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PubMed1995

Establishing water and sanitation programmes in conflict situations: the case of Iraq during the Gulf War.

In armed conflicts, health and technical assessments made before initiating emergency water and sanitation programmes are hardly ever complete and accurate. Obstacles and constraints inherent in the initial assessment phase have an inevitable impact on the selection and ranking of priorities. The emergency phase of a programme calls for short-term objectives: the first activities are already under way as problem identification proceeds. Frequently updated assessments are an integral component of ongoing programmes, so as to ensure continuous readjustment of short-, medium- and long-term objectives and an appropriate response to needs. In this article, as an example, we describe the various stages in assessing water and sanitation problems, first in Baghdad and then in southern and northern Iraq, between February and May 1991. Our aim is to explain the background that led to the implementation of the programme in the Iraqi capital and the provinces.

Emergencies↗

PubMed2006

Poor sanitation and helminth infection protect against skin sensitization in Vietnamese children: A cross-sectional study.

BACKGROUND: Geohelminth infection and poor hygiene may be protective against allergic sensitization. OBJECTIVE: To determine whether current helminth infection is associated with a reduced prevalence of allergen skin test sensitization in a Southeast Asian population of children with a high prevalence of hookworm infection. METHODS: A total of 1742 Vietnamese schoolchildren were invited to take part in a cross-sectional survey. Allergen skin sensitization to house dust mites (Dermatophagoides pteronyssinus and Dermatophagoides farinae) and American cockroach (Periplaneta americana) were measured and stool samples for qualitative and quantitative geohelminth estimation collected. RESULTS: A total of 1601 children age 6 to 18 participated. Sensitization to dust mites was present in 14.4% and to cockroach in 27.6% of children. In a mutually adjusted model, the risk of sensitization to dust mites was reduced in those with higher hookworm burden (adjusted odds ratio [OR] for 350+ vs no eggs per gram, 0.61; 95% CI, 0.39-0.96) and with Ascaris infection (adjusted OR, 0.28; 0.10-0.78), and increased in those using flush toilets (adjusted OR for flush toilet vs none/bush/pit, 2.51; 1.00-6.28). In contrast, sensitization to cockroach was not independently related to geohelminth infection but was increased in those regularly drinking piped or well water rather than from a stream (adjusted OR, 1.33; 1.02-1.75). CONCLUSION: Geohelminth infection, sanitation, and water supply influence the risk of allergic sensitization in Vietnamese children. This is consistent with a protective effect against allergy by geohelminth or other gastrointestinal infection. CLINICAL IMPLICATIONS: If the inverse relationship between geohelminth infection, poor sanitation, and allergic sensitization proves to be causal, drugs derived from parasite products may help to alleviate clinical allergic disease.

Adolescent↗

PubMed1993

Breast-feeding, water and sanitation, and childhood malnutrition in the Philippines.

This study examines effects and interactions of socioeconomic status, access to water supply and sanitation, and breast-feeding practices in relation to child growth in two provincial cities in the Philippines. Multivariate analysis identified food expenditure per head, education of the household head and gender of the child as significant predictors of nutritional status. The duration of partial and full breast-feeding was negatively (though non-significantly) associated with growth. Sanitation facilities and breast-feeding are, however, important determinants during the first year of life. Among children over 1 year of age, socioeconomic variables and gender are the most important predictors. Breast-feeding is shown to provide more important health benefits for children in lower income households. The need for further studies on the causes of gender differences in nutritional status was apparent.

Breast Feeding↗

PubMedDate not supplied

Panel 2.8: water, sanitation, food safety, and environmental health.

This is a summary of the presentations and discussion by the panel that addressed issues with Water, Sanitation, Food Safety, and Environmental Health during the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to water, sanitation, food safety, and environmental health as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) needs assessments; (2) institutional capacity and coordination; (3) what was done well, and what could have been done better?; and (4) capacity building and preparedness. Topics discussed in the needs assessment section included: (1) water supply; (2) hygiene; and (3) lessons learned. Topics discussed realated to capacity building and preparedness included: (1) waste and vector-borne diseases; (2) food safety; (3) nutrition; and (4) environmental health.

Disasters↗

PubMed2002

Bacterial contamination of Japanese households and related concern about sanitation.

The bacterial contamination of Japanese homes and the attitudes of Japanese people toward sanitation were studied. By taking bacterial counts of approximately 90 places each in five homes, this study found kitchens to have the greatest degree of bacterial contamination, followed by bathing rooms. Toilets had less bacterial contamination than was expected. While concern about bacteria on highly contaminated items such as sponges, towels for wiping counters, and other reservoirs/disseminators was common, there was a relative lack of concern regarding contact surfaces such as dining tables. It is believed that an in-depth study of bacterial contamination in the home and concern about it would lead to the promotion of greater public understanding of home sanitation and help to facilitate the provision of useful information and products to the public.

Activities of Daily Living↗

PubMed2000

A participatory approach to sanitation: experience of Bangladeshi NGOs.

This study assesses the role of participatory development programmes in improving sanitation in rural Bangladesh. Data for this study came from a health surveillance system of BRAC covering 70 villages in 10 regions of the country. In-depth interviews were conducted with one adult member of a total of 1556 randomly selected households that provided basic socioeconomic information on the households and their involvement with NGO-led development programmes in the community. The findings reveal that households involved with credit programmes were more likely to use safe latrines than others who were equally poor but not involved in such programmes. The study indicates that an unmet need to build or buy safe and hygienic latrines existed among those who did not own one. Such latent need could be raised further if health education at the grassroots level along with supervised credit supports were provided to them. Unlike conventional belief, the concept of community-managed jointly owned latrines did not seem a very attractive alternative. The study argues that social and behavioural aspects of the participatory development programmes can significantly improve environmental sanitation in a traditional community.

Bangladesh↗

PubMed1987

An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. I. Application of the case-control method for development of an intervention.

A case-control study was performed to develop an empirically based intervention for improving water-sanitation practices and rates of childhood diarrhea among families residing in urban Bangladesh. For three months fortnightly, histories of diarrhea were taken for all children under six years of age among 1,350 families to estimate age-specific rates of diarrhea in the population. A total of 247 randomly sampled families, termed sentinel families, were visited once during the study for prolonged observations of water-sanitation practices. Behaviors potentially affecting incidence of diarrhea were compared in a case group (n = 45), defined as sentinel families whose children had rates at least 1.7 times the rates expected for similarly aged children, and in a control group (n = 53), defined as sentinel families without any episodes of childhood diarrhea during the period of observation. Three practices differentiated the two groups: more control (82%) than case (53%) mothers who were observed to prepare food washed their hands before beginning the preparation (p less than 0.01); fewer control families (33%) than case families (80%) had ambulatory children who, when observed to defecate, did so in the family's living area (p less than 0.01); and fewer control (30%) than case (47%) families had children who were observed to place garbage or waste products in their mouth (p less than 0.10). Focus on these three empiric associations enabled the design of a community-specific educational intervention which is simple in construction and based upon naturally occurring, financially feasible, salutory practices.

Bangladesh↗

PubMed1987

An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. II. A randomized trial to assess the impact of the intervention on hygienic behaviors and rates of diarrhea.

An educational intervention was designed to improve three water-sanitation behaviors empirically shown to be associated with high rates of childhood diarrhea in Dhaka, Bangladesh: lack of handwashing before preparing food, open defecation by children in the family compound, and inattention to proper disposal of garbage and feces, increasing the opportunity for young children to place waste products in their mouth. Fifty-one communities, each comprising 38 families, were randomized either to receive (n = 25) or not to receive (n = 26) the intervention. During the six months after the intervention, the rate of diarrhea (per 100 person-weeks) in children under six years of age was 4.3 in the intervention communities and 5.8 in the control communities (26% protective efficacy; p less than 0.0001). A corresponding improvement in handwashing practices before preparing food was noted, although no improvement was observed for defecation and waste disposal practices. These data suggest that educational interventions for water-sanitation practices can have an important beneficial effect upon childhood diarrhea in developing countries, particularly when the interventions are designed in a simple way to promote naturally occurring salutory behaviors that are empirically associated with lower rates of childhood diarrhea.

Bangladesh↗

PubMed1997

Health study of New York City Department of Sanitation landfill employees.

Employees currently working at a large municipal landfill expressed concern that they experience higher rates of illness than other municipal sanitation workers. Therefore, this study was designed to examine acute health effects among employees working at the New York City Department of Sanitation, with special emphasis upon the landfill workers. Interviews conducted with 238 landfill and 262 off-site male employees asked questions about health symptoms experienced in the six months prior to the interview and about workplace exposures. This study found a higher prevalence among landfill employees of work-related dermatologic, neurologic, hearing, and respiratory symptoms, and sore and itching throats than among off-site employees. The respiratory and dermatologic symptoms were not associated with any specific occupational title or work task, other than working at the landfill. Off-site laborers experienced more neuromuscular symptoms and injuries.

Cross-Sectional Studies↗

PubMed2005

Planning environmental sanitation programmes in emergencies.

Environmental sanitation programmes are vital for tackling environmental-related disease and ensuring human dignity in emergency situations. If they are to have maximum impact they must be planned in a rapid but systematic manner. An appropriate planning process comprises five key stages: rapid assessment and priority setting; outline programme design; immediate action; detailed programme design; and implementation. The assessment should be based on carefully selected data, which are analysed via comparison with suitable minimum objectives. How the intervention should be prioritised is determined through objective ranking of different environmental sanitation sector needs. Next, a programme design outline is produced to identify immediate and longer-term intervention activities and to guarantee that apposite resources are made available. Immediate action is taken to meet acute emergency needs while the detailed programme design takes shape. This entails in-depth consultation with the affected community and comprehensive planning of activities and resource requirements. Implementation can then begin, which should involve pertinent management and monitoring strategies.

Disasters↗

PubMed2005

Restoring sanitation services after an earthquake: field experience in Bam, Iran.

A powerful earthquake hit the city of Bam in southeast Iran on 26 December 2003. In its aftermath, a number of international relief agencies, including Oxfam, assisted in providing emergency sanitation services. Oxfam's programme consisted of constructing and repairing toilets and showers in villages located outside of the city. In contrast with other organisations, Oxfam opted for brick-work structures, using local materials and human resources rather than prefabricated cubicles. The choice illustrates the dilemmas faced by agencies involved in emergency sanitation: responding to needs in a manner consistent with international standards and offering assistance in a timely fashion while involving beneficiaries. Following a preliminary survey, Oxfam concluded that the provision of showers and latrines, in addition to utilisation of local materials and human resources, was essential for ensuring well-being, empowerment and dignity among members of the affected population, thereby maximising the benefits.

Disaster Planning↗

PubMed1998

A fearsome enemy (1); A history of sanitation in the British Army 1899-1914.

The Boer War acted as a catalyst for military reform, including reform of the Army Medical Services (AMS). The subsequent medical debate was centred on the value of sanitation as a provision for war. This article looks at the forces, political, military and economic, that propelled the provision of sanitation to a prominent position in the reforms of the army, and the effect this had on the status and role of the Royal Army Medical Corps (RAMC).

Health Care Reform↗

PubMedDate not supplied

[Health promotion and education: a diagnosis of sanitation conditions using participatory research and community education (São João dos Queiróz - Quixadá/Ceará, Brazil)].

This study was conducted in a rural community, São João dos Queiróz, a township in the county of Quixadá, Ceará, Brazil, using a combination of participatory research and community education in compliance with the health promotion reference and principles of the 1986 Ottawa Charter. The project was joined by representatives of several local government institutions and organizations from the grassroots community movement. The theme generating the research, as defined by an assembly meeting of the community association, was a diagnosis of sanitation conditions in the community. The starting point was the assessment of local conditions. Results showed adverse local conditions in sanitation, literacy, income, and employment. Suggestions for solving the problems were organized so as to be included in the planning agenda for local health policies. Evaluation was procedural and enriched with daily research activities. The problem-solving pedagogical approach developed during the educational process contributed to a critical reconstruction, appropriation, and sharing of the resulting knowledge.

Adolescent↗

PubMedDate not supplied

[Resignifying hygienic concepts: the establishment of a sanitation authority in Buenos Aires in the 1880s].

The late nineteenth century saw the establishment of a sanitation authority in Buenos Aires, grounded on the ideas of nineteenth century hygienics. The article focuses on the scientific, technical and political innovations that were introduced and on the role that the process of medical professionalization played within this institution. The features of the sanitation policy that came to prevail in Buenos Aires at the turn of the century helped shape a system of standards and archetypes regarding the human body and its physical and mental well-being.

Brazil↗

PubMed1986

Infectious diseases and field water supply and sanitation among migrant farm workers.

An audit for fecal-related symptoms was performed on clinic patient charts of 936 migrant farm workers without access to water and sanitation facilities in the work fields and on an urban poor population of 8,968 patients. Migrants displayed a clinic utilization rate for diarrhea 20 times higher than that of the urban poor; similar findings for other enteric disease symptoms were documented. The data suggest that a water and sanitation standard mandating facilities in the work field for farm workers would reduce the incidence of fecal-related disease.

Diarrhea↗

PubMed1988

The value of water supply and sanitation in development: an assessment.

The attractiveness of oral rehydration therapy (ORT), a new and simple ministration that averts many child deaths from diarrhea among children, is diverting attention among donor agencies from the importance of water supply and sanitation (WS&S) in developing nations. The principal factor that led to the adoption of ORT is its apparent low cost per diarrheal death averted in children when compared with WS&S. However, WS&S provides many more benefits that are essential to sustaining the lives saved by ORT and vital to maintaining and enhancing the lives of adults and children. Among many other benefits WS&S prevents spread of the causes of diarrhea, controls many other water- and sanitation-related diseases, releases women from the heavy and time-consuming burden of carrying water from distant sources, and improves the quality of life in the community. Cost comparisons between WS&S and ORT are misleading. WS&S is a long-term investment in preventive health while ORT is a response to an immediate life-threatening situation. WS&S interventions eliminate unsanitary conditions leading to illness and death while ORT has no effect on the causes of diarrheal morbidity. The costs of WS&S are not high: $5 to $10 per capita annually. Without WS&S and hygiene education ORT programs are not likely to effect long-term improvement in child health status. ORT and WS&S programs are complementary; one should not displace the other.

Child↗

PubMed1997

Public health on the railroad: William Freeman Snow and the California Sanitation Exhibit.

This paper describes the California Sanitation Exhibit, a railroad car outfitted for instruction in public health that toured California in 1909 and 1910. The sanitation exhibit used display models, photographs, and lectures to educate the public about tuberculosis and other infectious diseases, waste contamination, and the dangers of bad milk. The success of the exhibit, which reached 5% of the state's population, resulted in the appointment of its creator, William Freeman Snow, as secretary of the California State Board of Health.

California↗

PubMedDate not supplied

The development and implementation of a hospital safety and sanitation task force.

We have found that the above activities are facilitated by utilizing a computerized filing program. The computer formal provides quick, concise reports and statistical data analysis. The formation catalogued can be easily analysis. The information catalogued can be easily categorized and analyzed. The time invested in organizational meetings concerning committee membership, guideline review and creating an efficient incident coding scheme was essential to the success of the project. Problems seem to arise when several different departments share a common space for different activities. For example, medication room sanitation throughout the hospital was suboptimal probably related to the fact that Nursing, Pharmacy and General Stores all utilized the area. No individual department felt it was their sole responsibility to ensure appropriate sanitation. Through the efforts of the task force, we were able to facilitate cooperation among the departments with each doing their share. As a result, medication rooms are now cleaner, neater and therefore safer. Additional incidents have been corrected since the original tabulation of this report. A priority goal is to facilitate corrective action in a more timely manner. It is critical that surveys should not be intended to be "white glove inspections" with criticisms placed on specific departments. This can be accomplished by informing department managers of the intent of the surveys and by allowing staff to participate in all activities. In addition, the support and cooperation of administration is a major factor in the potential success of a program of this nature. As a result of the interdisciplinary team approach, the general safety environment for patients, visitors, employees and volunteers has significantly been improved at our institution.

Accident Prevention↗