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PubMed1997

The urgent need for environmental sanitation and a safe drinking water supply in Mbandjock, Cameroon.

Studies were conducted to assess the physical, chemical, and bacteriological qualities of drinking water in Mbandjock, Cameroon. Study results indicated that the vast majority of drinking water sources possessed acceptable physical and chemical qualities, according to the World Health Organization standards. However, microbiological analyses revealed that only the waters treated by the Cameroon National Water Company (SNEC) and the Sugar Processing Company (SOSUCAM) were acceptable for human consumption. All spring and well waters presented evidences of fecal contamination from human and/or animal origin. Water from these sources should, therefore, be treated before use for drinking. Since the majority of the population gets its water from wells and springs, there is an urgent need to develop a health education program, within the framework of primary health care, with respect to environmental sanitation and safe drinking water supply in this community.

Health Education↗
PubMedDate not supplied

The Imo State (Nigeria) Drinking Water Supply and Sanitation Project, 2. Impact on dracunculiasis, diarrhoea and nutritional status.

Morbidity due to dracunculiasis (guinea worm disease) and diarrhoea in persons of all ages, and nutritional status of young children, were used as health impact indicators in the evaluation of the Imo State Drinking Water Supply and Sanitation Project in south-eastern Nigeria. Data were collected using repeated cross-sectional surveys and longitudinal follow-up. The study area was found to have a low level of endemicity of dracunculiasis. While no impact could be demonstrated on overall period or point prevalence rates in the cross-sectional surveys, a prospective longitudinal survey showed a significant reduction in the percentage of person-fortnights positive for dracunculiasis in areas served by the project, while the control areas showed no such change. In the cross-sectional surveys it was found that, in the project villages, those persons drinking only borehole water had significantly lower period prevalence rates one year later than others. Moreover, those living further from the nearest borehole had higher rates of dracunculiasis. An impact of the project on diarrhoea morbidity was found only in limited sub-groups of the population. A greater association with water availability rather than quality was suggested for rates in young children. The prevalence of wasting (less than 80% weight-for-height) among children aged less than 3 years decreased significantly over time in all 3 intervention villages; there was no such decline in the control villages.

Child, Preschool↗
PubMed1985

Impact of environmental sanitation and crowding on infant mortality in rural Bangladesh.

In two villages of Bangladesh, 2471 infants born in 1976 and 1977 were followed up for a year to study the impact of environmental sanitation and crowding on their mortality. Neonatal and postneonatal mortality rates in the study cohort were 100 and 75 per 1000 live-births, respectively. Multiple logistic regression analysis was done to estimate the effects of the selected risk factors while controlling for some socioeconomic, demographic, and biological characteristics. Risk of postneonatal mortality (PNNM) in the households which did not use latrines was 3 X 12 times (p less than 0.01) higher than in those which did and 1.5 times (p less than 0.05) higher in the households with 10 or more persons than in smaller households. PNNM in the households which did not use tube-wells (hand-pump) water was higher, but not significantly so, than in those which used tube-well water for all purposes. Neonatal mortality was completely unrelated to the environmental factors investigated.

Bangladesh↗
PubMed2001

Biofilm formation by salmonella spp. on food contact surfaces and their sensitivity to sanitizers.

Biofilm formation by two poultry isolates of Salmonella on three commonly used food contact surfaces viz plastic, cement and stainless steel were studied. Biofilm formation of both the isolates showed a similar trend with the highest density being on plastic followed by cement and steel. Salmonella weltevreden formed biofilm with a cell density of 3.4 x 10(7), 1.57 x 10(6) and 3 x 10(5) cfu/cm2 on plastic, cement and steel respectively while Salmonella FCM 40 biofilm on plastic, cement and steel were of the order of 1.2 x 10(7), 4.96 x 10(6) and 2.23 x 10(5) cfu/cm2 respectively. The sensitivity of the biofilm cells grown on these surfaces to different levels of two sanitizers namely hypochlorite and iodophor for varying exposure times was studied. Biofilm cells offered greater resistance when compared to their planktonic counterparts. Such biofilm cells in a food processing unit are not usually removed by the normal cleaning procedure and therefore could be a source of contamination of foods coming in contact with such surfaces.

Animals↗
PubMed1999

Use of quantitative microbial risk assessment for evaluation of the benefits of laundry sanitation.

The goal of this study was to evaluate the risk assessment process for quantifying the contribution of contamination in the home to microbial infections. Whereas risks of enteric pathogens spread through food has been assessed, the spread of fecal-oral pathogens through surfaces likely at low rates would be difficult to address through epidemiologic studies. An alternative is quantitative risk assessment. The 4-step process of hazard identification, dose-response, exposure assessment, and risk characterization can be used; however, exposure assessment may follow a complicated pathway consisting of survival and transference. Microbial hazards in the home have focused primarily on enteric bacteria. Dose-response data are available; however, the transfer from the hands to the dose is uncertain. Through day care studies, Shigella has been shown to be transferred in this manner, and a dose-response model is available. By using these data and information on the transference of bacteria between clothing and hands, risk estimates were made for contaminated laundry. Risks were calculated as high as 10 per million population to much lower levels associated with lower excretion rates of the bacteria in the feces. Approximately a 90% and 99% reduction in the probability of disease through laundering and use of a sanitizing detergent, respectively, were suggested by the models. Better data are needed on incidence of disease in the population, excretion rates over the course of an infection, amount of feces spread in the home, distribution of bacteria, survival, and the transfer of the bacteria from surfaces to the hands and to the mouth.

Clothing↗
PubMed2000

The effects of water supply and sanitation on childhood mortality in urban Eritrea.

Child mortality differentials according to water supply and sanitation in many urban areas of developing countries suggest that access to piped water and toilet facilities can improve the survival chances of children. The central question in this study is whether access to piped water and a flush toilet affects the survival chance of children under five in urban areas of Eritrea. The study uses data collected by the Demographic and Health Survey (DHS) project in Eritrea in 1995. The results show that while the unadjusted effect of household environment (water supply and toilet facility) is large and statistically significant during the post-neonatal and child periods, it is relatively small and statistically insignificant during the neonatal period. The effect of household environment remains substantial during the post-neonatal and child periods, even when other socioeconomic variables are held constant. However, the household environment effect totally disappears during the neonatal period when the socioeconomic factors are controlled for.

Child, Preschool↗
PubMed1990

Environmental sanitation, food and water contamination and diarrhoea in rural Bangladesh.

This study examined the role of food and water contamination in a health impact evaluation of a water and sanitation intervention project. Although lower diarrhoea rates were found in the improved area no consistent difference in food and water contamination was observed between areas. Furthermore, no relationship was found between contamination and diarrhoea in either area, even after controlling for the nutritional status of children. These results imply that other vehicles of transmission might be more important than food and water in diarrhoeal transmission. The focus of interventions should therefore be on changing behaviours to improve overall hygiene.

Bangladesh↗
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↗
PubMedDate not supplied

Assessment of water use and sanitation behavior of a rural area in Bangladesh.

A health development project was established in a rural area of Bangladesh that entailed training village health promoters to provide health education and to motivate families to install tubewells and sanitary latrines. Following a 2-y period of project implementation, the authors sought to assess knowledge and practice of mothers and family members about use of safe water and household tubewells. A household survey in the project area was compared with a similar one in a nearby control area. Three-hundred households in each area were selected, and mothers were interviewed with a standard questionnaire. Significantly more mothers in the health development project area (45.7%) used tubewell water for domestic purposes than in the control area (32.8%). However, hygienic practices of mothers were inadequate. Sanitary latrines were present in less than 20% of households in both areas. Approximately 97% of mothers and 78% of adult family members always used household latrines. However, the use of household latrines by children was low (26.7%). There was no statistically significant difference in the use of household latrines between the project and control areas. The results showed an improvement in use of household tubewells in the project area; however, there was no improvement in sanitation practices of families in the project area. Health education alone, without improvement of socioeconomic status, is not effective in changing behavior.

Adult↗
PubMed2003

Sanitation and hygiene in urban and rural households in East Africa.

Latrine possession, disposal of children's faeces and waste-water in 1015 households in 33 sites in Kenya, Tanzania and Uganda were studied in 1997. Assistants conducted interviews and observed the state and use of latrines, disposal of children's faeces, wastewater, and household socio-demographic characteristics. Latrine possession was 92.4% in Uganda, 95% in Kenya and 99.5% in Tanzania. In unpiped sites, 73.5% of Ugandan, 90.5% of Tanzanian and 95% of Kenyan households had latrines. Over 30% of latrines in rural Uganda were contaminated with faeces, compared with 10% in Tanzania. More latrines in urban Kenya and Uganda had contaminated surroundings than in the rural areas. The mean number of people using a toilet in the urban areas (10) was significantly higher than in rural areas (7), (F = 45.5; P < 0.001). Toilets in Kenya and Uganda were more likely to be fouled than in Tanzania. Households where the head was an educated professional or business person, or the toilet had a door, lid or concrete wall or floor or waste water was disposed of in the latrine, were less likely to have fouled toilets. Most households disposed of the faeces safely with a few placing them in the garden or elsewhere. The study emphasises the need to promote appropriate sanitation and hygiene.

Adult↗
PubMed2005

Harmful postures and musculoskeletal symptoms among sanitation workers of a fish processing factory in ghana: a preliminary investigation.

This study investigated musculoskeletal symptoms among sanitation workers of a fish-processing factory. The methods used included administration of a questionnaire, walk through observation, interview, task analysis and future workshop. All 27 male participants answered and submitted their questionnaires. Of the 11 operations identified, all except one was considered safe. Bent back, bent legs, and heavy manual handling were observed to impose intolerable health risk on participants. This corresponds with questionnaire results in which musculoskeletal symptoms were mostly prevalent in the neck, the shoulder, the low back, the wrists/hands and the upper back regions. Poor psychosocial complaints were also made on the job. There was no significant correlation (p < .05) between musculoskeletal symptoms and age, working hours and length of service. Neither was any significant correlation observed (p < .05) between psychosocial work factors and musculoskeletal symptoms. Recommendations such as task redesign to eliminate high-risk elements in operations, workplace changes and worker training were suggested.

Animals↗
PubMed1988

Case-control studies of the effect of environmental sanitation on diarrhoea morbidity: methodological implications of field studies in Africa and Asia.

The problems and prospects in the use of case-control studies to assess the effects of improvements in environmental sanitation on diarrhoea morbidity are discussed on the basis of two field studies. It is concluded that an adequate design is available for assessing the effects of a single improvement on diarrhoeal disease. The estimates of effect appear to be valid and sufficiently precise. For addressing more complex questions of interactions, sample sizes would have to be increased substantially. The experience with two field studies suggests that there is hope that a simpler protocol may be feasible, in which only limited information is collected, in which few home visits are made, and in which analytical techniques are simple. Until more field studies have been conducted definitive conclusions cannot be reached on the applicability of such a simple, rapid and inexpensive approach.

Child, Preschool↗
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

Water sanitation practices on the Texas-Mexico border: implications for physicians on both sides.

With the epidemic of cholera in South and Central America and reports of cholera in the Northern Hemisphere in Mexico, increasing concern focuses on sanitation problems along the border between the United States and Mexico. It is feared that binationally shared water supplies are threatened or contaminated by sewage and other wastes. Although much anecdotal information exists, surprisingly few hard data are available in the United States (or in Mexico, for that matter) regarding water quality on the Mexican side of the border. This shortage of data is felt most acutely in the semiarid portions of the border, where water is extraordinarily scarce. In 1987, researchers at the University of Texas School of Public Health (UTSPH) began gathering data on the availability, accessibility, and bacteriologic and chemical safety of raw and finished drinking water in Mexico at its border with Texas. In view of their timely significance, we wish to share pertinent data. This particular study was carried out in Ciudad Juarez, a city of more than 1 million people, situated just across the Rio Grande from the Texas city of El Paso. The investigation was conducted at the invitation and with the assistance of municipal authorities of Cd. Juarez. As far as we know, this was the first time the water in Cd. Juarez had been tested for indicator fecal bacteria and other selected contaminants.

Enterobacteriaceae↗
PubMed2006

Intersections of 'sanitation, sexual coercion and girls' safety in schools'.

OBJECTIVE: To explore safety for girls in schools, particularly how girls perceive and negotiate dangers and risks associated with the use of toilets. METHODS: Participatory action research over a period of 3 days at three schools in South Africa. Informants were 81 girls 16 years and older, teachers and other relevant school personnel. Data were collected through focus group discussions, in-depth interviews, participant observation, mapping and photography. RESULTS: Toilets had inadequate or no sanitation. Both their use and their avoidance were risky for female students and discouraged hygienic practices. Experience of sexual violence from male students and teachers was a major theme, but unrelated to school toilets. Male teachers used various strategies and opportunities to gain sexual access to the girls and previous experience of victimization prevented the girls from reporting them. CONCLUSION: To ensure a healthy school environment that promotes gender equality, all threats to safety, including the physical and social environment, must be considered.

Adolescent↗
PubMed1977

Sanitation in self-service automatic washers.

The potential for microbial transfer in self-service laundry washing machines was investigated by obtaining swab samples from the interior surfaces of commercial machines and wash water samples before and after disinfectant treatment. Three disinfectants (chlorine, a quaternary ammonium product, and a phenolic disinfectant) were used. Four self-service laundry facilities were sampled, with 10 replications of the procedure for each treatment at each location. Although washers were set on a warmwater setting, the wash water temperatures ranged from 24 to 51 degrees C. The quaternary ammonium product seemed most effective, averaging a 97% microbial kill; chlorine was the second most effective, with a 58% kill, and the phenolic disinfectant was least effective, with only a 25% kill. The efficacies of the chlorine and phenolic disinfectants were reduced at low water temperatures commonly experienced in self-service laundries. Interfamily cross-contamination in self-service facilities is a potential public health problem, which is aggravated by environmental conditions, such as water temperature and the practices of the previous users of the equipment. Procedural changes in laundering are recommended, including the use of a disinfectant to maintain adequate levels of sanitation.

Chlorine↗
PubMed1990

Crisis in our schools: survey of sanitation facilities in schools in Bloomsbury health district.

OBJECTIVE: To survey sanitation facilities in schools in Bloomsbury health district. DESIGN: Postal questionnaire. SETTING: Inner London health district. PARTICIPANTS: School nurses. RESULTS: 16 of 17 school nurses responded (37 of 41 schools). Fifteen schools did not have the minimum number of toilets and hand basins established in the Education (School Premises) Regulations 1981. In two schools toilets were kept locked for most of the day. In 10 schools toilet paper was not always available, and three of five secondary schools did not have disposal units for sanitary towels in the girls' toilet areas. In 18 of the schools the toilets were not kept adequately clean. CONCLUSIONS: These conditions raise serious questions about environmental health, with the potential for the spread of infectious diseases, and undermine attempts to teach children basic hygiene. Health professionals have an important role in assessing health and safety standards in schools and ensuring that necessary improvements are made.

Environmental Health↗
PubMed1987

Water supply, sanitation and health education programmes in developing countries: problems of evaluation.

There are several methodological problems related to evaluating the impact that improved water supply, sanitation and health education projects have on public health. Fifteen studies of intervention programmes, one by the present authors, are discussed. Since non-intervention studies of water supply are difficult to assess, a valid study design must include an intervention programme, even though such studies are more costly and time-consuming. Detailed descriptions of programmes, study plans, and analytical methods are often lacking, and different studies reach greatly diverging conclusions. It may be proposed that studies based on "weak" methodology give a more positive impression of improved public health after improvement of water supply than do before-after studies using comparison groups.

Developing Countries↗