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PubMed2006

Assessment of health-related needs after tsunami and earthquake--three districts, Aceh Province, Indonesia, July-August 2005.

On December 26, 2004, an earthquake measuring 9.2 on the Richter scale off the northwest coast of the island of Sumatra, Indonesia, produced a tsunami that caused the deaths of an estimated 230,000 persons in India, Indonesia, the Maldives, Somalia, Sri Lanka, and Thailand. The majority of casualties were in Aceh Province (population 4.5 million) in northern Sumatra, Indonesia, where an estimated 130,000 persons died. In addition, 500,000 persons were displaced from their homes, and 37,000 remain unaccounted for in the province. In the Aceh Province districts of Banda Aceh and Aceh Besar, an estimated 90,000 persons died; approximately 75% of health workers in Banda Aceh either died or were displaced from their homes. On March 28, 2005, a second major earthquake, measuring 8.7 on the Richter scale, caused large-scale damage to the islands of Simeulue and Nias off the western Sumatra coast; approximately 300 persons died, and thousands were displaced. The international community responded to these events with the largest relief measures ever undertaken for a natural disaster. To determine the health and nutrition status of the affected populations and to evaluate the effectiveness of relief interventions 7 months after the tsunami and 3 months after the second earthquake, Cooperative for Assistance and Relief Everywhere, Inc. (CARE) International Indonesia and CDC conducted surveys in three districts of Aceh Province (Aceh Besar, Banda Aceh, and Simeulue). This report summarizes the results of those surveys, which identified routine vaccinations and provision of toilets or latrines as particular areas for improvement and revealed no significant difference in health indicators between internally displaced persons (IDPs) and nondisplaced populations. The relief response in Aceh Province should target areas needing improvement with programs that serve both IDPs and nondisplaced persons, as measures are implemented to rebuild the public health infrastructure.

Adolescent↗
PubMed2004

Improving environmental conditions of a slum in Chandigarh by an awareness campaign.

An intervention project, in the form of an environmental awareness campaign was conducted in a slum of Chandigarh with a population of about 40,000, from December 1998-April 1999. The activities enforced during this campaign included focus group discussions with general public and mothers, household visit by medical students, distribution of literature, use of mass media by involving local residents, primary child care workers, teachers and school children. Evaluation of this campaign was carried out in May 1999 and compared with the baseline data obtained from a survey done in 1997. The study revealed that the method of storing water in covered buckets and utensils had improved significantly from 14.3% and 4.7% in the baseline survey to 35.2% (P < 0.001) and 16.2% (P < 0.01) respectively. Refuse disposal in the community bin and own bin had significantly improved to 22.2% (P < 0.001) and 19% (P < 0.01) from 8.4% and 11.2% respectively in the baseline survey. 51.2% of the residents using own bins disposed the refuse finally into the community bin. The use of community latrines had significantly increased among males (50.0%), females (47.7%) and children (41.2%) after intervention as compared to 32.8%, 32.5% and 16.7% respectively as found in the baseline survey (P < 0.001) and similarly open defaecation had significantly reduced among them. Further the study shows that the awareness regarding diarrhoea as hazard of unsafe water had improved significantly from 28.7% in baseline survey to 55.6% after intervention (P < 0.001). Knowledge of the residents regarding hazards of refuse disposal in the open and open defaecation had also improved significantly. Simple environmental awareness campaign can change the knowledge and behavioural practices of slum dwellers and could be a model for launching similar projects in other slums of India and other developing countries.

Adult↗
PubMed2006

[Factors contributing to endemic cholera in Douala, Cameroon].

Cholera has been endemic in Douala, Cameroon since 1971. A number of environmental factors favourize the survival of the Vibrio in Douala including location at the mouth of Wouri delta on the Atlantic Ocean, sandy clay soil, shallow dirty polluted foul-smelling groundwater, presence of vast expanses of swamp, streams/drainage ditches infested with algae, and high temperatures with low rainfall and drought during certain periods of the year. Most outbreaks have started in Bepanda, a slum area built on a garbage dump in a swampy zone fed by drainage ditches carrying the faecal pollution from neighbouring upstream districts. It is a densely overcrowded area of uncontrolled urbanization generated by the influx of poor city new-comers who live without adequate access to clean water or basic sanitary facilities. The most affected areas are those resulting from recent unregulated urban sprawl in polluted swamp zones or garbage dumps. Since access to the public water system is inadequate with only 65000 persons connected for 3 million inhabitants, dwellers in most areas must take water from the 70000 urban wells (estimated in 2004) that are often not more than 1.5 m deep. Sewage facilities are insufficient to provide complete evacuation of solid and liquid waste. The network of rivers, streams and man-made ditches waste are poorly maintained and often overflow during the rainy season. The contents of latrines are often discharged directly into the environment. Social factors such as the reformation of urban tribes and persistence of traditional attitudes toward waste disposal and water use have not only led to high-risk behaviour but also created barriers to sanitation and hygiene education. With an inadequate sanitation inspection system, a large but purely accessible public health system and a highly disorganized private health sector exists, effective preventive measures are difficult to implement. The combination of these factors probably account for the endemicity of cholera in Douala.

Cameroon↗
PubMedDate not supplied

[Assessment of 24 years of infant growth monitoring in a rural area of Senegal (1969-1992)].

UNLABELLED: Undernutrition in young children in developing countries is associated with an increased risk of death. But in several studies, a decrease in mortality was not associated with any decrease in the prevalence of undernutrition. STUDY AREA: A rural population of Casamance (Senegal) has been under yearly demographic surveillance by The French National Institute of Demographic Studies (INED) since 1985. Between 1960-1964 and 1990-1994, under-5 and child (1-4 years) mortality rates dropped from 312 to 127 and from 201 to 68 per 1,000, respectively. Since 1961, French Catholic nuns who are also professional nurses have been in charge of a private village dispensary located in a rural area of Casamance. This dispensary delivers permanent, high quality service and is widely attended. GROWTH MONITORING PROGRAMME: A growth-monitoring programme, supported by Cathwell, was initiated in 1969 for 0-5-year-old children (0-3 from 1985). Children were weighed wearing light clothes to the nearest 10g. Weights were recorded in a register that also contained information concerning identity (name, sex, date of birth) and address. All weights were plotted on growth charts kept by the mothers. During the sessions, the nurses provided nutrition education messages (i.e., preparation of high-energy and nutrient-dense infant gruels using local foods), advice on illness management (oral rehydration during diarrhoea) and hygiene (well and water-jar disinfection, construction of pit-latrines), importance of vaccination. From 1975, they also distributed free chloroquine during the malaria transmission season (May-November) for prevention and early presumptive treatment. Most likely thanks to this programme, infant and child mortality reached a low level at the end of the 1980s. In 1990, plasmodium resistance to chloroquine appeared, increasing malaria mortality. METHODS: All weight measurements taken in 1969-1994 were entered into a database. This paper presents an analysis of weight measurements taken at 3-23 months of age from 1969-1992. A total of 4,636 infants were weighed at least once, but only 3,912 infants (1,983 boys and 1,929 girls) were available for the analysis, 724 being excluded due to missing data. RESULTS: The average coverage of the programme during the month of February was 88% for infants aged 3-23 months. Mean weight was examined at three target ages: 5, 11 and 15 months. Not only did the nutritional status not improve between 1969 and 1989, it even deteriorated in some years for all three age-cohorts. The nutritional status of infants in this community did not differ significantly from that of 12-23 month-old Senegalese children in the 1992-1993 Demographic and Health Survey (DHS). Seasonal differences in mean weight and the prevalence of underweight became significant in the rainy season since 1975. Underweight for the 15-month-old children increased over time during the rainy season. These findings were unexpected, since malaria morbidity is thought to be at least partially responsible for seasonal variations in the nutritional status of young children, and despite the fact that the nurses began a malaria control programme in 1975. CONCLUSION: The rapid transition towards lower childhood mortality observed in this rural area of Casamance (Senegal), was not concomitant with any improvement in infants' nutritional status from 1969 through 1992. Focused public health interventions such as vaccinations and malaria prevention probably did not improve the nutritional status. Paradoxically, growth monitoring may have been more helpful in improving health than growth. Targeted specific nutritional interventions are needed to significantly improve growth of children in this community.

Antimalarials↗
PubMed1995

Maternal knowledge, attitudes, and practices as predictors of diarrboeal disease in Saudi children < 3 years of age.

Diarrhoeal disease continues to be a leading cause of morbidity and mortality in many developing countries. This study demonstrates the importance of behavioral risk factors as determinants of diarrhoeal disease. The study design used is incidence-base, case-control design. The cases were obtained from Primary Health Care Centers (PHCC) in Makkah area, Saudi Arabia, during October 1994 to January 1995. The studied sample consisted of 319 cases and 312 controls < 3 years of age. The results showed that mothers of cases were significant inferior knowledge about aetiology and transmission of diarrhoeal disease than did mothers of controls. Poor hygiene was significantly high in households of cases for two items; disposal of faeces in latrine and presence of toilet papers (p < 0.05). Assuming causal association between the risk factors and diarrhoeal disease, up to 60% of diarrhoeal disease in the study population may be attributable to the studied behavioral factors.

Adult↗
PubMed1991

Transmission factors and socioeconomic status as determinants of diarrhoeal incidence in Lima, Peru.

As part of a longitudinal, community-based study of diarrhoeal morbidity in a peri-urban community in Lima, Peru, a household survey was administered to ascertain possible risk factors, based on transmission routes, for diarrhoeal incidence. Socioeconomic information was also obtained in the survey and a composite socioeconomic status (SES) indicator was created based on four variables: income (wealth), ownership of 4 functioning electrical household appliances, community participation, and house construction. Both transmission factors and the SES indicator were analysed for their effects on diarrhoeal incidence using both bivariate and multivariate methods. The SES indicator, method of water storage, if the child was seen eating faeces or soil were all significantly associated with diarrhoeal incidence. In a final logistic model, water storage, location of defecation for children, child eating soil or faeces, and age, demonstrated significant results. Children in households with water stored in containers without a faucet were twice as likely to have a high incidence of diarrhoea (greater than 7 episodes/child/year). The SES indicator was not significant in the logistic model, but high SES was associated with whether or not the child was reported as having been seen eating faeces or soil and with non-use of latrines by adults. Also low SES households were more likely to have better water storage methods. Therefore, it would seem that (SES) does not independently determine diarrhoeal incidence, but rather may be functioning through these transmission factors to affect diarrhoeal incidence.

Child, Preschool↗
PubMed1991

Community control of schistosomiasis in Zimbabwe.

The community-based primary health care approach to control schistosomiasis morbidity is the strategy adopted in Zimbabwe. The paper outlines the results of such a control strategy in a rural community with over 30,000 people in the Madziwa area of Zimbabwe from 1985 to 1989. The community-based control strategy involved diagnosis of infection in school children (seven-15 years of age) using reagent strips followed by treatment with praziquantel. The treatment was linked to programmes aimed at improved sanitation, better water supplies and health education. Following chemotherapy, there was a marked reduction in schistosomiasis prevalence (urinary and intestinal forms combined) (from 60 to 20pc) in the affected groups. Of even greater importance was the significant reduction of 90pc in heavy infections (greater than 50 S. haematobium eggs per 10 ml of urine of greater than 100 S. mansoni eggs per gram of faeces). Progress made through chemotherapy was consolidated by the implementation of intervention measures aimed at reducing human water contact with cercariae infested water. In the last three years of the community-based programme, 2,152 improved ventilated pit latrines were constructed and 104 hand pumps installed at new or existing water points. Drama competitions at schools showed great potential in communicating health education messages. However, technical and organisational difficulties limited the impact of the health education to the general population. A single application of the synthetic molluscicide Bayluscide was carried out in the main streams at the beginning of the programme in support of the initial chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Influence of water current on the distribution of Opisthorchis viverrini infection in northeastern villages of Thailand.

The prevalences of Opisthorchis viverrini infection in the villages on the banks of rivers and those far from the rivers were studied in Loei and Nong Khai Provinces in Thailand. Most of the people examined in the present study were agriculturalists. The overall prevalence of O. viverrini infection was 41.3%. The prevalence of infection in males and in females in the villages far from the rivers were 52.6% and 51.7%, respectively, while the percent of people in the villages on the banks with infection were 27.9% and 21.7%, respectively. Prevalence of infection among the people residing far from the rivers was higher than those residing on the banks. This was observed despite the higher recording of raw fish consumption in villages on the banks. Infection level increased sharply in the age-group 6-10 years old among people residing far from the rivers. High prevalences of infection were observed in age groups from 11 to 50 years. Both types of villages had a similar proportion of houses with sanitary latrines.

Age Factors↗
PubMed1991

Knowledge and practice of mothers/care-takers towards diarrhoea and its treatment in rural communities in Ethiopia.

Diarrhoeal diseases are major causes of childhood morbidity and mortality in developing countries. Knowledge and practices of mothers or other care-takers of children are important determinants of the occurrence or outcome of diarrhoeal diseases. Base-line information on these variables is also needed for developing health education programmes and for formulating national policy on home fluid therapy. This study was conducted with the objectives of assessing the knowledge and practice of mothers and other caretakers of children towards diarrhoeal diseases and the sociodemographic correlates of adequate knowledge and practice. A study was conducted in the rural North, South, East and West Shewa Administrative Regions in April, 1990. A two-stage cluster sampling proportionate to size was used to select a total of 750 mothers or other caretakers. These were interviewed by trained and supervised health workers who used a pretested questionnaire. The three major ethnic groups were Oromo, Guragie and Hadya. Of the total respondents, 79.3% were illiterate, 78.5% got their water from unprotected sources, 88.9% had no latrines, 80.4% had no access to mass media and 7.1% spent more than 2 hours to reach to the nearest health facilities. Only 2.6% and 5.7% of mothers had adequate knowledge and practice on diarrhoea or its treatment, respectively. Age and educational level of mothers or other caretakers were found to be positively associated with adequate knowledge and practice towards diarrhoea and its treatment. The study clearly indicated that health education messages have not been effectively disseminated to the rural population. It is, therefore, strongly recommended that the Diarrhoeal Diseases Control Programme strengthens its communication activities through increasing persuasion of health workers who could serve as effective means of reaching the population who have access to health services.

Adult↗
PubMed1990

Transitional society, health status and international migration of Muslim villagers in the lower part of southern Thailand.

A survey was carried out in a Malay-speaking Muslim community in southern Thailand to obtain baseline data for planning of long term multidisciplinary research and development. By using a 30-cluster sampling technique, 210 households of 1,308 subjects were studied in the post-Ramadan period. It was found that the community was in a social transition. The crude birth rate was 4% and 37.6% of the households had at least one migrant. About half of these migrants had been to Malaysia and mainly worked in rubber plantations. Ninety-five per cent of the households had electricity whereas only 23.8% had a latrine. Boiled or rain water was regularly drunk in only 13.3 per cent of the households. Home-grown agricultural products were not sufficient to provide adequate food. Twenty-six per cent of the adults were unemployed and 24.6% were illiterate. Of the pregnancies 26.7% had no antenatal care and complete tetanus toxoid was given to only 27.8%. Traditional birth attendants conducted 81.1% of the deliveries and only 28.9 and 24.4% of the umbilical cords were correctly cut and correctly dressed, respectively. Breast feeding was still a common (87.8%) practice. However, complete immunization was given to only 10.8%, and 37.8% of the infants had at least one diarrheal episode in the previous month. It was concluded that high birth rate, high migration, low education, low income and bad health of infants are major problems. These problems were interlinked and needed a special multidisciplinary approach. In addition to common obstacles for routine health delivery, migration may create international complications, particularly related to maternal and child care.

Adolescent↗
PubMed1990

Household faecal contamination and diarrhoea risk.

We conducted a study in a low-ranking socioeconomic community in Yangon, Myanmar (Burma) to determine the source of household faecal contamination (HFC), devise an index, and associate this index with diarrhoeal incidence in children. Observation was used to collect information on the sources of household faecal contamination (HFC) and a twice-weekly monitoring scheme was employed for determining diarrhoea incidence. A valid household faecal contamination index (HFCI) was developed using three sources of HFC: going about without footwear, indiscriminate defaecation near or under the house, and absence of latrine. The risk of diarrhoea significantly increased from 4.21 to 8.66 per 1000 child-days (P less than 0.001) when HFCI increased from 0 to 3. Although the adjusted rate ratios for the three levels of HFCI were approximately equal to 2.00 (2.16, 1.77, 2.14), they were not statistically significant. Further studies are needed to corroborate the results of what seems to be the first study attempting to associate HFC with diarrhoea incidence.

Cohort Studies↗
PubMed1990

Transmission of diarrhoea in two crowded areas with different sanitary facilities in Dhaka, Bangladesh.

To determine the importance of water-borne and water-washed transmission of diarrhoea we compared the degree of contamination of children's hands and drinking water with their diarrhoeal morbidity. Diarrhoeal incidence in 137 children aged 1-6 years was obtained through fortnightly home visits during the calendar year 1985. Bacterial contamination of hands and drinking water was assessed semi-quantitatively by direct contact using agar-coated slides incorporating a selective medium permitting growth of Enterobacteriaceae (Hygicult, Orion Diagnostica, Finland). Results were expressed as 2-day mean log of colony forming units per gram (cfu/g). Children were studied in two densely populated urban areas: 56 children in one area with latrines and tubewells and 81 children in the other without such facilities. Mean diarrhoea attack rates were lower in the better sanitary area (2.5 vs 3.2, P less than 0.05) as were mean log levels of water contamination (3.1 cfu/g vs 4.3 cfu/g, P less than 0.001). There was no significant correlation between water contamination and diarrhoeal incidence on an individual basis. However, in both areas diarrhoea incidence was significantly correlated with the degree of contamination of hands. After adjusting for age the risk of diarrhoea increased significantly for children with more contaminated hands in the unimproved area. This relationship strongly supports the promotion of handwashing as a method of controlling diarrhoeal diseases and, by implication, the greater importance of water quantity compared to quality.

Bangladesh↗
PubMed1989

A programme to control taeniasis-cysticercosis (T. solium): experiences in a Mexican village.

A study was carried out in a rural community of the state of Guerrero in order to find ways to control human taeniasis/cysticercosis (Taenia solium). At the beginning of the study the frequency of porcine cysticercosis was established to be around 6.6%. Fecal examination in the human population showed that of 760 persons, 24 were carriers of Taenia sp (3%). Of 440 human sera tested for antibodies against cysticercus cellulosae, 9 showed absorbance values of 0.2 or higher (2.3%). 900 persons received treatment against taeniasis. 400 soil samples and 600 flies were examined for the presence of eggs of Taenioae, all with negative results. Meetings with the adult population were organized to explain the disease and the life cycle of the parasite. Lectures and demonstrations for adults were given at the school for primary and secondary grade children. Special emphasis was given to the need to construct latrines in every home, as it was found that defaecation was practiced mainly in the open, usually at places where pigs had immediate access and ingested the faeces. One year after the initiation of the programme, pigs under the age of 1 year were inspected, to determine whether the cestocide treatment of humans has had an effect on the degree of parasitized pigs and if hygiene had improved. 11% of these animals were found to have cysticerci in their tongue. Two years after the initiation of the programme 78% of the children and 2% of adults answered questions about the lifecycle of the parasite correctly. The results of the trial are discussed and suggestions for future programmes are made.

Adult↗
PubMedDate not supplied

The effect of misclassification of diarrhoea on estimates of its occurrence, the identification of risk factors, and the assessment of prevention efforts.

Inaccurate assessment of true diarrhoea status introduces bias into estimates of its occurrence. A cross-sectional study of diarrhoea among 357 children in a rural Kenyan community found the sensitivity and specificity of the mother's report of diarrhoea to be 0.79 and 0.94 respectively, when compared to an independent observation of loose stool consistency. The observed diarrhoea prevalence of 9.5% overestimated the "true" prevalence estimated at 4.8%. With data on an exposure variable, lack of latrine ownership, an observed odds ratio of 2.0 (95% confidence interval (CI) 0.9-4.3) underestimated the "true" odds ratio of 5.4 (95% CI 2.0-14.5). Misclassification of diarrhoea can hinder the identification of communities of high incidence, the determination of risk factors for diarrhoea, and the evaluation of preventive intervention strategies. A precise definition and reliable means of measuring diarrhoea are critical for evaluating prevention or intervention efforts.

Child↗
PubMedDate not supplied

Carriage of enteric bacterial pathogens by house flies in Yangon, Myanmar.

The carriage of enteric bacterial pathogens by house flies, caught from different places of human habitation and at different seasons, was quantitatively determined in the town of Tamwe, Yangon, Myanmar. A total of 186 fly-pools, each containing 10 live flies, were caught in entomological cages by random sampling regarding season, month, frequency and place of collection. A 10% suspension of each homogenised fly-pool in sterile normal saline was prepared on the day of collection and was cultured to isolate pathogens using standard microbiological methods. Escherichia coli, Vibrio cholerae non-O1, and species of Salmonella and Shigella were isolated from 76.3%, 45.7%, 11.8% and 4.8% respectively from all the fly-pools. Enteric bacterial pathogens were isolated more frequently in flies from refuse dumps and animal pens and least commonly in flies from kitchens. Of the E. coli isolates, one pool each from flies trapped in animal pens (n = 30 fly-pools), latrines (n = 32) and refuse dumps (n = 34) produced enterotoxins (ETEC). These ETEC isolates were obtained in the months of June and July. The rates of isolation of pathogens were highest in the hot-wet season. The faecal coliform counts in the fly-pools also increased in this season compared with those in cool-dry and hot-dry seasons. These data suggest that flies may be an important carrier of enteric infections in Myanmar.

Animals↗
PubMed1989

Hookworm and roundworm infections in farm-worker communities in the large-scale agricultural sector in Zimbabwe.

Surveys were carried out to assess the prevalences and intensities of hookworm and roundworm infections in 15 farm-worker communities in Zimbabwe with poor living conditions. Examination of 1635 faecal samples showed that hookworms (Necator americanus and Ancylostoma duodenale) were the commonest helminths (61.7% of infections). They were followed by Ascaris lumbricoides and Trichuris trichiura at less than 3%. There were striking differences in prevalences and intensities of infection of the different helminthic parasites among the 15 communities surveyed. In general, differences between males and females were not statistically significant. Age-prevalence and age-intensity profiles for hookworms showed that infection increased with age, with a peak in the adult age groups. A. lumbricoides prevalence was relatively high in children but declined to a very low plateau in adults. There were no significant relationships between number of households per latrine at each community and the prevalence and intensity of infection by hookworms and prevalence of roundworms. The relevance of the above findings is discussed in relation to the control of morbidity and transmission of the helminths.

Adolescent↗
PubMed1986

Schistosomiasis in a mining area: intersectoral implications.

The high prevalence (greater than 90%) and intensity of infection (50% of those infected excreted greater than 600 eggs per gram of faeces) of schistosomiasis in a tin mining area in eastern Zaire is related to extensive man-made ecological changes and intensive man/water contact. Construction of latrines, water supply and availability of diagnosis and treatment through occupational health services have been used in control efforts. The integration of environmental measures is limited by their high costs. The control of schistosomiasis in this area of intense transmission would require repetitive chemotherapy and other measures which are beyond available resources.

Adolescent↗
PubMed1986

Circumstantial epidemiology of Schistosoma mansoni in the West-Nile district of Uganda: results of a cross-sectional study in the Rhino Camp area.

A cross-sectional survey of Schistosoma mansoni was undertaken at the Rhino Camp of the West-Nile district of Uganda to establish baseline data for subsequent studies intended to compare this area (a low transmission area) with Pakwach area (high transmission). An overall prevalence of 37% of S. mansoni infection was demonstrated. There was no statistically significant difference in prevalence between males and females. Six per cent of all cases were heavily infected (400 eggs g-1 of faeces). There was no statistically significant difference in prevalence between those with pit-latrines and those with no conventional method of excreta disposal.

Adolescent↗