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PubMed2002

The impact on health and risk factors of the diarrhoea epidemics in the 1998 Bangladesh floods.

The 1998 flood in Bangladesh ravaged approximately 60% of the land and affected over 30 million people. The aim of this study is to examine the impact of the flood on the health of the communities affected and to explore factors associated with episodes of diarrhoea. We conducted structured interviews with 517 people in two districts that had been affected in October 1998, when the flood water level was at its peak. Of the 517 respondents, 98.3% developed health problems or found that existing health problems were exacerbated. Many perceived that their general health condition was 'much worse' (16.9%) or 'worse' (64.3%). The most prevalent condition was fever (63.6%), followed by respiratory problems (46.8%), diarrhoea (44.3%), and skin problems (41.0%). Only 1.0% and 6.7% of the respondents treated water before drinking, by boiling and chlorination, respectively, although water collected from tube-wells (93.2%) and rivers (6.0%) was perceived by 75.0% of the respondents to be contaminated. Factors associated with developing or worsening diarrhoea were as follows; the number of family members, poor economic status, a lack of distribution of water purification tablets, the type of water storage vessels, not putting a lid on the vessel, no use of latrines, perceived change of drinking water, food scarcity, and worries about the future. In logistic regression analysis, men, poor economic status, lack of distribution of water purification tablets, and the type of water storage vessels had a significant association with diarrhoea. The 1998 Bangladesh flood had a substantial impact on the health of communities. Diarrhoea was associated with socioeconomic status, water handling and household sanitation. There ought to be more emphasis on health education in the pre-disaster period in order to empower communities against floods.

Adolescent↗
PubMed2001

Human and other faeces as breeding media of the trachoma vector Musca sorbens.

The fly Musca sorbens Wiedemann (Diptera: Muscidae) apparently transmits Chlamydia trachomatis, causing human trachoma. The literature indicates that M. sorbens breeds predominantly in isolated human faeces on the soil surface, but not in covered pit latrines. We sought to identify breeding media of M. sorbens in a rural Gambian village endemic for trachoma. Test breeding media were presented for oviposition on soil-filled buckets and monitored for adult emergence. Musca sorbens emerged from human (6/9 trials), calf (3/9), cow (3/9), dog (2/9) and goat (1/9) faeces, but not from horse faeces, composting kitchen scraps or a soil control (0/9 of each). After adjusting for mass of medium, the greatest number of flies emerged from human faeces (1426 flies/kg). Median time for emergence was 9 (inter quartile range = 8-9.75) days post-oviposition. Of all flies emerging from faeces 81% were M. sorbens. Male and female flies emerging from human faeces were significantly larger than those from other media, suggesting that they would be more fecund and live longer than smaller flies from other sources. Female flies caught from children's eyes were of a similar size to those from human faeces, but significantly larger than those from other media. We consider that human faeces are the best larval medium for M. sorbens, although some breeding also occurs in animal faeces. Removal of human faeces from the environment, through the provision of basic sanitation, is likely to greatly reduce fly density, eye contact and hence trachoma transmission, but if faeces of other animals are present M. sorbens will persist.

Adolescent↗
PubMed1997

Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaïre.

To date questionnaire surveys have been the most commonly used instruments to measure hygiene behaviours related to water and sanitation. More recently, a number of studies have used structured observations to study practices related to diarrhoea. During a trial of a hygiene education intervention to reduce diarrhoea among young children in Bandundu, Zaire, both instruments were used to measure the disposal of child faeces and various hand-washing practices. Three hundred families were observed and follow-up interviews performed with 274 (91%) mothers. At the individual level, agreement between observed and reported behaviour was little better than might be expected by chance. There was evidence of over-reporting of hand-washing before food preparation (44% vs 33%; P = 0.03), hand-washing before eating (76% vs 60%; P < 0.001) and disposal of the child's faeces in a latrine (75% vs 40%; P < 0.001). On the other hand, hand-washing before feeding the child was reported less often than it was observed (7% vs 64%; P < 0.001). Our data are consistent with the hypothesis that, in general, mothers over-report 'desirable' behaviours. At the same time, our data indicate that open questions may lead to under-reporting of certain behaviours. The repeatability of observations at both the individual and population levels remains to be established.

Adolescent↗
PubMed1997

Trachoma in Jimma zone, south western Ethiopia.

A population-based survey on trachoma was carried out in Jimma zone. The survey showed that trachoma is hyperendemic: of 7,423 people examined, 33.02% had signs of trachoma, 28.9% of males and 37.01% of females; 26.13% of the urban and 34.09% of the rural population had clinical signs of trachoma. Active trachoma (TF/TI) was seen in 24.5% of the study population (an estimated half million people). The prevalence of signs of active trachoma among children 0-10 years of age was 35.7%. Blinding trachoma (CO/TT) was seen in 3.81% of the population: 6.86% of the female population aged 15 years had trichiasis and/or entropion. Both active and critical trachoma were significantly associated with the female gender (P < 0.0000001 for each), living in rural areas (P < 0.0001 for each type), parental illiteracy (P < 0.0000001 for each) and absence of a latrine (P < 0.01 for each). Shorter distance of the household water supply was associated with a higher prevalence of both active and cicatricial trachoma. This was significant only for cases of active trachoma living in households within 16 to 30 minutes walking distance from the water source (P < 0.03). An estimated 17000 people in the zone are blind; 3500 of these from trachoma. About 52,000 people are in danger of blindness from trichiasis. Primary eye care activities such as promoting health education (face washing) among community members, especially women and children, mass chemotherapy for trachoma, training of health workers and establishment of community-based surgical services are recommended. These are to be executed by the Zonal Health Department in close collaboration with the community, governmental and non-governmental organisations.

Adolescent↗
PubMed2002

Diarrhoea and effects of different water sources, sanitation and hygiene behaviour in East Africa.

Apart from "Drawers of Water (DOW I)" published in 1972, there have been only a handful of published studies on domestic water use and environmental health in East Africa, based on direct observations or other reliable research methods. The objective of this study was to carry out a repeat analysis of domestic water use and environmental health in East Africa based on DOW I. The study was conducted in the same sites as DOW I. Field assistants spent at least 1 day in each household observing and conducting semi-structured interviews. They measured the amount of water collected, recorded the amount of water used in the home, and noted household socio-demographic characteristics, prevalence of diarrhoea, state and use of latrines, sources of water and conditions of use. We surveyed 1015 households in 33 sites in Uganda, Tanzania and Kenya in 1997. From 1967 to 1997, the prevalence of diarrhoea, in the week preceding the survey, increased from 6% to 18% in Kenya and from 16% to 21% in Uganda; it declined slightly in Tanzania (11-8%). Determinants of diarrhoea morbidity included poor hygiene (unsafe disposal of faeces and wastewater), education level of household head, obtaining water from surface sources or wells and per capita water used for cleaning. Hygiene practices are an important complement to improved water and sanitation in reducing diarrhoea morbidity.

Diarrhea↗
PubMed2003

Prevalence of intestinal parasitic infections in northern Vietnam.

We surveyed the prevalence of parasitic infections in the mountainous province of Hoa Binh, north-west Vietnam, involving 526 households of six ethnic groups: Muong, Kinh, Dao, Thai, Tay and Hmong. Eggs or cysts of at least one parasite species were detected in 88% of stool samples (n = 2522). Prevalences of nematodes were high among all ethnic groups: hookworm (52%), Trichuris trichiura (50%) and Ascaris lumbricoides (45%). Ascaris infection appeared to be lower in households owning a latrine, was highest among children and decreased with age. Prevalence of hookworm rose during childhood, remained high until old age, was highest among adult women, but was not linked to anaemia. Eggs of Chlonorchis spp. were found in 126 (5%) individuals (of the Muong, Kinh or Thai groups only). Chlonorchiasis increased with age and was highest among adult men. Taenia eggs were found in three individuals (0.1%). Giardia lamblia was found in all districts and among all groups and the prevalence of infection was estimated at 3%.

Adolescent↗
PubMed2001

Trial of the Trachoma Rapid Assessment methodology in The Gambia.

PURPOSE: To test the validity and repeatability of a newly designed Trachoma Rapid Assessment (TRA) methodology. METHOD: Results from an initial TRA in 20 villages (TRA1) are compared with those of a second validation TRA (TRA2) after 6 weeks in 13 villages, randomly selected out of the original 20, conducted by different field staff. Findings of TRA1 and TRA2 are compared with those of a door-to-door survey of the entire population of all 13 villages. RESULTS: There is a considerable amount of variation between the results of TRA1 and TRA2 and between the results of both TRA's and the door-to-door survey. Even indicators that should have remained the same, like distance to Primary Health Centre or distance to trichiasis surgery facility, scored differently. CONCLUSIONS: The TRA methodology is easy to use and the results are quickly available. The scoring system indicates which intervention(s) of the SAFE strategy are needed and facilitates priority setting. The definition of some indicators, like availability and use of latrines, may need modification. In some cases, the scoring system seems to exaggerate differences between the actual findings. The consistency between two TRA's in the same village is low and the accuracy in measuring the actual situation is doubtful.

Anti-Bacterial Agents↗
PubMed2004

The epidemiology of good nutritional status among children from a population with a high prevalence of malnutrition.

OBJECTIVES: To identify socio-economic demographic and environmental factors that predict better height-for-age for children under 5 years of age in a Dhaka slum population. DESIGN: A panel survey, conducted between 1995 and 1997. A random sample of households was selected. Socio-economic, demographic and environmental variables were collected monthly by questionnaire and nutritional status was assessed. SETTING: Dhaka slums in Bangladesh. SUBJECTS: Three hundred and ninety-two children, surveyed in September-November 1996. MAIN OUTCOME MEASURES: Height-for-age Z-score (HAZ) above -2. RESULTS: Thirty-one per cent of children had HAZ >-2. Logistic regression adjusted for cluster sampling showed that better nourished children were more likely to have taller mothers, to be from female-headed households and from families with higher income, electricity in the home, better latrines, more floor space and living in Central Mohammadpur. Better nourished children were less likely to have fathers who have taken days off from work due to illness. CONCLUSIONS Interest in 'positive deviance' is motivated by the recognition that a focus on the malnourished only--the bottom tail of the distribution--provides indications of how families fail, but not of how they succeed in maintaining child nutrition in the face of adversity. Our analysis provides an alternative perspective on nutrition and vulnerability in an urban slum setting.

Bangladesh↗
PubMed2005

Lipid-soluble antioxidants status and some of its socio-economic determinants among pregnant Ethiopians at the third trimester.

OBJECTIVE: To determine the serum levels of three lipid-soluble antioxidants (retinol, beta-carotene and alpha-tocopherol) in pregnant women attending an antenatal clinic (ANC) in Gondar, Ethiopia. DESIGN: A cross-sectional study involving laboratory determination of serum levels of retinol, alpha-tocopherol and beta-carotene using high-performance liquid chromatography and questionnaire-based assessment of socio-economic status. SETTING: ANC of a university teaching hospital. SUBJECTS: Three hundred and twenty-two healthy pregnant women in their third trimester, who attended the ANC. RESULTS: Mean serum levels of retinol, alpha-tocopherol and beta-carotene were found to be 1.23+/-0.5, 25.5+/-0.9 and 0.21+/-0.09 micromol l(-1), respectively. The prevalence of vitamin A deficiency (<1.05 micromol l(-1)) among pregnant women was 38.5%. Women having low retinol (vitamin A) levels were highly likely to live in earth-floored and mud-walled houses, and less likely to own a house and to have a latrine. CONCLUSION: The study shows that serum levels of lipid-soluble antioxidants were low among ANC attendees in northern Ethiopia. It also indicates that some socio-economic factors (such as poor housing standard) are associated with vitamin A deficiency.

Adolescent↗
PubMed2006

Predictors of poor anthropometric status among children under 2 years of age in rural Uganda.

OBJECTIVE: To assess predictors of poor anthropometric status among infants and young children. DESIGN: Cross-sectional survey. SETTING: The rural subsistence agricultural district of Hoima, western Uganda. SUBJECTS: Seven hundred and twenty children aged 0-23 months with their mothers/carers. METHODS: Participants were recruited in September 2002, using a two-stage cluster sampling methodology. A structured questionnaire was administered to mothers in their home settings. Information on health, household socio-economic status, child feeding practices and anthropometric measurement was gathered. Conditional logistic regression analysis was applied taking into account the hierarchical relationships between potential determinants of poor anthropometric status. RESULTS: The mean Z-score for weight-for-height was -0.2 (95% confidence interval (CI) -0.1, -0.7), for height-for-age was -1.1 (95% CI -1.2, -0.9) and for weight-for-age was -0.7 (95% CI -0.8, -0.6). Wasting was independently associated only with a history of fever in the 2 weeks prior to the survey (odds ratio (OR)=4.4, 95% CI 1.5, 13), while underweight was associated with a history of fever (OR=2.4, 95% CI 1.3, 4.4) and cough (OR=3.0, 95% CI 1.3, 6.8). Stunting was positively associated with a wider range of factors, including: history of a fever episode (OR=1.7, 95% CI 1.0, 2.9), lack of a latrine in the household (OR=2.7, 95% CI 1.5, 4.9), failure to de-worm children 12 months or older (OR=1.7, 95% CI 1.1, 2.8), and being born to a non-formally educated mother compared with mothers educated above primary school (OR=2.1, 95% CI 1.1, 4.0). CONCLUSIONS: In analyses guided by the hierarchical interrelationships of potential determinants of malnutrition, wasting and underweight turned out to be independently predicted by morbidity (proximal) factors. Stunting, however, was predicted by socio-economic (distal), environmental and health-care (intermediate) factors in addition to morbidity. Strategies aimed at improving the growth of infants and young children in rural communities should address morbidity due to common childhood illness coupled with environmental and socio-economically oriented measures.

Anthropometry↗
PubMed1995

Infection and transmission pattern of Schistosoma mansoni in the Managil irrigation scheme, Sudan.

The endemicity (prevalence, intensity and incidence) of schistosomiasis mansoni and its patterns of transmission (focality, seasonality) were studied in five villages in the Managil irrigation scheme, Sudan. Marked differences between villages were observed in overall prevalence (33.3%-54.8%), intensity (77.3-135.0 eggs/g faeces), incidence (15.2%-57.9%) and age-related patterns of Schistosoma mansoni infections. Overall, prevalence and intensity of infection peaked in those aged 10-14 years and then declined slowly with increasing age. However, there were second, smaller peaks in both prevalence and intensity of infection in the older males (> 40 years) and, in general, the indices of infection for males exceeded those for females. The infection pattern was influenced by occupation and possibly by having a latrine. Transmission of S. mansoni in the Managil irrigation scheme is highly focal and seasonal, taking place in a few major human-contact sites near villages and peaking during the hot and dry season (April-June). The infection and transmission patterns of S. mansoni in the scheme show great resemblance to those in the neighbouring Gezira irrigation scheme.

Adolescent↗
PubMed1992

The use of ethnography and structured observations in the study of risk factors for the transmission of diarrhea in highland Papua New Guinea.

Methods that combine anthropological and epidemiological data are needed for the study of behavioral risk factors in communicable diseases, but as yet remain undeveloped. Ethnography is often undervalued as both the preliminary and integrative step in the design and execution of such studies. The analysis of critical methodological issues emerging from a case-control study of the behavioral and environmental risk factors for the transmission of childhood diarrhea in both urban and rural highland Papua New Guinea suggests that focused ethnographic assessments, complemented by structured observations performed by nonprofessionals, may provide a viable research design. In highland Papua New Guinea, significant risk factors include non-usage of latrines and sleeping with pigs; the latter is a factor that could have important implications regarding women's roles in a changing economy.

Anthropology, Cultural↗
PubMedDate not supplied

The quality of life of families of female-headed households in Botswana: a secondary analysis of case studies.

Previous studies note a positive relationship between female-headed households (FHHs) and poverty in urban and rural areas of Botswana. To explore this further, data were collected from 7 FHHs through participant observation and open-ended interviews. A secondary analysis of data described the quality of life (QOL) of members of the households according to one's ability to meet basic human needs (food, water, shelter, safety, and health). FHHs ranged in age from 40-91 years, with family size ranging from 1-11 members. Monthly income for 6 of the 7 families was 30 dollars (U.S.) per month or less. Physical living environments were overcrowded, with poorly maintained latrines and unsafe refuse disposal. Family illnesses included hypertension, cataracts, mental illness, knee pain, ringworm, leg sores, and tonsillitis. Health risk behaviours included unprotected sex, alcohol abuse, and breastfeeding among potentially HIV positive mothers. Although Botswana claims rapidly rising levels of national income after independence, the QOL of FHHs remains poor. We suggest that, to alleviate poverty, governments in developing African countries should explore strategies that effectively target families headed by women.

Adult↗
PubMedDate not supplied

The ethnographic context of illness among single-women-headed households in rural Peru.

Peru is undergoing many deleterious economic and social changes, and the health consequences for families headed by single women is of special concern. However, not all single mothers' families may be at similar risk of morbidity. My purpose in the present study was to determine whether variation in illness prevalence was associated with ostensibly small differences in socioeconomic resources and physical living conditions in areas like Peru. I used both qualitative and quantitative methods in this study. The sample included single-women-headed households from the rural Nuñoa District, located in the southern Peruvian Andes (N = 22 families with 90 individuals). Quantitative cross-sectional survey results suggested that the mother's formal education, the availability of a latrine, drinking water contamination, the gender ratio of the household, and the quality of the social support network were key risk factors. They statistically predicted 35-91% of the morbidity variance between families (p < or = .03-.0001). I illustrate these findings in three ethnographic case studies. The case studies show how the degree of illness among single-women-headed families was affected by small differences in their social and physical living conditions.

Adult↗
PubMed2006

Impact of face washing and environmental improvement on reduction of active trachoma in Vietnam-a public health intervention study.

PURPOSE: A public health intervention study in Vietnam was conducted between 2002 and 2005 to assess the impact of improved water and sanitation facilities and increased awareness about active trachoma in the community. METHODS: In My Thon village (MT), all four components of the SAFE strategy were implemented. In Xom Ngoai village (XN), only the S & A components of the trachoma control strategy were implemented. The villagers improved water and sanitation facilities in MT. Women's Union and school authorities assisted in increasing awareness in the community. Ophthalmologists examined the residents for trachoma. The decline in active trachoma and other water-related diseases was determined by pre- and post-intervention assessments. The impact of the differential F & E strategy on two villages was evaluated. RESULTS: The active trachoma prevalence in MT (SAFE) and XN (SA) at baseline was 13.3% and 10.2%, respectively. In two years, the masons constructed or improved 281 double-vault and three septic tank latrines, 241 bathrooms, 273 dug wells and 252 water tanks in MT. The prevalence in MT (SAFE) & XN (SA) after two years was 1.4% and 6.7%, respectively. The additional decline of active trachoma due to the differential F & E strategy among children under the age of 15 was 6.8%. The F & E strategy was responsible for 58.7% of the decline at all ages and 37.4% in children under the age of 15. Knowledge of the prevention of trachoma had improved in two years. However, the attitude towards and practice of trachoma control were not different in the two villages. CONCLUSIONS: 'F' & 'E' implementation made a significant contribution to the reduction of active trachoma. Community participation and collaborative efforts of partners are crucial. The indicators used to monitor F & E strategies are interrelated and therefore should be evaluated together.

Adolescent↗
PubMed2006

Trachoma control in Southern Zambia--an international team project employing the SAFE strategy.

PURPOSE: To determine the prevalence of trachoma and to measure the impact of the SAFE strategy (World Health Organization GET 2020 strategy) for treating trachoma in the Gwembe District of Southern Zambia. DESIGN: This is an observational study of the introduction of the SAFE strategy employing a collaborative approach and its impact on trachoma in the area. PARTICIPANTS: Three thousand eight hundred ninety two persons in communities at 26 well sites in the Gwembe district of Southern Zambia were included in this study. METHODS: New, clean water wells were drilled under local supervision for each of 26 identified villages. All people living in villages near the wells were screened for trachoma and then treated with antibiotic if required. Education on personal and environmental hygiene was provided by trained volunteers. Patients affected by trichiasis and corneal scarring received surgery, locally if possible. Attempts to control fly populations by cleaning villages, penning livestock, and digging latrines were undertaken. This was performed under advisement and consultation with local villagers and government officials. Data was collected on variables normally associated with trachoma and others relating to demographics, water quality, environment and hygiene. MAIN OUTCOME MEASURES: Prevalence of trachoma in the area at two years post introduction of SAFE strategy. RESULTS: The overall prevalence of trachoma in the area was 47% in 2001; however, the prevalence was 55% among children under 10 years. At two years post intervention, the overall prevalence of trachoma reduced to 7.6%, and decreased to 10.6% in children under 10 years, and 5.9% among adults. CONCLUSIONS: Continued monitoring and risk factors will need to continue to be addressed in order to sustain this trachoma control project in this area of Zambia.

Adult↗
PubMed2006

Clinical and microbiological diagnosis of trachoma in children living in rural areas in the district of Attock, Punjab, Pakistan.

BACKGROUND: Trachoma is a sight-threatening process triggered by infection of the conjunctiva with Chlamydiae. When this infection becomes chronic and is associated with poverty it triggers trachoma, the prime cause of infectious blindness in the world. Since the 1958 report indicating that the highest incidence of trachoma in Pakistan was found in the province of Punjab, no new trials have been published. In the present study, we assessed the prevalence of trachoma in 3968 children living in 11 rural villages in the district of Attock, Punjab, Pakistan. The children with trachoma were sampled to detect C. trachomatis by PCR. METHODS: Children in rural villages in the district of Attock were examined for trachoma in February 2004. Samples were obtained by scraping, and DNA was extracted (MagnaPure-LC Robot) and amplified to detect C. trachomatis (Amplicor-Roche). The quality of sampling was assessed by quantifying the number of cells by real-time PCR. RESULTS: The prevalence of trachoma was 3.7% (0 to 6.2%). PCR was positive in 20% of samples from trachomatous children and the number of cells was always > 100/sample. The income levels, illiteracy, use of latrines, water supply, and the presence of animals close to dwellings were similar in all the villages. In Sujjenda, the prevalence was doubled in the warmest season. CONCLUSIONS: Trachoma was diagnosed in 3.7% of the children aged < 10 years. The low rates for positive PCR may be due to loss of the plasmid, the involvement of other Chlamydiae, or their absence in chronic infections. The results obtained here underestimate the prevalence of trachoma because most of the mothers (and babies) were not tested in the district of Attock.

Child↗
PubMed2002

The risk of enteric diseases in young children and environmental indicators in sentinel areas of Mexico City.

The overall objective of this study is to promote the development of environmental health indicators in Mexico City. Specific examples focused on water quality, household characteristics e.g., sanitation and risk of enteric diseases. A geographic information system (GIS) was used in order to identify eligible wells and their surrounding homesteads (0.5 km around each well). A pilot study was conducted during the rainy season (1999), and a total of 1, 250 eligible households were visited on a random sample basis; only those having children under 5 years of age were interviewed. Data on diarrheal disease (i.e. occurrence in the previous two weeks) were obtained from 950 children, and their guardians provided information on their water supply, sanitation and socioeconomic variables. A total of 320 water samples were obtained from 40 wells, and tested for Total coliforms (TC/100 ml), Fecal coliforms (FC/100 ml). Escherichia coli (EC) and Fecal streptococci (FS). Bacterial indicators were detected in 40% of the wells in the western zone and in 32% of the southern zone (p = 0.01). The rate of diarrheal diseases was higher for children from the southern areas than in the west (OR = 1.7 and 95% CI: 0.99, 2.86). The final analysis showed a higher risk of diarrhea in children from rented homes than those living in owned dwellings (OR = 1.7 and 95% Cl: 1.04, 2.77): the risk was also highest for children living in houses with poor sanitation facilities (e.g., latrine) than those connected to a sewerage (OR = 1.7 and 95% Cl: 1.00, 2.93). Children from households perceiving unpleasant taste of water showed a higher risk than those without complaints (OR = 2.2 and 95% Cl: 1.28, 3.75). Linkages between environmental factors and health risk were created from spatially distributed information, and the proposed environmental health indicator (EHI) summarized the most significant predictors of diarrheal diseases. This baseline information may contribute to further environmental health investigation and policy making analysis.

Child Welfare↗