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Microbiological sampling of utensils, tableware, and kitchen ware, in addition to equipment, permits objective evaluation of sanitation practices and procedures used for these items from food service operations.
During the second half of 1986 the impact of the improvement of water supply and excreta disposal facilities on diarrheal diseases and intestinal parasitosis was studied in 254 children up to six years of age from two favelas (shanty towns) of Belo Horizonte, Brazil. The estimated incidence of diarrhea was 6.2 episodes/child year and the estimated period prevalence reached 31.0 episode days/child/year. The point prevalence of parasitosis was 70.7% (Ascaris lumbricoides: 55.4%, Trichuris trichiura: 19.6%, Giardia lamblia: 17.9%). The estimated prevalence of diarrhea decreased with improvement of water supply and sanitation facilities to 45% and 44% respectively, but no statistically significant impact was observed in the case of parasitosis. School education and weaning practice were found to be other important determinants of diarrhea.
The distribution of the most frequent enteroparasites in the population of Assis, State of São Paulo, was studied from 1990 to 1992. A total of 18,366 medical examinations from six sanitary care centers in the neighbourhoods of Marialves, Progresso, city center, Xavier, Fiúza and Bonfim were analyzed. The general prevalence of enteroparasites was 23.3%. The most frequently found enteroparasites were: Giardia intestinalis (8.7%), Ascaris lumbricoides (5.5%), Trichuris trichiura (2.4%) and Hymenolepis nana (1.9%). In Marialves, a low income neighborhood, the prevalences were: 17%; 13.1%; 5.9% and 4.2%, respectively. The age group from 3 to 12 years showed the largest number of infected individuals. There was a correlation between basic sanitation conditions, expressed as the number of places connected to the city water and sewage systems, and the prevalence of parasites. There was also a decrease of parasite prevalence in all sanitary care centers from 1990 to 1992, which coincided with the increase in the number of new water and sewage systems in these neighborhoods.
The paper offers a historical analysis of the creation of the sector responsible for inaugurating and managing Rio de Janeiro's basic sanitary services, examining the period from the mid-nineteenth century, when sanitary issues were first posed, through the 1920s. The analysis centers on the relation between the service structure established by the state, on the one hand, and urban space, on the other, taking a particular look at the special interests involved in creation of this structure. Exploring the vast literature available on Rio de Janeiro's urban world at that time, the present text supplements this with an analysis focused above all on the architecting of Brazil's first policies on sanitation infrastructure.
We conducted an environmental manipulation study over a 7-km2 area to examine the effect of different control levels on the population dynamics of Ceratitis capitata (Wiedemann) (Diptera: Tephritidae) in the central mountains of Israel. Adult male monitoring was carried out from spring to fall during 1988-1991 and year-round from 1994 to 2001. From 1995 to 1997, we manipulated the study area, imposing different levels of control by using a combination of insecticide sprays, tree pruning and removal, and fruit stripping. In the years preceding the manipulation, population dynamics was characterized by a peak summer population size in June-July, followed by a population decrease in August, leading to an early fall peak in September-October. If flies overwinter locally, we expected the intensive control to decrease the early summer population after the control. If flies do not overwinter locally, the control and sanitation activities should not decrease the population level in the following summer. During the entire period discussed, no flies were captured between January and May. The first appearance was recorded in late May or early June, reaching a peak in July. Regardless of control level and extent, the early summer peak remained unchanged during the entire study period, whereas the later fall peak decreased as host density decreased. We suggest that the first peak is the result of a seasonal reinvading population, whereas the later peak is governed by host availability and multiplication of the invading flies. The meaning and possible practical implications of our findings are discussed.
Today, many of the 10 million childhood deaths each year are caused by diseases of poverty--diarrhea and pneumonia, for example, which were previously major causes of childhood death in many European countries. Specific analyses of the historical decline of child mortality may shed light on the potential equity impact of interventions to reduce child mortality. In our study of the impact of improved water and sanitation in Stockholm from 1878 to 1925, we examined the decline in overall and diarrhea mortality among children, both in general and by socioeconomic group. We report a decline in overall mortality and of diarrhea mortality and a leveling out of socioeconomic differences in child mortality due to diarrheal diseases, but not of overall mortality. The contribution of general and targeted policies is discussed.
The present study addresses the use of analytical epidemiologic approaches to subsidize the establishment of priorities in environmental sanitation interventions. An epidemiological investigation was carried out in 1993 in the urban area of Betim, a southeast Brazilian City of 160,000 inhabitants. The case-control 'inclusive' (or case-cohort) design, with a sample of 997 cases and 999 controls, was employed. Cases were defined as children of less than five years of age presenting diarrhoea episodes, while controls were randomly selected among children of the same age, living in the study area. After logistic regression adjustment, 11 of several exposure variables analysed were significantly associated with diarrhoea. Four different criteria, using as risk measures the relative risk, the attributable risk, the standardized coefficient of the logistic regression and the cost standardized coefficient, were used in order to define intervention priorities.
OBJECTIVES: This study was conducted to test several hypotheses: 1. That rheumatoid arthritis and syphilis were New World diseases, only transmitted to the Old World subsequent to the passages of Christopher Columbus; 2. To indirectly test the hypothesis that lead poisoning was prevalent in Roman Italy by looking for its byproduct, gout; 3. To test the hypothesis of compromised sanitation in ancient Italy, on the basis of spondyloarthropathy frequency; and 4. To assess variation of trauma frequencies in ancient Italy, by examining frequency of focal periosteal reaction. METHODS: Skeletons from sites ranging from the Bronze Age to the Black Plague epidemic of 1485-1486 were macroscopically evaluated for focal periosteal reaction and for the cardinal signs of rheumatoid arthritis, treponemal disease, gout and spondyloarthropathy. RESULTS: Examination of 688 individuals revealed low frequency of focally distributed periosteal reaction (bumps) in sites dated from the 3400-700 years before present, sharply increasing in the 15th century. Diffuse periosteal reaction was present only as isolated occurrences secondary to hypertrophic osteoarthropathy and sabre shin reaction was notably absent. Erosive disease was uncommon and always oligoarticular in distribution. No marginal erosions were present, with the exception of an isolated metatarsal with classic overhanging edge sign of gout. Subchondral erosions, peripheral joint fusion and axial skeletal involvement identified spondyloarthropathy frequencies of 1-3%, independent of the antiquity of the site. CONCLUSIONS: Italy, prior to Columbus was like a virgin. Rheumatoid arthritis and treponemal disease (specifically syphilis) were not present, further supporting the contention that they are New World-derived diseases. Periosteal signs of minor trauma were rare prior to fifteenth century plague times. This suggests a potential role of domestic (as opposed to outside environment activities) in is development. The hypothesis for a role of lead poisoning in the demise of the Roman Empire is falsified by the rarity of gout. The frequency of spondyloarthropathy was significantly below that found in sanitarily challenged populations, suggesting high standards of hygiene in ancient Italy.
The ability of Salmonella Stanley to attach and survive on cantaloupe surfaces, its in vivo response to chlorine or hydrogen peroxide treatments, and subsequent transfer to the interior tissue during cutting was investigated. Cantaloupes were immersed in an inoculum containing Salmonella Stanley (10(8) CFU/ml) for 10 min and then stored at 4 or 20 degrees C for up to 5 days. Periodically, the inoculated melons were washed with chlorine (1,000 ppm) or hydrogen peroxide (5%), and fresh-cut tissues were prepared. The incidence of Salmonella Stanley transfer from the rinds to the fresh-cut tissues during cutting practices was determined. A population of 3.8 log10 CFU/cm2 of Salmonella Stanley was recovered from the inoculated rinds. No significant (P < 0.05) reduction of the attached Salmonella population was observed on cantaloupe surfaces stored at 4 or 20 degrees C for up to 5 days, and the population was not reduced after washing with water. Salmonella Stanley was recovered in fresh-cut pieces prepared from inoculated whole cantaloupes with no sanitizer treatment. Washing with chlorine or hydrogen peroxide solutions was most effective immediately after inoculation, resulting in an approximate 3.0-log10 CFU/cm2 reduction, and the level of recovered Salmonella population transferred to fresh-cut samples was reduced to below detection. The effectiveness of both treatments diminished when inoculated cantaloupes stored at 4 or 20 degrees C for more than 3 days were analyzed, and the fresh-cut pieces prepared from such melons were Salmonella positive. Salmonella outgrowth occurred on inoculated fresh-cut cubes stored above 4 degrees C.
Cost-effectiveness analysis indicates that some water supply and sanitation (WSS) interventions are highly cost-effective for the control of diarrhoea among under-5-year-olds, on a par with oral rehydration therapy. These are relatively inexpensive "software-related" interventions such as hygiene education, social marketing of good hygiene practices, regulation of drinking-water, and monitoring of water quality. Such interventions are needed to ensure that the potentially positive health impacts of WSS infrastructure are fully realized in practice. The perception that WSS programmes are not a cost-effective use of health sector resources has arisen from three factors: an assumption that all WSS interventions involve construction of physical infrastructure, a misperception of the health sector's role in WSS programmes, and a misunderstanding of the scope of cost-effectiveness analysis. WSS infrastructure ("hardware") is generally built and operated by public works agencies and financed by construction grants, operational subsidies, user fees and property taxes. Health sector agencies should provide "software" such as project design, hygiene education, and water quality regulation. Cost-effectiveness analysis should measure the incremental health impacts attributable to health sector investments, using the actual call on health sector resources as the measure of cost. The cost-effectiveness of a set of hardware and software combinations is estimated, using US$ per case averted, US$ per death averted, and US$ per disability-adjusted life year (DALY) saved.
A review of the available evidence for the associations between environmental sanitation and transmission of trachoma was undertaken with a view to identifying preventive interventions. The WHO Global Alliance for the Elimination of Trachoma by the Year 2020 (GET2020) has adopted the "SAFE" strategy, consisting of four components: Surgery, Antibiotic treatment, promotion of Facial cleanliness and initiation of Environmental changes. This review of 19 studies selected from the 39 conducted in different parts of the world shows that there is clear evidence to support the recommendation of facial cleanliness and environmental improvements (i.e. the F and E components of the SAFE strategy) to prevent trachoma. Person-to-person contact and flies appear to constitute the major transmission pathways. Improvement of personal and community hygiene has great potential for a sustainable reduction in trachoma transmission. Controlled clinical trials are needed to estimate the relative contribution of various elements to the risk of transmission of trachoma and the effectiveness of different interventions. These could show the relative attributable risks and effectiveness of interventions to achieve improvement of personal hygiene and fly control by environmental improvements, alone or in combination, and with or without antibiotic treatment.
In the 19th century, sanitation solutions were designed and built on the premises that human excreta was a waste suitable only for disposal and that the environment was capable of assimilating the waste. The prevailing view last century was that vapors from smells caused disease, and the best way to deal with excreta was to convey it to rivers and streams where it could be diluted and cleansed. Times have changed, the premises are outdated, and current solutions contribute, either directly or indirectly, to many of the problems faced by society today: water pollution, scarcity of fresh water, food insecurity, destruction and loss of soil fertility, loss of biodiversity, depletion of the ozone layer, and global warming. A common denominator of all these problems is how society deals with its wastes, specifically how it deals with human excrement. We have to rethink past premises, design and build new systems, and contribute to the solving of society's most pressing problems. The panacea of the 19th century is turning out to be the pandora's box of the 21st century.
The establishment of a strong independent regulator appears to be the most successful means to remedy the endemic poor management of water supply and sanitation services. This paper discusses why this is so and illustrates the argument with reference to recent experience in Chile.
A field survey was conducted on four slum, squatter and pavement dweller communities of Mumbai City, India with a total sample size of 1,070 households. Study revealed extremely low water consumption pattern averaging merely 30 l/c x d, no sewerage and safe excreta disposal facilities manifested by high occurrence of water-borne diseases. The annual diarrhoeal, typhoid and malaria cases were estimated to 614, 68 and 126 per thousand populations respectively. At point prevalence scale, at least 30% of all morbidity can be accounted for by water-related infections. In addition to the impacts of neighborhood water pollution and sanitation, such diseases were also found positively correlated with low water consumption and poverty related factors as, poor housing and family income. Analysis of variance also revealed intra-poor gradient both in living standards and health conditions on which the pavement dwellers were observed to be the greatest sufferers of all.
The effects of adhesion and of biofilm development on the efficiency of cleaning and disinfection procedures were investigated on three strains belonging to the E. coli, C. freundii and K. pneumoniae species, which were able to raise more or less complex biofilms. Resistance to a rinsing procedure was strain dependent but not related to the biofilm structure: E. coli was poorly adherent although embedded in an organic matrix. Conversely, a similar increase in the heat- and disinfectant-resistance was observed, regardless of the complexity of the biofilm (more or less significant organic matrix). These result suggested the essential role of the bacterial physiological state in resistance to sanitation procedures.
High levels of nutrients recovery can be achieved with source control sanitation--technologies are already available. Separation toilets for example separate urine that can be used in agriculture with some crop restrictions as a fertiliser after about 6 months of storage. The grey water has very low loads of nitrogen and can be treated in different combinations of biological and physical treatment and reused. Faecal matter with flush water from the separation toilet can be discharged into Rottebehaelter (an underground pre-composting tank) that retains solid material and drains liquid to a certain extent. Investigation of Rottebehaelter in the different sites and laboratory experiments showed that retained faecal material still contained a high percentage of water. However, odour was not noticed in those Rottebehaelters that have been examined. One of the major advantages of this system over other forms of pre-treatment as the septic tanks is that it does not deprive agriculture of the valuable nutrients and soil conditioner from human excreta. It has to be stated that maintenance is a crucial factor. As an intermediate result of the intensive research of Rottebehaelter it seems that these systems are rather a way of solids retaining, de-watering and long-term storage before the contents are further treated.
A cross-sectional analytic study of 190 hill-tribe youth in a community in the north of Thailand was conducted to investigate the sero-prevalence of HAV and factors related to positive anti-HAV antibody. The studied youth, whose ages ranged from 15 to 24 years, were interviewed about socio-economic status and personal hygiene. Blood specimens were collected to detect anti-HAV by ELISA commercial kit. Household environmental sanitation conditions were observed and drinking water samples were screened for bacterial contamination using SI2 medium. Following the anti-HAV assay, the studied youth were divided into two groups: anti-HAV positive, and anti-HAV negative. The studied variables of the two groups were analyzed by chi2 test to find factors related to anti-HAV positivity. The results revealed that 87% of the studied youth were positive for anti-HAV. There was no statistically significant difference between age group/gender and anti-HAV positivity, p = 0.46 and 0.16, respectively. Approximately 35.79 to 45.79% washed their hands with soap before preparing food, before eating and after using the latrine. About 88% did not improve the potability of their drinking water. The results of screening for bacterial contamination in drinking water samples found that 73.53% were contaminated with coliform bacteria. Factors related to positive anti-HAV antibody included monthly income, number of household members, use of latrine, hand-washing with soap after using latrine, household refuse management and control of insects and rodents; p = 0.04, 0.007, 0.013, 0.008, <0.001 and <0.001, respectively. The findings suggested that appropriate household environmental management should be improved in this community to reduce HAV transmission.
Water utilities in Africa find it increasingly difficult to provide adequate services to the needy areas: their core business operations are often stagnant, compounded by a dramatic rise in peri-urban and poor settlements. To address these challenges, the Water and Sanitation Program Africa has designed a work program to disseminate the best practice in pro-poor service development and to help utilities and municipal authorities to develop roadmaps to the MDGs for their service areas. Activities will primarily be directed at: (i) helping utilities and municipal authorities to include pro-poor objectives in their reform; and, (ii) working jointly with local partners, CBOs and NGOs, and SSPs to develop strategies and actions specifically targeting informal settlements. WSP-AF will focus on utilities that are engaged in reform or planning to do so. This program builds on support developed for Water Utility Partnership (WUP#5). Key entry points for pro-poor strategies: (i) pro-poor tariffs and financing mechanisms for service improvement, (ii) institutional arrangements to improve services to the urban poor, (iii) pro-poor transaction design (including regulation and monitoring), (iv) advocacy and communications regarding the urban poor, and (v) consumer voice and civil society engagement.