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PubMed2003

Water, sanitation and hygiene: a situation analysis paper for Lao PDR.

The Lao People's Democratic Republic (Lao PDR) is located in the Greater Mekong sub-region in East Asia, neighbouring with China, Cambodia, Myanmar, Thailand and Vietnam, with a land area of 236,800 square kilometres, and an average population density of 22 persons per square kilometre. The population of Lao PDR is 5.5 million with 49 ethnic groups. Most of the population is located in rural areas, with a significant number of the neediest villages in remote localities. In the past decade, there have been many positive developments in the rural water supply and sanitation (RWSS) sector. Despite improved coverage in latrine and water supply services, health remains a serious problem. The improved services were often not sustained or poorly maintained, while hygiene received inadequate attention. In Lao PDR, as in many other countries, the provision of a safe and reliable water supply and appropriate sanitation services, based on sustainable approaches, therefore, remains a challenge. This paper will provide an overview of the Lao PDR's RWSS Sector. Special emphasis is placed on actual field level application of informed choices for water supply, sanitation and hygiene awareness.

Community-Institutional Relations↗
PubMed2005

Environment, wealth, inequality and the burden of disease in the Accra metropolitan area, Ghana.

The study examines environmental problems and adverse impacts on the health of urban households in the Accra metropolitan area, Ghana. Accra is faced with severe inadequacy of urban infrastructure in the face of rapid population growth in the metropolis. More than half of the city's population do not have access to solid waste collection services. Only 39.8% of households have indoor pipe and over 35.0% of households depend on unsanitary public latrines whilst 2.5% do not have access to toilet facilities. Human excrement, garbage and wastewater are usually deposited in surface drains, open spaces and streams in poor neighbourhoods. The resultant poor sanitation has serious health impacts as more than half of reported diseases are related to poor environmental sanitation. The majority of households depend on solid fuels for cooking and this leads to indoor air pollution and high incidence of respiratory infections. Poor households bear a disproportionately large share of the burden of environmental health hazards than their wealthy counterparts, due to their particular vulnerability resulting from inadequate access to environmental health facilities and services.

Air Pollution, Indoor↗
PubMed2006

The impact of water supply and sanitation on area differentials in the decline of diarrhoeal disease mortality among infants in Stockholm 1878-1925.

This study analyses the impact of improved water supply and sanitation on the level and rate of decline of child diarrhoea mortality in Stockholm 1878-1925. Previous studies have failed to demonstrate an effect of improved water supply on the risk of diarrhoea mortality at the individual level. Using data on access to water and sanitation from a household survey in 1895 and mortality rates and sociodemographic information from individual data 1878-1925 to analyse area differentials in diarrhoea mortality, it was found that the proportion having their own latrine in the household was associated with lower mortality risk in 1895-1900, while the proportion having water in the household was associated with lower diarrhoea mortality risk during the mortality decline until 1925. Population effects of improved water and sanitation on diarrhoea mortality may be better measured at area level than at individual level.

Diarrhea, Infantile↗
PubMed1999

Epidemiology of enterotoxigenic Escherichia coli diarrhea in a pediatric cohort in a periurban area of lower Egypt.

Enterotoxigenic Escherichia coli (ETEC) are diverse pathogens that express heat-labile (LT) and/or heat-stable (ST) enterotoxins, yet little is known about whether epidemiologic patterns of pediatric ETEC diarrhea vary by the expressed ETEC toxin phenotype. In total, 242 Egyptian children aged <3 years were prospectively followed in 1993-1995. ETEC episodes were detected during twice-weekly home visits, and asymptomatic ETEC excretion was identified from monthly cross-sectional surveys. ETEC episodes were 0.6 per child-year. ST-only ETEC was 2.6 times (P<.001) more common in warmer than cooler months, while LT-only ETEC showed no seasonal variation. Ownership of a household sanitary latrine, but not breast-feeding, was associated with a lower risk of both enterotoxin phenotypes. Coexpression of a colonization factor by LT- or ST-only ETEC strengthened the association with diarrhea. These findings indicate that the epidemiologic patterns of LT-only and ST-only ETEC are not identical and that disease interventions should include improved household sanitation.

Cohort Studies↗
PubMed2004

Isolation and characterization of circulating type 1 vaccine-derived poliovirus from sewage and stream waters in Hispaniola.

Twenty-one cases of acute flaccid paralysis (AFP) were reported on the island of Hispaniola in 2000. Laboratory analysis confirmed the presence of circulating vaccine-derived poliovirus (cVDPV) type 1 in stool samples obtained from patients. As a complement to the active search for cases of AFP, environmental sampling was conducted during November and December 2000, to test for cVDPV in sewage, streams, canals, and public latrines. Fifty-five environmental samples were obtained and analyzed for the presence of polioviruses by use of cell culture followed by neutralization and reverse-transcription polymerase chain reaction. Of the 23 positive samples, 10 tested positive for poliovirus type 1, 7 tested positive for poliovirus type 2, 5 tested positive for poliovirus type 3, and 1 tested positive for both poliovirus type 2 and type 3. By sequence analysis of the complete viral capsid gene 1 (VP1), a 2.1%-3.7% genetic sequence difference between 7 type 1 strains and Sabin type 1 vaccine strain was found. Phylogenetic analysis showed that these viruses are highly related to cVDPV isolated from clinical cases and form distinct subclusters related to geographic region. Our findings demonstrate a useful role for environmental surveillance of neurovirulent polioviruses in the overall polio eradication program.

Animals↗
PubMed2005

Formative research for hygiene promotion in Kyrgyzstan.

Formative research for hygiene promotion was used to gather data relating to hygiene practices in rural Kyrgyzstan. Some of the hand-washing and faeces disposal practices observed were sub-optimal from a public health perspective. In combination with the poverty, limited medical services and poor water supply infrastructure characteristic of the study area, it is likely that these factors increase the risk of diarrhoeal infections among Kyrgyz children. An association was found between increased rates of hand-washing following latrine use and ownership of a washstand. This offers some empirical support for the idea that promotion of hand-washing technologies can form a useful part of a hygiene promotion intervention. The process followed in conducting the formative research is outlined in some detail along with a discussion of some of its achievements and limitations.

Adult↗
PubMed1981

Modelling determinants of health.

The linear regression procedure of stepwise elimination has been used to examine the association between a range of environmental variables and infant mortality rates (IMR) in Sri Lanka. The nature of the water supply was found to be significantly associated with IMR. Latrines were significantly associated with IMR once qualitative differences between districts were allowed for. Other 'environmental determinants of health', 3 indices of housing quality and the presence of electricity supplies, were not significant. The cost of effecting changes in IMR by extending subsidies to water supply improvements is estimated.

Developing Countries↗
PubMed1991

Water supply, sanitation and diarrhoeal disease in Nicaragua: results from a case-control study.

A case-control study of risk factors for child diarrhoeal disease was undertaken in a rural area of Nicaragua. Some 1229 children under the age of five were matched with an equal number of children of the same age presenting with other illnesses unrelated to water and sanitation. The main types of water supply were sampled at monthly intervals and tested for the presence of faecal coliforms in order to characterize their microbiological quality. In spite of marked differences in water quality between the different types of water supply, no relationship was found with diarrhoea morbidity. In contrast, there was a statistically significant association between water availability and diarrhoea morbidity. Children from homes with water supplies over 500 meters from the house had incidence rates of diarrhoea 34% higher than those of children from houses with their own water supply. Owning a latrine was not found to be significantly related to diarrhoea morbidity. A mother's level of schooling was inversely correlated with the frequency of diarrhoea in her children. A significant association was also found between the number of children under the age of five living in the house and the incidence of diarrhoea. These effects remained significant after controlling for confounding variables by conditional logistic regression.

Case-Control Studies↗
PubMed1992

Risk factors for the development of persistent diarrhoea and malnutrition in Burmese children.

To identify socioeconomic and behavioural risk factors for development of persistent diarrhoea and malnutrition in children, a case-control study was carried out in Burma. Cases were 67 children 1-59 months old hospitalized for diarrhoea lasting > 14 days and complicated by severe malnutrition; for each case, a healthy control child was selected who was age- and sex-matched from the same neighbourhood. Homes of cases and controls were visited for interviews and for direct observation of household child-care practices. Risk factors were catalogued and calculations made for relative risk and etiologic fractions. Risk factors that were associated with persistent diarrhoea and malnutrition included low family income, low education of mothers, unhygienic latrines, flies in the house and on the child, dirty appearance of child and mother, mother not using soap and water when washing child's hands, defaecation of child on floor, breastfeeding on demand, child eating food from floor, not feeding recommended weaning foods, and lack of knowledge by mother about causes of diarrhoea and about foods that prevent malnutrition. These results indicated that persistent diarrhoea and malnutrition in Burma is caused by a complex of several interrelated socioeconomic factors, unsanitary behaviour pertaining to personal hygiene, the practice of demand breastfeeding and lack of certain weaning foods, and low education of mothers who showed less knowledge about causes of diarrhoea and prevention of malnutrition.

Case-Control Studies↗
PubMed1993

Safety, immunogenicity, and transmissibility of single-dose live oral cholera vaccine strain CVD 103-HgR in 24- to 59-month-old Indonesian children.

Recombinant A-B+ Vibrio cholerae O1 strain CVD 103-HgR is a safe, highly immunogenic, single-dose live oral vaccine in adults in industrialized countries. Safety, excretion, immunogenicity, vaccine transmissibility, and environmental introduction of CVD 103-HgR were investigated among 24- to 59-month-old children in Jakarta. In 81 households, 1 child was randomly allocated a single dose of vaccine (5 x 10(9) cfu) and another, placebo. Additionally, 139 unpaired children were randomly allocated vaccine or placebo. During 9 days of follow-up, diarrhea or vomiting did not occur more often among vaccines than controls. Vaccine was minimally excreted and was isolated from no controls and from 1 (0.6%) of 177 unvaccinated family contacts. A 4-fold or higher rise in serum vibriocidal antibody was observed in 75% of vaccines (10-fold rise in geometric mean titer over baseline). Of 135 paired placebo recipients or household contacts, 5 had vibriocidal seroconversions. Moore swabs placed in sewers and latrines near 97 households failed to detect vaccine. These observations pave the way for a large-scale field trial of efficacy.

Antibodies, Bacterial↗
PubMed1995

Antimicrobial-resistant epidemic Shigella dysenteriae type 1 in Zambia: modes of transmission.

To determine the modes of transmission of an epidemic caused by Shigella dysenteriae type I (Sd1) in Zambia, a case-control study was conducted. Case-patients were more likely to have recent contact with a person with dysentery (P = .03) and to have a family member with preceding dysentery (P = .01). Case households were more likely to share their latrine (P = .06). Stored drinking water was obtained by hand-dipping a cup into wide-mouthed vessels or by pouring from narrow-mouthed vessels; case households were more likely to obtain drinking water only by hand-dipping (P = .03). Case-patients were more likely to have eaten relish (a cooked meat or vegetable dish; P = .03) purchased from a vendor. Evidence from this study suggests that Sd1 was transmitted by person-to-person spread, by water stored in vessels that permitted hand-dipping, and by prepared foods sold by vendors. Preventive measures should be directed at these risk factors.

Adolescent↗
PubMed1992

Epidemiology of taeniasis and cysticercosis in a Peruvian village. The Cysticercosis Working Group in Peru.

To determine the prevalence of cysticercosis in a rural area where the disease is endemic, the authors studied the seroepidemiology of human and porcine cysticercosis in a Peruvian jungle community (Maceda, Peru) in 1988 using an enzyme-linked immunoelectrotransfer blot (EITB) assay. Of the 371 sampled inhabitants, 30 (8%) were seropositive, most of whom were asymptomatic. After niclosamide therapy, four Taenia species worms were identified in the seropositive group, compared with one in the control group (p = 0.06). Pigs were frequently infected: 44 of 133 (33%) were found positive for Taenia by tongue examination and 57 of 133 (43%) were positive by EITB. In 69% of the sampled households that had pigs, there was at least one seropositive pig. The number of pigs diagnosed positive by the tongue examination was significantly greater in households that had latrines than in those that did not. Cysticercosis is a common but usually asymptomatic infection that affects both humans and pigs in the high jungle areas of Peru.

Adolescent↗
PubMed1993

Estimation of design effects and diarrhea clustering within households and villages.

The degree to which diarrheal disease clustered within households and within villages among preschool age children was examined using data from four population-based prevalence surveys undertaken in Malawi, Zambia, Indonesia, and Nepal over the past decade. The design effect for each cluster survey was calculated using the diarrhea prevalence, the cluster sizes, and the magnitude of diarrhea clustering within the sampling unit (villages). A recently developed statistical method, alternating logistic regression, was used to estimate disease associations within households of up to nine preschool age children residing within villages of up to 589 such children. Pairwise odds ratios estimating diarrhea clustering within villages ranged from 1.03 (95% confidence interval (CI) 1.01-1.07) in Zambia to 2.19 (95% CI 1.73-2.78) in Indonesia. The design effects ranged from 2.07 (95% CI 1.26-3.19) in Zambia to 7.93 (95% CI 5.16-11.52) in Indonesia. Design effects were strongly dependent on cluster size. The design effects for clusters of size 50 would have ranged from 1.38 to 4.73. Pairwise odds ratios for diarrhea clustering within households ranged from 1.88 (95% CI 1.61-2.19) in Nepal to 10.05 (95% CI 8.46-11.94) in Indonesia. Household odds ratios were always larger than village odds ratios. The village and household pairwise odds ratios adjusted for age, the type of latrine used by the household, and presence of a market in the village were slightly higher than the unadjusted odds ratios. Alternating logistic regression provided useful estimates of disease clustering within villages and household while allowing for covariate adjustment.

Child, Preschool↗
PubMed1995

Epidemiology of cholera in Delhi--1992.

Cholera is endemic in Delhi and is a highly seasonal disease. Suspected cholera cases are referred to Infectious Diseases Hospital, Delhi. Rectal swabs from 2783 cases were bacteriologically examined during 1992, out of which 1075 were found to be positive for Vibrio cholerae O1 biotype El Tor. First isolation was made on 3 April and the last on 14 December. About 87 per cent isolations were made between May and September, which are summer and monsoon months in Delhi. Detailed epidemiological information was collected for about 198 cases of diarrhoea out of which 103 were confirmed cases of cholera. Half of these cases occurred in children below 10 years of age. The other major group affected was adult females, especially housewives. All the cholera cases occurred in those who were illiterate or educated up to primary level. Important risk factors were: contact with person having similar illness, storage of water in wide-mouthed containers, use of glass or mug to draw water from containers, absence of sanitary latrines and habit of washing hands with water alone after defecation, before cooking and eating food. About 30 percent cases had access to piped water supply which was found safe in Delhi during 1992. The findings suggest that the hygienic practices were more important than contaminated water sources for transmission of cholera in Delhi during the year 1992.

Adolescent↗
PubMed2002

Elimination of blinding trachoma.

PURPOSE OF REVIEW: A recently initiated major effort to eliminate blinding trachoma as a public health problem is discussed. RECENT FINDINGS: Mass (community-wide) treatment with a short course of oral azithromycin has been shown to be at least as effective as long courses (42 doses over a 6-week period) of topical tetracycline in reducing clinically active trachoma and the prevalence of chlamydial infection. The beneficial effects last for more than a year, in contrast to the short-lived results typically seen after previous control programs that used topical therapy. Azithromycin is a key element in the integrated approach towards eliminating blinding trachoma summarized as the 'SAFE' strategy (surgery for deformed eyelids; antibiotic treatment of whole communities with azithromycin, to control infection; face washing and improved hygiene of young children; and environmental improvements, particularly the provision of water and latrines). The first regional application of this strategy has shown dramatic results, producing a reduction in trachoma activity of more than 70% in Morocco. SUMMARY: The goal of eliminating blinding trachoma may be reachable. Further research is needed to determine how best to use azithromycin and which environmental improvements will be most effective. The important questions are as follows: how often antibiotic treatment programs will be required in the endemic areas; how best to evaluate the effects of treatment; and when (and perhaps whom) do we retreat.

Anti-Bacterial Agents↗
PubMed2000

Prevalence of Helicobacter pylori infection in Kenyan schoolchildren aged 3-15 years and risk factors for infection.

OBJECTIVES: To determine the prevalence of Helicobacter pylori (Hp) infection in Kenyan schoolchildren aged 3-15 years and the risk factors for infection. DESIGN: A cross-sectional survey and study of risk factors. SUBJECTS: Primary-school children in Trans Nzoia district, Kenya. METHODS: Hp status was determined using the 13C-urea breath test. Risk factors were assessed using a structured interview schedule. RESULTS: Of 205 children interviewed, valid breath test results were obtained for 192 (93.7%), of whom 155 (80.7% (95% CI 75.2-86.3)) were infected. Univariate analysis showed weak associations between Hp infection and rural areas (location of home, Relative Risk (RR)= 1.2 (1.0-1.4); location of school, RR = 1.2 (1.0-1.3)) and lower socio-economic status (RR = 1.2 (1.0-1.4)). Access to only a pit-latrine in the home (RR = 1.2 (1.0-1.4)) and plate-sharing with other family members in the home also increased the likelihood of Hp infection (RR = 1.3 (1.1 -1.6)). However, after logistic regression modelling only plate-sharing in the home remained as an independent risk factor (odds ratio (OR) = 2.8 (1.3-6.3)). CONCLUSIONS: The prevalence of Hp infection in Kenyan schoolchildren aged 3-15 years is already high, suggesting that most acquisition occurs before age 3 years. Children who normally shared a plate with other family members during meals in the home had a higher prevalence of infection, suggesting that oro-oral transmission may be important in this population. Future studies in developing countries should focus on younger children (before age 3 years), and consider the possibility of adult-child, oro-oral transmission in order to establish likely modes of transmission.

Activities of Daily Living↗
PubMed2006

Is Mycobacterium bovis in the environment important for the persistence of bovine tuberculosis?

Mycobacterium bovis is the causative agent of bovine tuberculosis (bTB) in cattle and wildlife. Direct aerosol contact is thought to be the primary route of infection between conspecifics, whereas indirect transmission via an environmental reservoir of M. bovis is generally perceived not to be a significant source for infection. Here, we report on the application of molecular technology (PCR) to quantify the prevalence of M. bovis in the environment and to explore its epidemiological significance. We show that the detectability of viable M. bovis at badger setts and latrines is strongly linked to the frequency of M. bovis excretion by infected badgers, and that putative M. bovis in the environment is prevalent on a large proportion of endemic cattle farms in Britain. These results raise important questions about the role of an environmental reservoir in bTB persistence.

Animals↗
PubMed2001

Needs assessment of the displaced population following the August 1999 earthquake in Turkey.

In August 1999 a major earthquake struck north-western Turkey. An assessment followed to identify the immediate needs of the displaced population. A random cluster sample of displaced families living in temporary shelter outside of organised relief camps was designed. Representatives of 230 households from the four communities worse affected by the earthquake were interviewed. Most families lived in makeshift shelters (84 per cent), used bottled water (91 per cent), obtained food from relief organisations (61 per cent), had access to latrines (90 per cent), had a member on routine medication (53 per cent) and obtained information by word of mouth (81 per cent). Many respondents reported having family members who were over the age of 65 (32 per cent) or under age three (20 per cent), who were pregnant (6 per cent), or who had been ill since the earthquake (64 per cent). The greatest immediate need reported by most families was shelter requirements (37 per cent), followed by food (23 per cent) and hygiene requirements (19 per cent). Ten days after the earthquake, basic environmental health needs of food, shelter and hygiene still predominated in this displaced population. Significant portions may have special needs due to age or illness.

Adult↗