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The epidemiology of schistosomiasis in Egypt: Ismailia governorate.

A multi-stage stratified sample of 12,515 individuals from 1,941 households in 42 villages in the Ismailia governorate of Egypt were surveyed for schistosomal infection. A subset of 2,390 subjects were surveyed for morbidity by physical and ultrasonographic examination. The prevalence of Schistosoma mansoni infection in rural Ismailia was 42.9% and the geometric mean egg count (GMEC) was 93.3 eggs/gram of stool, with considerable variability between communities. Prevalence and intensity peaked in the 20-30-year-old age group and was higher in males than in females. Prevalence and intensity of S. haematobium was very low: 1.8% and 3.5 ova/10 ml of urine GMEC, respectively. Canal water exposure risk factors for S. mansoni infection were males bathing (odds ratio [OR] = 2.2), females washing clothes (OR = 1.9), and children playing or swimming (OR = 2.3). Presence of in-house piped water supply and latrine lowered infection rates (P < 0.001 and P = 0.002, respectively). Histories of S. mansoni infection (OR = 1.6) or treatment (OR = 1.5) and blood in feces (OR = 3.5) were associated with infection. Hepatomegaly (16.0%) was more frequently detected than splenomegaly (3.6%) by physical examination, with both being more frequent in older age groups. Splenomegaly, but not hepatomegaly, was associated with presence of S. mansoni ova in stools (OR = 1.4) and the community burden of infection (P = 0.02). Ultrasonographically detected hepatomegaly, splenomegaly, and periportal fibrosis (PPF) were detected in 43.0%, 17.4%, and 39.7% of the subjects, respectively. The higher grades of PPF were rare. Ultrasonographically detected splenomegaly, not hepatomegaly, was associated with S. mansoni infection, community burden of infection, and PPF. Risk factors for PPF were the same as for S. mansoni infection. There was a marginal association of PPF with infection and none (P = 0.33) with the intensity of infection in individuals or in the community. We conclude that in rural Ismailia, S. haematobium infection is rare but the prevalence and intensity of infection with S. mansoni is high. The risk of infection is associated with environmentally detected factors and behaviors. Hepatosplenic morbidity attributable to S. mansoni infection is low, presumably because of the favorable effect of wide application of praziquantel therapy.

Adolescent↗

Oral fecal parasites and personal hygiene of food handlers in Abeokuta, Nigeria.

BACKGROUND: Ingestion of infective eggs and cysts of faecal orally transmissible parasites has been linked with the level of environmental and personal hygiene. The possibility of contamination of food with eggs and cysts by infected food vendors has also been recorded. OBJECTIVES AND METHODS: This study was aimed at assessing the prevalence of parasites with direct transmission and the level of hygiene among food vendors. Stools of randomly selected food vendors selling in schools and streets in Abeokuta were examined for ova and cysts of parasites using formo-ether concentration method. Questionnaires, interviews, and field observation were also used to assess the activities of food vendors. RESULTS: Ninety-seven (97%) percent of the food vendors were infected with one or more faecal-orally transmissible parasites while 3% were free from such parasites; Parasites observed were Entamoeba histolytica with a prevalence of 72% Ascaris lumbricoides (54%), Enterobius vermicularis (27%), Trichuris trichiura (24%) and Giardia duodenalis (13%). School food vendors recorded lower prevalence of infection (92%) than the street food vendors (98.7%) (P>0.05) Fifty-two percent (52%) of the food vendors have dewormed in the last four years; Eighty percent (80%) of this were school food vendors. Infections with helminthes were recorded in 63.5% of the dewormed food vendors. Food vendors involved in child care activities were found to be more infected than those not involved in such activities. Toilet facilities available to the vendors were mainly pit latrine and other related structure (75%) while 25% had access to water system closets. During hawking, dung hills were majorly used for defaecation. Hand washing after defaecation did not include the use of soap in the few vendors that were involved in hand washing. CONCLUSION: There is need to enact food handling policies and implementation of such policies ensured in order to reduce transmission of oral faecal parasites.

Adolescent↗

The experience of self-care groups with people affected by leprosy: ALERT, Ethiopia.

This paper describes the development of self-care groups in Ethiopia by ALERT, and the successes and failures experienced in the process. The groups were started in 1995 in response to two main problems, the increasing number of people dependent on ALERT to heal their wounds despite years of health education, and the limited financial resources of ALERT for wound healing supplies. By December 1999, there were a total of 72 established groups. Group membership was voluntary. There have been a number of positive outcomes. Group members have taken up responsibility for managing and monitoring their own wounds and supplying their own wound healing materials. More attention is paid to their personal hygiene and personal appearance. They also report increased confidence to participate in society, restored dignity and self-respect, and a sense of belonging within the community. In addition, some members have started to pay more attention to their local environmental hygiene by building pit latrines and waste disposal sites. The ALERT staff involved in this initiative had to change their role from that of a leprosy service provider to a self-care group facilitator, but not all were successful in making this transition. The remaining challenge for the programme is sustainability and further development through the National Tuberculosis and Leprosy Control Programme, The Ethiopian National Association for Ex-Leprosy Patients and possibly other organizations too.

Ethiopia↗

Effect of intestinal helminth infection on some nutritional parameters among rural villagers in Nepal.

We report the prevalence of intestinal helminthiasis and its impact on health of Nepalese in two different rural Village Development Committees (VDC) in Nepal. A total of 261 school children from Okharpauwa VDC in Nuwakot district (Central Region) and 242 inhabitants of Boya VDC in Bhojpur district (Eastern Region) in Nepal were included in this study. The overall prevalence in these two different districts were 57.5% and 55.4%, respectively. Altogether four types of helminths were detected. In both districts, Ascaris lumbricoides was the commonest helminth. Mixed helminth infection in both study areas accounted for less than 5.0%. All helminth infected subjects were treated with a single dose of albendazole. Heavy Trichuris trichiura infection needed a second dose. Blood hemoglobin and serum total protein level in school children in Okharpauwa VDC increased significantly after chemotherapy (P < 0.05). Eosinophil count (10.1%; SD 5.0325) returned to normal (4.8%; SD 4.6997). Helminth infection in Boya VDC was more common in children than in adults. Serum total protein, albumin, total cholesterol and triglycerides levels were not influenced by the presence or absence of helminths among the inhabitants of Boya VDC. In both districts, more than 80.0% of the household had no latrine. In Boya VDC, 94.0% of inhabitants interviewed were not aware of other intestinal parasite other than A. lumbricoides.

Adolescent↗

A study of the cost effectiveness of selective health interventions for the control of intestinal parasites in rural Bangladesh.

The study examined the cost effectiveness of 4 different regimens in reducing the prevalence and intensity of infection of Ascaris lumbricoides, Trichuris trichiura, and hookworm over an 18-mo period in randomized community samples of children aged 2-8 yr living in rural Bangladesh. The household was the unit of randomization in each community. The 4 regimens were (1) only chemotherapy to all household members at the commencement of the study (i.e., at an interval of 18 mo), (2) same as group (1) and regular health education throughout the study period, (3) chemotherapy to all household members at the commencement of the study and subsequent chemotherapy to all children at intervals of 6 mo, and (4) same as group 3 with the addition of regular health education throughout the study period. Health education (through home and school visits and focus group discussions) was aimed at increasing awareness of worm transmission and the disabilities caused by intestinal helminths. Simple ways of improving personal hygiene and sanitation through hand washing, nail trimming, wearing of shoes, and use of a latrine and clean water supplies were encouraged. Because albendazole is a broad spectrum anthelmintic, the cost effectiveness of the 4 interventions were compared by the weighted percentage reduction in prevalence and the weighted percentage reduction in intensities of infection as measured by geometric mean egg loads of all 3 worms combined. The most cost-effective strategy was the single albendazole mass chemotherapy at an interval of 18 mo. The 2 regimens involving health education were the least cost effective.

Albendazole↗

Control of Schistosoma japonicum infection in Lindu Valley, Central Sulawesi, Indonesia.

In Indonesia, schistosomiasis is presently confined to two endemic areas in Central Sulawesi; Lindu (1,500) and Napu (5,000 inhabitants) valleys. Because of various development schemes now underway, it is feared that the natural balance which existed for many years between the parasite, the snail intermediate hosts and man, will be upset and will place some 70,000 people of the adjoining Palu and Palolo areas at risk. Measures are being taken to control and prevent the spread of the disease. A pilot control programme is planned for two years in the village of Anca in Lindu with a population of 391 and a prevalence rate of 70.5%. Langko village with a population of 464 and a prevalence rate of 53.7% will be utilized as the comparison area. Baseline data on human, malacological and animal reservoir hosts are being collected and control operations are anticipated to commence in July 1975. Measures to be applied to control schistosomiasis in the order of priorities are: (a) agro-engineering or modification of the environment; (b) environmental sanitation through the provision of adequate water supply and construction of latrines; (c) mollusciciding of remaining snail infested areas; (d) chemotherapy, and (e) health education campaign. At the end of the two-year control programme, the following activities will be carried out to determine the degree of intervention achieved; (a) human data: calculation of prevalence rates, incidence rates, and changes in the intensity of infection based on quantitative egg counts; (b) malacological data: changes in the number and extent of snail foci; snail density, and snail infection rates; (c) reservoir hosts: changes in the prevalence rates among domestic and wild animals. Calculation of reclaimed areas and increase in agricultural production will also be assessed together with the overall cost/benefit analysis of the project undertaking.

Adolescent↗

Agro-engineering and sanitation improvement in the control of schistosomiasis japonica in the Philippines: a review.

Measures that would change the habitat of the snails were found to prevent its breeding. Among these are clearing and drainage of waterlogged areas; filling of depressions where filling materials are available; ponding of areas which cannot be drained, and improved rice culture. The degree of success in snail control depends to a large extent on the amount of change brought about in the habitat. The more radical the change, the greater the reduction in snail density. It can be expected that improvement in sanitation in the form of toilet construction and use, provision of safe water supply, building of footbridges and the control of stray animals will bring a further decline in the transmission of the disease. Studies have shown that perfect sanitation in the form of toilet construction and use will reduce transmission by about 75%, the other 25% being contributed by lower mammals. Agro-engineering control measures are presently being carried out intensively in 7 town of Leyte, with food assistance from the UN/FAO World Food Program being given to volunteer workers as incentives for them to work. Snail evaluation after 2 years has shown a snail reduction by 72% in the areas covered. It may be mentioned here that sanitation improvement, especially latrine construction, is an ongoing program of the Department of Health in all rural areas.

Agriculture↗

Different patterns of intestinal helminth infection among young workers in urban and rural areas of Alexandria Governorate, Egypt.

The process of urbanisation taking place in most developing countries is creating favourable conditions for an increase in prevalence of infections, especially with intestinal parasites, in the marginal areas of the towns. The present study was implemented in 1996 to assess the varying prevalence and intensity of infection among young workers in urban and rural areas of the same Governorate (Alexandria, Egypt). The sample comprised 408 male subjects, 8 to 19 years of age, in various occupations: 308 from urban areas, 67 from an industrialised village close to the desert, and 33 from a rural village. A quantitative diagnosis of intestinal helminth infections was made using the Kato-Katz technique, with a double reading of each slide. The results showed a higher prevalence (> 50%) and intensity of infection (indirectly measured as number of eggs per gram of faeces) than in previous studies. Furthermore, a higher prevalence and intensity of infection with Ascaris lumbricoides and Trichuris trichiura was detected in urban districts, as compared to rural areas. This difference was statistically significant. High crowding index, latrine shared with other families and no piped water inside the household, were more common in urban areas as compared with rural settlements and also associated with a higher intensity of infection by soil-transmitted helminths. The trend toward urbanisation seems to have caused deterioration of living conditions and sanitation standards in some areas of Alexandria city, with the most vulnerable people experiencing an increase in intestinal parasitic infections.

Adolescent↗

[Prevalence of Giardia lamblia, its detection in water and its relationship with environmental factors in Gualeguaychú, Argentina].

The increasing environmental contamination affects the water quality, and is going to raise the waterborne intestinal infections such as giardiosis. This study determined the prevalence of G.lamblia infection in 1201 persons of Gualeguaychú, Argentina. It was observed the relationship between giardiosis and the detection of G.lamblia in the recreational and drinking water and with homes environmental factors. General rate of infection was 19.7%. The group 2-11 years old was the highest (28.0%). No cysts of G.lamblia were found in drinking water, but recreational water was contaminated. Higher rate of infected persons lived in suburban dwellings with dirt floor, latrine, ground-water and close contact with dogs. It is concluded that to drink water is no risk-infection at present, but it will be if this community continues discharging excretsa into the river because this is the source of water for the habitants.

Adolescent↗

[Physical growth of children from the Peruvian Amazon born in the eighties].

This paper presents data of physical growth for 673 children under 5 years born in the eighties in Iquitos and Punchana, Peruvian Amazon. The data were based on a clinical and nutritional research survey and a multiple stratified probability sample procedure was used. The statistical analysis were performed on EPI-INFO Version 6.04 and MULTLRM and included: prevalence of z-score under-2 standard deviation, means and standard deviation, ANOVA, t-test, relative risk and odds ratio. The results showed a high prevalence of low height/age (28.3%) and a relatively low for weight/age (12.5%). The final model obtained from the unconditional logistic regression included the following variables as independent factors significantly associated with low height/age: child age (RR = 1.05, CI 95%: 1.03-1.07); maternal education > 5 and < 10 years (RR = 0.48, IC 95%: 0.32-0.73), maternal education > 10 years (RR = 0.11, CI 95%: 0.01-0.89) and hygienic services with latrine (RR = 2.22, CI 95%: 1.46-3.37) and without WC (RR = 4.15, CI 95%: 1.56-10.99). These findings coroborate the influence of ecological factors on the determination of low height/age, and suggest that interventions should be centered on the enlargement of educational coverage and on improvements of hygienic conditions, as for this Peruvian school sample, both variables were defined as potential determinants for the low height/age.

Age Factors↗

Quantitative bacterial examination of domestic water supplies in the Lesotho Highlands: water quality, sanitation, and village health.

Reported are the results of an examination of domestic water supplies for microbial contamination in the Lesotho Highlands, the site of a 20-year-old hydroelectric project, as part of a regional epidemiological survey of baseline health, nutritional and environmental parameters. The population's hygiene and health behaviour were also studied. A total of 72 village water sources were classified as unimproved (n = 23), semi-improved (n = 37), or improved (n = 12). Based on the estimation of total coliforms, which is a nonspecific bacterial indicator of water quality, all unimproved and semi-improved water sources would be considered as not potable. Escherichia coli, a more precise indicator of faecal pollution, was absent (P < 0.001) in most of the improved water sources. Among 588 queried households, only 38% had access to an "improved" water supply. Sanitation was a serious problem, e.g. fewer than 5% of villagers used latrines and 18% of under-5-year-olds had suffered a recent diarrhoeal illness. The study demonstrates that protection of water sources can improve the hygienic quality of rural water supplies, where disinfection is not feasible. Our findings support the WHO recommendation that E. coli should be the principal microbial indicator for portability of untreated water. Strategies for developing safe water and sanitation systems must include public health education in hygiene and water source protection, practical methods and standards for water quality monitoring, and a resource centre for project information to facilitate programme evaluation and planning.

Adolescent↗

Soil contamination and infections by soil-transmitted helminths in an endemic village in southern Thailand.

The aim of this study was to test the association between soil contamination and infection of the household members by soil-transmitted helminths in dry and rainy seasons. A lake-side community in southern Thailand with a population of 2,340 was studied twice, in the dry season and rainy season of 1995. Fifty households were randomly selected. Soil samples near the latrine, in the yard, at the foot-washing area and under the trees were taken and analysed for presence of helminthic eggs. All members of the selected household were interviewed and stool samples obtained. Age-adjusted odds ratios of presence of Ascaris and Trichuris eggs in the household soil for ascariasis and trichuriasis were 10.5 (95% CI 1.5-77.1) and 5.5 (95% CI 2.4-12.7) in dry season and 10.4 (95% CI 2.5-43.8) and 8.3 (95% CI 3.4-20.0) in rainy season. The levels of hookworm eggs detected in the soil were too low to test the association. Soil analysis for eggs of Ascaris and Trichuris may be used to predict infections among the household members but not that for hookworm.

Ascariasis↗

[Intestinal parasitosis in the inhabitants of a suburban zone in which the groundwater is polluted by nitrates of fecal origin (Yeumbeul, Senegal)].

This study was carried out in 1997 to 1998, to determine the prevalence of intestinal parasite infestations due to groundwater pollution at Yeumbeul, Senegal, and to follow the progression of parasite infestations following anti-parasite treatment. The study included 705 people living in a suburban zone in which the water table was polluted with nitrates of fecal origin. These individuals consumed either well water or water from springs. The overall prevalence of parasite infestation was 42.26%, but varied significantly with age (p < 0.001). Individuals who consumed well water were more frequently infested than those who consumed spring water, but the difference was not significant (p > 0.3). Giardia and Entamoeba coli were the most frequently isolated parasites, with Giardia predominating in the 0 to 9 year age-group. There was no significant correlation between the prevalence of the various parasites and indicators of water pollution (R2 = 0.0566 for nitrates and 0.1086 for fecal coliform bacteria). Similarly, no correlation was found with water pollution factors such as the depth of the water table (R2 = 0.027) and the distance between the wells and the latrines (R2 = 0.00007). Following specific treatment, the prevalence of parasite infestation fell to 30.81%. This indicates the limitations of drug treatment, which is always used alone to combat intestinal parasites, in the face of possible reinfestation.

Adolescent↗

Challenges for health and water resources in the Birim districts of eastern Ghana.

In the late 1970s and early '1980s, the Ghana Water and Sewerage Corporation (GWSC) with assistance from the government of Germany (KfW through IGIP) drilled 144 wells in the Birim North and South Districts of the Eastern Region of Ghana. This was part of an overall provision of water to rural communities which later came to be known as the 3000 Wells Project. The wells were supply-driven and were centrally-maintained, without community involvement in planning and operation. Earlier in 1970, an agricultural development project was also promoted in the two otherwise deprived districts with the aim of increasing output of produce and thereby improving incomes of rural farmers with emphasis on cocoa, rice and oilpalm. In 1992, under a United Nations' Development Programme Rural Water and Sanitation Project with the GWSC, another 141 wells were drilled and assistance provided to households to build 750 Ventilated Improved Pit (VIP) latrines coupled with hygiene education under a demand-driven community management approach. (About 60% of the budget was allocated to water, another 30% to sanitation while some 10% was meant for hygiene education interventions). All the wells were fitted with modified Indian Mk II pumps. These measures together were meant to improve the health of rural communities and make them contribute more positively to national development. The paper looks at some of the possible factors of the two water projects and the agricultural development project that could impact negatively on the water resources and health of people in these two districts.

Agriculture↗

Management of rural drinking water supplies and waste using the participatory hygiene and sanitation transformation (PHAST) initiative in Zimbabwe.

This paper focuses on the use of Participatory Hygiene and Sanitation Transformation (PHAST) and how the methodology can be taken to scale. It uses the Zimbabwe experience and highlights some of the benefits in the application of PHAST, conditions necessary for scaling up and possible constraints. The PHAST initiative started off as a pilot process seeking to promote improved hygiene behaviour and promotion of sanitation. Having successfully piloted PHAST, Zimbabwe has scaled up the use of the methodology at a country level. While impact studies have not yet been conducted, reviews of the effects of the process have indicated positive behaviour change in such areas as management of water, construction and use of latrines. The process has also led to a change of institutional approaches in planning for improved water and sanitation from supply driven projects to demand responsive approaches. Some lessons learnt have included the need for baseline surveys at the start of the use of PHAST, the difficulty in developing monitoring indicators and hence difficulty in measuring impacts. Conclusions being drawn using assessment studies are that the use of participatory approaches has led to improved hygiene behaviour with communities being able to link causes and effects. The use of participatory methods also necessitates a change in institutional approaches from supply driven approaches to demand responsiveness. Other lessons drawn were related to the creation of an enabling environment for the application of participatory processes. Such enabling environment includes capacity building, resource allocation, policy and institutional support.

Community Participation↗

Conflict of technologies for water and sanitation in developing countries.

Borehole water supplies, in basement rock aquifers in the West Africa Sub-region, face potential pollution hazards as a result of their close location within the same geological environments as indiscriminately sited latrines, rubbish dumps, farms and animal watering points in the communities. The heterogeneous nature of the overburden and fractures in the bedrock constitute relatively fast flow paths for surface water contaminated mainly by bacteria and nitrates which enhance the pollution of the groundwater and boreholes. To improve the drinking water quality, some measures have been taken to minimize the hazards. Further studies are required to understand better the nature and scale of the problem and to avoid the apparent conflict of technologies. It is necessary to incorporate improvements in sanitation into rural water supply projects, if the otherwise good drinking water source should not be lost to society's wastes.

Conflict, Psychological↗

Environmental determinants of diarrheal morbidity in under-five children, Keffa-Sheka zone, south west Ethiopia.

A population-based cross-sectional study on diarrheal morbidity was carried out in thirty two rural and urban areas of Keffa-Sheka zone, to determine the prevalence of diarrhea in under-5 children and identify environmental risk factors. A total of 952 children between the ages of 0 and 59 months living in the sampled households formed the study population. Data collected include demographic characteristics of the child, and information on environmental and housing variables. The overall diarrheal prevalence was 15%. Acute watery diarrhea, dysentery, and persistent diarrhea were responsible for 66%, 20%, and 14% of the episodes, respectively. Overall a third of the diarrheal episodes were bloody and/or persistent. Young age, male gender, living in a house with fewer number of rooms, and obtaining water from storage containers by dipping showed statistically significant association with diarrheal morbidity (p < 0.05). Type of water source, amount of water consumed, and latrine availability were not found to be significant risk factors (p > 0.05). Diarrhea, particularly dysentery and/or persistent diarrhea, affect a large proportion of children. Water is scarce and the environmental status of the area is generally poor. Efforts to educate the community about correct water handling behavior, personal and domestic hygiene should also be important components of the diarrhea control strategy. Further study on other environmental determinants, socio-demographic factors, feeding patterns and immunization status of children, and ORS accessibility is also recommended.

Age Distribution↗

Keeping clean water clean in a Malawi refugee camp: a randomized intervention trial.

OBJECTIVE: This study was undertaken to assess the ability of a water container with a cover and a spout to prevent household contamination of water in a Malawian refugee camp. METHODS: A randomized trial was conducted in a refugee population that had experienced repeated outbreaks of cholera and diarrhoea and where contamination of water in the home was found to be a significant cause of cholera. Four hundred Mozambican refugee households were systematically identified and followed over a 4-month period, one fourth of the households were randomly assigned to exclusively use the improved container for water collection. FINDINGS: Water flowing from the source wells had little or no microbial contamination although the water collectors quickly contaminated their water, primarily through contact with their hands. Analysis of water samples demonstrated that there was a 69% reduction in the geometric mean of faecal coliform levels in household water and 31% less diarrhoeal disease (P = 0.06) in children under 5 years of age among the group using the improved bucket. Regression models examining diarrhoea among under 5-year-olds confirmed the protective effect of the bucket and found that visible faeces in the family latrine and the presence of animals were significantly associated with an increased diarrhoeal incidence in children. CONCLUSION: Household contamination of drinking-water significantly contributed to diarrhoea in this population. Proper chlorination is a less expensive and more effective means of water quality protection in comparison with the improved bucket, but was unpopular and rarely utilized by the camp inhabitants.

Chlorine↗