the interventions, indicating that behaviour change had occurred and persisted. Recall of participation in health education classes was significantly associated with good hygiene as indicated by women's handwashing practice (OR 2.04, CI 1.05-3.96) and by several other outcomes, suggesting that the classes were an effective component of the intervention. The evidence for a specific impact on behaviour from home visits and an awareness campaign is less strong, although the home visits had influenced knowledge. The finding of an association between interventions and male handwashing, in ecological analysis (comparing administrative areas i.e. panchayats) but not at individual level, suggests that the effect of the interventions on men may have been indirect, via women or neighbours, underlining the need to direct interventions at men as well as women. The finding that hygiene behaviour persisted for years implies that hygiene promotion is a more cost-effective health intervention than previously supposed.
Adult↗
Childhood diarrhoea symptoms, management and duration: observations from a longitudinal community study.
This study examined the evolution and duration of diarrhoea episodes observed in a community setting, with regard to symptoms and carers' responses. The study group comprised 1156 children, aged 0-36 months, who were followed-up with twice-weekly home visits in 30 sampling areas in the city of Salvador, northeast Brazil. A total of 2403 diarrhoea episodes (mean duration: 2.9 days) were recorded. The number of soft/liquid motions per day (3.6) did not vary significantly with duration, but other symptoms were more commonly reported in the longer episodes. However, when the data were analysed by day of the episode, rather than the episode's overall duration, the reported frequency of fever and vomiting declined significantly with time. During the course of an episode, rehydration, medication and care-seeking also showed a decline in frequency after the first or second week. As episodes continue, less rehydration and medical care are provided by carers, whereas they ought to be maintained because of the continued purging and cumulative effect of the symptoms. Since most cases of diarrhoea are managed at home, it is important to understand how to encourage better management of the longer episodes, which cause an increasing proportion of mortality in some countries.
Age Distribution↗
Community-based surveillance: a pilot study from rural Cambodia.
OBJECTIVE: This study seeks to assess the performance of a community-based surveillance system (CBSS), developed and implemented in seven rural communes in Cambodia from 2000 to 2002 to provide timely and representative information on major health problems and life events, and so permit rapid and effective control of outbreaks and communicable diseases in general. METHODS: Lay people were trained as Village Health Volunteers (VHVs) to report suspected outbreaks, important infectious diseases, and vital events occurring in their communities to local health staff who analysed the data and gave feedback to the volunteers during their monthly meetings. RESULTS: Over 2 years of its implementation, the system was able to detect outbreaks early, regularly monitor communicable disease trends, and to provide continuously updated information on pregnancies, births and deaths in the rural areas. In addition, the system triggered effective responses from both health staff and VHVs for disease control and prevention and in outbreaks. CONCLUSION: A CBSS can successfully fill the gaps of the current health facility-based disease surveillance system in the rapid detection of outbreaks, in the effective monitoring of communicable diseases, and in the notification of vital events in rural Cambodia. Its replication or adaptation for use in other rural areas in Cambodia and in other developing countries is likely to be beneficial and cost-effective.
Acute Disease↗
Environmental risks in the developing world: exposure indicators for evaluating interventions, programmes, and policies.
BACKGROUND: Monitoring and empirical evaluation are essential components of evidence based public health policies and programmes. Consequently, there is a growing interest in monitoring of, and indicators for, major environmental health risks, particularly in the developing world. Current large scale data collection efforts are generally disconnected from micro-scale studies in health sciences, which in turn have insufficiently investigated the behavioural and socioeconomic factors that influence exposure. STUDY DESIGN: A basic framework is proposed for development of indicators of exposure to environmental health risks that would facilitate the (a) assessment of the health effects of risk factors, (b) design and evaluation of interventions and programmes to deliver the interventions, and (c) appraisal and quantification of inequalities in health effects of risk factors, and benefits of intervention programmes and policies. Specific emphasis is put on the features of environmental risks that should guide the choice of indicators, in particular the interactions of technology, the environment, and human behaviour in determining exposure. The indicators are divided into four categories: (a) access and infrastructure, (b) technology, (c) agents and vectors, and (d) behaviour. The study used water and sanitation, indoor air pollution from solid fuels, urban ambient air pollution, and malaria as illustrative examples for this framework. CONCLUSIONS: Organised and systematic indicator selection and monitoring can provide an evidence base for design and implementation of more effective and equitable technological interventions, delivery programmes, and policies for environmental health risks in resource poor settings.
Air Pollution↗
Impact of drainage and sewerage on intestinal nematode infections in poor urban areas in Salvador, Brazil.
This cross-sectional study was conducted in 1989 among children aged between 5 and 14 years old living in nine poor urban areas of the city of Salvador (pop. 2.44 million), capital of Bahia State, in Northeast Brazil. Three of these areas had benefited from both drainage and sewerage, 3 from improved drainage only, and 3 from neither. The children studied thus belonged to 3 exposure groups regarding their level of sanitation infrastructure. An extensive questionnaire was applied to collect information on each child and on the conditions of the household, and stool examinations of the children 5-14 years old were performed to measure nematode infection. Comparison of the sewerage group with the drainage-only group and the latter with the control (no sewerage or drainage) group showed that, when the level of community sanitation was better, the prevalence of infection among children was less, but risk factors identified for infection were more numerous and more significant. Intensity of infection with Trichuris, but not with Ascaris or hookworm, was also less. The results suggest that sewerage and drainage can have a significant effect on intestinal nematode infections, by reducing transmission occurring in the public domain.
Adolescent↗
Household water management: refining the dominant paradigm.
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Diarrhea↗
Reducing diarrhea through the use of household-based ceramic water filters: a randomized, controlled trial in rural Bolivia.
Ceramic water filters have been identified as one of the most promising and accessible technologies for treating water at the household level. In a six-month trial, water filters were distributed randomly to half of the 50 participating households in a rural community in Bolivia; the remaining households continued to use customary water handling practices and served as controls. In four rounds of sampling following distribution of the filters, 100% of the 96 water samples from the filter households were free of thermotolerant coliforms compared with 15.5% of the control household samples. Diarrheal disease risk for individuals in intervention households was 70% lower than for controls (95% confidence interval [CI] = 53-80%; P < 0.001). For children less than five years old, the reduction in risk was 83% (95% CI = 51-94%; P < 0.001). These results show that affordable ceramic water filters enable low-income households to treat and maintain the microbiologic quality of their drinking water.
Adolescent↗
Assessing water-related risk factors for Buruli ulcer: a case-control study in Ghana.
To assess water-related risk factors of Buruli ulcer, a case-control study of 102 patients (51 cases and 51 controls) was undertaken by matching age group, sex, and bacille Calmette-Guerin (BCG) vaccination history in Ghana. The factors used here for matching have previously been implicated as factors of Buruli ulcer, an emerging infectious disease. This is the first study to delineate a set of previously suspected, water-related risk factors, in a case-control study matching for age group, sex, and BCG vaccination status. The results of both bivariate and multivariate analyses presented a significantly high odds ratio (OR) only for swimming in rivers on a habitual basis (OR = 18.00, P < 0.01) among the major water-related risk factors. Use of water from rivers and ponds for drinking, cooking, bathing, and washing purposes were not significant risk factors. Our data suggest that swimming, or activities on riverbanks associated with it, is a risk factor.
Adolescent↗
Water, sanitation, and hygiene at Kyoto.
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Congresses as Topic↗
Effect of washing hands with soap on diarrhoea risk in the community: a systematic review.
We set out to determine the impact of washing hands with soap on the risk of diarrhoeal diseases in the community with a systematic review with random effects meta-analysis. Our data sources were studies linking handwashing with diarrhoeal diseases. Seven intervention studies, six case-control, two cross-sectional, and two cohort studies were located from electronic databases, hand searching, and the authors' collections. The pooled relative risk of diarrhoeal disease associated with not washing hands from the intervention trials was 1.88 (95% CI 1.31-2.68), implying that handwashing could reduce diarrhoea risk by 47%. When all studies, when only those of high quality, and when only those studies specifically mentioning soap were pooled, risk reduction ranged from 42-44%. The risks of severe intestinal infections and of shigellosis were associated with reductions of 48% and 59%, respectively. In the absence of adequate mortality studies, we extrapolate the potential number of diarrhoea deaths that could be averted by handwashing at about a million (1.1 million, lower estimate 0.5 million, upper estimate 1.4 million). Results may be affected by the poor quality of many of the studies and may be inflated by publication bias. On current evidence, washing hands with soap can reduce the risk of diarrhoeal diseases by 42-47% and interventions to promote handwashing might save a million lives. More and better-designed trials are needed to measure the impact of washing hands on diarrhoea and acute respiratory infections in developing countries.
Adolescent↗
Water supply and sanitation: some misconceptions.
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Developing Countries↗
Handwashing with soap - a new way to prevent ARIs?
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Acute Disease↗
Effect of chlorination of drinking-water on water quality and childhood diarrhoea in a village in Pakistan.
To evaluate the importance of public-domain transmission of pathogens in drinking-water, an intervention study was carried out by chlorinating the public water-supply system in a village in Pakistan. The water quality improved and reached a geometric mean of 3 Escherichia coli per 100 mL at the last standpipe of the water-supply system. Drinking-water source used and the occurrence of diarrhoea were monitored on a weekly basis over a six-month period among 144 children aged less than five years in the village. In this group, the children using chlorinated water from the water-supply scheme had a higher risk of diarrhoea than children using groundwater sources, controlled for confounding by season and availability of a toilet and a water-storage facility. The incidence of diarrhoea in the village (7.3 episodes per 10(3) person-days) was not statistically different from that in a neighbouring village where most children used water from a non-chlorinated water-supply system with very poor water quality. In this study area, under non-epidemic conditions, the reduction of faecal bacteria in the public drinking-water supply by chlorination does not seem to be a priority intervention to reduce childhood diarrhoea. However, the study was of limited size and cannot provide conclusive evidence.
Calcium Compounds↗
Domestic transmission routes of pathogens: the problem of in-house contamination of drinking water during storage in developing countries.
Even if drinking water of poor rural communities is obtained from a 'safe' source, it can become contaminated during storage in the house. To investigate the relative importance of this domestic domain contamination, a 5-week intervention study was conducted. Sixty-seven households in Punjab, Pakistan, were provided with new water storage containers (pitchers): 33 received a traditional wide-necked pitcher normally used in the area and the remaining 34 households received a narrow-necked water storage pitcher, preventing direct hand contact with the water. Results showed that the domestic domain contamination with indicator bacteria is important only when the water source is relatively clean, i.e. contains less than 100 Escherichia coli per 100 ml of water. When the number of E. coli in the water source is above this value, interventions to prevent the domestic contamination would have a minor impact on water quality compared with public domain interventions. Although the bacteriological water quality improved, elimination of direct hand contact with the stored water inside the household could not prevent the occasional occurrence of extreme pollution of the drinking water at its source. This shows that extreme contamination values that are often thought to originate within the domestic domain have to be attributed to the public domain transmission, i.e. filling and washing of the water pitchers. This finding has implications for interventions that aim at the elimination of these extreme contaminations.
Bacterial Infections↗
Dynamics of dengue virus circulation: a silent epidemic in a complex urban area.
Serotypes of dengue DEN-1 and DEN-2 have been reported in much of Brazil over the last 15 years, and DEN-3 serotype was only recently detected. This prospective study was conducted in Salvador, a large city in north-east Brazil, where two epidemics were previously recorded (DEN-1 and DEN-2). We obtained the seroprevalence and 1-year incidence of dengue infections in the population of 30 sampling areas of Salvador and analysed the relationship between intensity of viral circulation, standard of living and vector density. High seroprevalence (68.7%) and annual incidence (70.6%) of infection for one or both circulating serotypes (DEN-1 and DEN-2) were found. High rates of transmission were observed in all studied areas, from the highest to the lowest socio-economic status. The mean PI (Premise Index) for Aedes aegypti was 7.4% (range 0.27-25.6%). Even in the areas with the lowest PI (</=3%) the observed seroincidence was 54.6%. These findings highlighted the existence of a silent epidemic during a period perceived by the Health Services as of low endemicity, indicating the strength and speed of dengue transmission in the city of Salvador.
Adolescent↗
Dracunculiasis (Guinea worm disease) and the eradication initiative.
Dracunculiasis, also known as guinea worm disease, is caused by the large female of the nematode Dracunculus medinensis, which emerges painfully and slowly from the skin, usually on the lower limbs. The disease can infect animals, and sustainable animal cycles occur in North America and Central Asia but do not act as reservoirs of human infection. The disease is endemic across the Sahel belt of Africa from Mauritania to Ethiopia, having been eliminated from Asia and some African countries. It has a significant socioeconomic impact because of the temporary disability that it causes. Dracunculiasis is exclusively caught from drinking water, usually from ponds. A campaign to eradicate the disease was launched in the 1980s and has made significant progress. The strategy of the campaign is discussed, including water supply, health education, case management, and vector control. Current issues including the integration of the campaign into primary health care and the mapping of cases by using geographic information systems are also considered. Finally, some lessons for other disease control and eradication programs are outlined.
Animals↗