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PubMed2003

Epidemiological perspective of domestic and personal hygiene in India.

When the application of epidemiology moves from mass phenomenon in a society or community to the specific family or individual level occurrences, new vistas unfold. The classical epidemiological triad, with its multi-mode influences and interactions, becomes modified as a result of several lifestyle factors coming into operation. It is well known that even under severely adverse climatic conditions, microbes are able to survive, and even propagate, if an appropriate micro-climate is encountered. This principle also applies to human beings. Many incidences of disease or ailments, occurrence or absence, can be traced to the home habitat, micro-ecosystem, human behaviour and lifestyles. Hygienic practices are largely a matter of behaviour and usually have biological and social origin. Human behaviour is influenced and determined by social traditions, customs and culture. Furthermore, factors such as health consciousness, practical knowledge of health sciences, motivation and concern for taking steps for promoting health and preventing disease, can change behaviour and make the lifestyle conducive to health. In a village or slum area, families live in more-or-less the same environment. However, in the event of an outbreak of a communicable disease, many escape the attack. While some experience frequent episodes of illness, others continue to live fairly healthily. Obviously, several social and cultural factors and associated human behaviours seem to make the difference between health and disease. This discussion examines the domestic and personal hygiene in its epidemiological perspective.

Communicable Disease Control↗
PubMed2003

Handwashing practices and challenges in Bangladesh.

Handwashing is universally promoted in health interventions. Studies in Bangladesh and elsewhere have shown a 14 - 40% reduction of diarrhoeal diseases with handwashing. The perceptions and methods related to washing of hands vary widely in Bangladesh. Socio-economic factors are also associated with methods practised. In general, the effectiveness of handwashing practices is poor. Faecal coliform bacteriological counts were reported to be high for both left and right hands. About 85% of women studied who lived in slums and 41% of rural women washed their hands using only water. However, most women rubbed their hands on the ground, or used soil, and rinsed them with water during post-defecation handwashing. Most women claimed that they could not afford to buy soap. Experimental trials showed that use of soap, ash or soil gave similar results when women washed their hands under the same conditions. The washing of both hands, rubbing of hands, and the amount and quality of rinsing water used were found to be important determinants in the reduction of bacterial counts on hands. Although handwashing messages have been revised by most of the main programmes after these studies, there is scope for further improvement, as well as evaluation of their impact.

Adult↗
PubMed2004

Physical intimate partner violence in Chile, Egypt, India and the Philippines.

BACKGROUND: Violence against women is recognized by globally as a serious health and social problem that impedes development. OBJECTIVES: To determine the magnitude of physical intimate partner violence against women in six selected communities from Chile, Egypt, India and the Philippines. DESIGN: Population-based household surveys. SETTINGS: Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum, and Vellore non-slum areas of India; and in Manila, the Philippines. PARTICIPANTS: Women aged 15-49 years who cared for at least one child younger than 18 years old. The number of participants per community was 442 (Santa Rosa, Chile), 631 (El-Sheik Zayed, Egypt), 506 (Lucknow, India), 700 (Trivandrum, India), 716 (Vellore, India) and 1000 (Paco, the Philippines). MAIN OUTCOME MEASURES: Lifetime and Current physical intimate partner violence (IPV) was measured using standard definitions and four behaviors of actions--namely slap, hit, kick and beat. Three derived variables for severity included: disabling IPV, IPV-related injury requiring health care and multiple severe IPV (presence of hit and kick and beat). RESULTS: Percentages of lifetime and current physical intimate partner violence (IPV) against women in our sample of 3975 were as follows: 24.9 and 3.6 (Santa Rosa), 11.1 and 10.5 (El-Sheik Zayed), 34.6 and 25.3 (Lucknow), 43.1 and 19.6 (Trivandrum) 31.0 and 16.2 (Vellore), and 21.2 and 6.2 (Paco). Multiple severe physical IPV was more common in the three communities within India (9.0%, 5.9% and 8.0% in Trivandrum, Lucknow and Vellore) than the other three communities (Santa Rosa 2.1%; El-Sheik Zayed 2.9% and Paco 1.9%). CONCLUSIONS: Physical IPV was found to be a common phenomenon in all six communities. Overall, patterns of IPV behaviors were similar among the six communities.

Adolescent↗
PubMed1999

Longitudinal study of Cryptosporidium infection in children in northeastern Brazil.

A prospective, 4-year cohort study of children born in an urban slum in northeastern Brazil was undertaken to elucidate the epidemiology of Cryptosporidium infection in an endemic setting, describe factors associated with Cryptosporidium-associated persistent diarrhea, and clarify the importance of copathogens in symptomatic cryptosporidiosis. A total of 1476 episodes of diarrhea, accounting for 7581 days of illness (5.25 episodes/child-year), were recorded: of these, 102 episodes (6.9%) were persistent. Cryptosporidium oocysts were identified in 7.4% of all stools, and they were found more frequently in children with persistent diarrhea (16.5%) than in those with acute (8.4%) or no (4.0%) diarrhea (P<.001). Low-birth-weight children and those living in densely crowded subdivisions were at greater risk for symptomatic infection. Disease course was highly variable and was not associated with the presence of copathogens. Recurrent Cryptosporidium infection and relapsing diarrhea associated with it were moderately common. In light of these data, the applicability of the current World Health Organization diarrheal definitions to Cryptosporidium-associated diarrheal episodes may need to be reconsidered.

Analysis of Variance↗
PubMed2002

Assessment of the Binax NOW Streptococcus pneumoniae urinary antigen test in children with nasopharyngeal pneumococcal carriage.

We evaluated the Binax NOW Streptococcus pneumoniae urinary antigen assay by testing 210 healthy children aged 2--60 months living in urban slums of Quito, Ecuador. Healthy children with nasopharyngeal carriage of S. pneumoniae were significantly more likely to have positive urinary antigen test results than were children who were not carriers (30 of 138 vs. 3 of 71 children; chi2=10.8; P<.001). The rate of nasopharyngeal carriage of S. pneumoniae decreased with increasing age; the lowest rates were found in children with the worst nutritional status.

Antigens, Bacterial↗
PubMed2002

Association between Helicobacter pylori infection and increased risk of typhoid fever.

Helicobacter pylori infection has been reported to increase the risk of cholera. This nested case-control study was conducted to determine whether H. pylori infection is associated with occurrence of typhoid fever. Eighty-three case subjects of culture-proven typhoid fever were identified through a 1-year surveillance of subjects aged 0-40 years in an urban slum. Two age- and sex-matched neighborhood control subjects were concurrently selected for each case subject. Serum anti-H. pylori immunoglobulin G antibodies were measured in case and neighborhood control subjects. For determining other risk factors, 2 additional community control subjects per case were selected. There was a significant association between the presence of serum anti-H. pylori immunoglobulin G antibodies and typhoid fever (adjusted odds ratio, 2.03; 95% confidence interval, 1.02-4.01). Illiteracy, being part of a nuclear family, nonuse of soap, and consumption of ice cream were also associated with a significantly greater risk of typhoid fever. This study provides the first empiric evidence that H. pylori infection is associated with an increased risk of typhoid fever.

Adolescent↗
PubMed2003

Association of hepatitis C virus infection with sexual exposure in southern India.

To determine the association between sexual exposure and hepatitis C virus (HCV) infection in urban Chennai, India, a random sample of adults who live in a slum community completed interviews and provided samples to test for HCV, herpes simplex virus type 2 (HSV-2), and other sexually transmitted infections (STIs). All analyses excluded recent and current injection drug users. HCV infection was not associated with the reported number of sex partners for men or women. Women were more likely to be HCV infected if they reported previous genital ulcer disease (adjusted odds ratio [AOR], 3.88; 95% confidence interval [95% CI], 0.94-16.0; marginally statistically significant). Men were more likely to be HCV infected if they were HSV-2 infected (AOR, 3.85; 95% CI, 1.18-12.6) or reported having had sex with men (AOR, 3.61; 95% CI, 1.00-13.1). Sexual transmission of HCV infection may be facilitated by ulcerative STIs and male-male sexual practices, but it appears to occur infrequently in this population.

Adult↗
PubMed2005

Incidence of severe rotavirus diarrhea in New Delhi, India, and G and P types of the infecting rotavirus strains.

A total of 62,475 children <5 years old from a defined population of approximately 500,000 children and adults from slums in New Delhi, India, were assessed for 1 year by means of passive surveillance, to identify children who were hospitalized for diarrhea. The incidence of severe rotavirus diarrhea was estimated, and the G and P types of the infecting rotavirus strains were determined and were correlated with the clinical severity of diarrhea. Of 584 children who were hospitalized with diarrhea, 137 (23.5%) had rotavirus detected in stool specimens (incidence of rotavirus diarrhea-associated hospitalizations, 337 hospitalizations/100,000 children <5 years of age). Most cases of diarrhea (98%) occurred during the first 2 years of life, peaking at 9-11 months of age. Rotavirus-associated diarrhea occurred year-round but was predominant in winter. Among the strains that could be G-typed, G1 was the most common serotype, followed by G9 and G2; 10% of cases of diarrhea were due to mixed G-type infections. Common strains identified in the present surveillance study were P[8]G1, P[4]G2, P[8]G9, P[6]G1, P[6]G9, and P[6]G3. Children infected with G1 strains had a greater risk of developing more-severe cases of diarrhea than did children infected with other rotavirus strains (odds ratio, 2.95; 95% confidence interval, 1.3-6.67).

Adult↗
PubMed1998

Enteroaggregative Escherichia coli produce intestinal inflammation and growth impairment and cause interleukin-8 release from intestinal epithelial cells.

Enteroaggregative E. coli (EAggEC) are emerging as an important cause of persistent diarrhea, especially in children in the developing world, yet the pathogenesis of EAggEC infection is poorly understood. In an ongoing prospective study of childhood diarrhea in an urban Brazilian slum, EAggEC are the leading cause of persistent diarrhea. Children from this study with EAggEC and persistent diarrhea had significant elevations in fecal lactoferrin, interleukin (IL)-8, and IL-1beta. Moreover, children with EAggEC without diarrhea had elevated fecal lactoferrin and IL-1beta concentrations. The children with EAggEC in their stool had significant growth impairment after their positive culture, regardless of the presence or absence of diarrhea. Finally, 2 EAggEC strains were shown to cause IL-8 release from Caco-2 cells, apparently via a novel heat-stable, high-molecular-weight protein. These findings suggest that EAggEC may contribute to childhood malnutrition, trigger intestinal inflammation in vivo, and induce IL-8 secretion in vitro.

Brazil↗
PubMed1994

The meaning of activities of daily living in a Thai elderly population: development of a new index.

Activities of daily living (ADL) of 703 Thai elderly people (aged 60+ years) living in a Bangkok slum community were studied with the aims of describing the prevalence of disability, considering the appropriateness of Western ADL scales and developing a new ADL index for Asian populations. The levels of disability found were higher than in industrial populations and the important areas of disability were in instrumental ADLs. The mean (SD) Barthel ADL Index (BAI) for the group was 19.5 (1.2) with a range of 10-20. The mean (SD) Office of Populations Censuses and Surveys (OPCS) disability score was 4.8 (1.9) with a range of 0-10 but was unsuitable for use in Thailand because of misinterpretation of behavioural and intellectual disability leading to 99% of subjects being scored as disabled. An analysis of the underlying dimensions making up ADL was conducted using factor analysis. Four dimensions of ADL were found: basic self-care ADLs, extended ADLs, mobility ADLs and continence. An extended ADL index suitable for use in developing countries was developed (the Chula ADL Index) which had strong hierarchical properties and high correlations with both the OPCS disability score and the Barthel ADL Index. Analysis of data derived from ADL instruments should consider each ADL dimension separately. The BAI is useful as an index of self-care ADL but the behaviour and intellectual disability sub-scales of the OPCS scale require further development for cross-cultural applications.

Activities of Daily Living↗
PubMed1981

Anthropometric and cycloergometric assessment of the nutritional status of the children of agricultural migrant workers in Southern Brazil.

In our survey of the food habits and nutritional status of "Boia-Fria" agricultural migrant workers in Southern Brazil, a special project was undertaken to assess the influence of socioeconomic and dietary deprivation on the physical growth and development and physical performance of their children. Four hundred fifty-five children in Boia-Fria families from Vila Recreio, a periurban slum of Ribeirao Preto located in the interior of the state of Sao Paulo, were examined for body weight, standing height, mid-upper arm muscle circumference, and head circumference. For comparison, 475 children from "Vita et Pax", a private school attended primarily by children of well-to-do families from the city of Ribeirao Preto, were also examined using similar anthropometric procedures. A small group of selected Boia-Fria children and their well-to-do counterparts were subjected to ergometric-cum-electrocardiographic testing for submaximal physical work performance. The overall results of this comparative study indicate that the physical growth and development and the physical performance of the Boia-Fria children are significantly lower than their well-to-do counterparts. It is suggested that the poor anthropometric and ergometric status of the Boia-Fria children is a reflection of poor dietary habits and socioeconomic deprivation prevalent among the agricultural migrant workers and poor periurban populations of Brazil.

Adolescent↗
PubMed1986

Relationship between measles, malnutrition, and blindness: a prospective study in Indian children.

A prospective study was conducted in slum children to determine the incidence of post-measles corneal disease and to clarify its relationship with nutritional status. A total of 318 cases of measles were identified over a period of 15 mo; maximum incidence was observed for children between 1-2 yr. Most of the children showed weight loss and serum proteins decrease during the acute stage of measles. Corneal lesions were observed in 3% of the children, and the lesions responded well to treatment. Serum vitamin A and RBP levels were significantly depressed during the acute stage of measles but were restored to normal 8 wk after recovery. There were no significant differences in the serum levels for those with and without eye lesions, which suggests that these lesions may not be mediated simply through the effect of infection on serum concentration of vitamin A.

Blindness↗
PubMed1987

Impact of massive doses of vitamin A on nutritional blindness in Bangladesh.

Impact of 6-monthly massive dosings of preschool-age children with oral vitamin A (VAC: 200,000 IU of oil soluble retinyl palmitate with 40 IU vitamin E) was evaluated in Bangladesh. In 100 sites, 11,889 households were visited and eyes of 22,335 children aged 3-71 mo were examined. About half the rural target population and less than 20% urban slum population were being reached. Risk of night blindness was halved for children reportedly given VAC, although 2.5% of the reportedly protected population were still night blind. There was no significant reduction in prevalence of Bitot's spot. Risk of corneal ulcers or keratomalacia (X3A/B) was 2.7 times higher in children not given VAC. Based on reported coverage, efficacy of protection against potentially blinding corneal lesions was 63%. For maximum impact on eye lesions, massive dosing with vitamin A at ideally less than 6-monthly intervals needs to be combined with other nutrition and health interventions.

Bangladesh↗
PubMed1991

Serum vitamin A distribution curve for children aged 2-6 y known to have adequate vitamin A status: a reference population.

Serum vitamin A was determined before and 30-45 d after the administration of 60.6 mg (212 mumol) vitamin A to 544 Brazilian children residing in slum areas of Recife. The frequency-distribution curves were compared in a subgroup of children whose vitamin A status was assessed initially by the relative-dose-response (RDR) test. The curves of children with negative (adequate status) and positive (inadequate status) RDR tests were different. The difference disappeared after supplementation. The shape of the distribution curve after supplementation was close to normal with a mean, median, and 95% confidence interval of 1.78 +/- 0.49, 1.68, and 1.02-2.90 mumol/L, respectively. The postsupplementation curve derived from this underprivileged child population may serve as a reference for diagnostic, surveillance, and program-evaluation purposes.

Brazil↗
PubMed1998

Growth, morbidity, and mortality of children in Dhaka after treatment for severe malnutrition: a prospective study.

Over 1300 severely malnourished children (< 60% of US National Center for Health Statistics weight-for-height, with edema, or both) are admitted each year to the Children's Nutrition Unit in Dhaka. Fatality during treatment is low and recovery is rapid. Our aim was to determine whether this initial success is sustained when children return home. A previous attempt to address this question was frustrated by the difficulty in tracing children after discharge because most are from slum settlements and families move frequently. This prospective study with fortnightly monitoring was therefore undertaken. The main outcomes of interest were anthropometric status, relapse, morbidity, and mortality. Children (n = 437) who had been treated for severe malnutrition when aged 12-59 mo and had reached the discharge criterion of 80% of weight-for-height, were followed for the next 12 mo. During follow-up, 7.5% were lost without trace, 0.6% relapsed, and 2.3% died. Morbidity was high, with a mean of seven episodes of diarrhea during the year. Outpatient visits for diarrhea occurred for 67% of children, and 58% had pneumonia (10% had pneumonia three times). After 12 mo, mean weight-for-height was 91% (-0.92 z score) but mean height-for-age remained at 84% (-4.14 z score). Weight gain, but not height gain, tended to be lower in children who experienced more diarrhea. Fever and cough were not associated with either weight or height gain. The high prevalence of illness highlights the need for continued accessible health care and for interventions to reduce disease acquisition.

Bangladesh↗
PubMed2000

A randomized, placebo-controlled trial of the effect of zinc supplementation during pregnancy on pregnancy outcome in Bangladeshi urban poor.

BACKGROUND: Maternal zinc supplementation has been suggested as a potential intervention to reduce the incidence of low birth weight in developing countries. To date, placebo-controlled trials have all been performed in industrialized countries and the results are inconsistent. OBJECTIVE: The objective of this study was to evaluate whether zinc supplementation in Bangladeshi urban poor during the last 2 trimesters of pregnancy was associated with pregnancy outcome. DESIGN: We conducted a double-blind, placebo-controlled trial in which 559 women from Dhaka slums, stratified by parity between 12 and 16 wk of gestation, were randomly assigned to receive 30 mg elemental Zn/d (n = 269) or placebo (n = 290). Supplementation continued until delivery. Serum zinc was estimated at baseline and at 7 mo of gestation. Dietary intake was assessed at baseline and anthropometric measurements were made monthly. Weight, length, and gestational ages of 410 singleton newborns were measured within 72 h of birth. RESULTS: At 7 mo of gestation, serum zinc concentrations tended to be higher in the zinc-supplemented group than in the placebo group (15.9 +/- 4.4 compared with 15.2 +/- 4.3 micromol/L). No significant effect of treatment was observed on infant birth weight (2513 +/- 390 compared with 2554 +/- 393 g; NS) or on gestational age, infant length, or head, chest, or midupper arm circumference. The incidence and distribution of low birth weight, prematurity, and smallness for gestational age also did not differ significantly after zinc supplementation. CONCLUSIONS: Supplementation with 30 mg elemental Zn during the last 2 trimesters of pregnancy did not improve birth outcome in Bangladeshi urban poor. These results indicate that interventions with zinc supplementation alone are unlikely to reduce the incidence of low birth weight in Bangladesh.

Anthropometry↗
PubMed1976

The distribution of hepatitis B surface antigen in Africa and the tropics: report of a population study in Nigeria.

This preliminary study was designed to examine the distribution of hepatitis B surface antigen (HBsAg) in two contrasting groups in an urban area situated in the tropical forest belt. The sample from the traditional area represents a population of low socio-economic status, living in the central slum areas of the city, and the sample from the peripheral area represents a population of high socio-economic status living in clean modern estates. The prevalence rate of HBsAg by complement fixation (CF) was 12-6 per cent in both areas. There was no statistically significant difference between the two groups with respect to prevalence of the antigen. When both groups were combined, no significant relationship was found between the presence of the antigen and sex, age, marital status, level of education, occupation, income, and a presumed exposure to the antigen from injections, dental treatment, blood tests, surgical operations, blood donations, tribal, (medicinal), tattoo and cosmetic marking, insanitary disposal of faeces, doubtful sources of water supply, and exposure to mosquitoes. No association with genotype was found.

Adolescent↗
PubMed2006

Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care.

BACKGROUND: Monitoring for disparities in health and services received based upon gender, income, and geography should continue as renewed efforts to reduce under-five mortality are made in response to millennium development goal #4. The purpose of this survey was to provide a nationally representative description of current childhood diarrhoea management practices and disparities in Bangladesh. METHODS: A nationally representative, cross-sectional, cluster-sample survey was carried out in randomly selected rural and urban populations across Bangladesh. The survey was completed over an 8 month period between November 2003 and June 2004. RESULTS: A total of 7308 children with a prevalent diarrhoeal illness episode within 560 clusters were identified and enrolled in the survey. In 61% of the cases help was sought from a health care provider, with over 90% practicing in the private sector. Caretaker practice disparities favouring males and higher income households were identified. Significant trends (P < 0.001) favouring higher income households were found for having sought help from any provider or a licensed doctor and for treating their child with oral rehydration solution or an antibiotic. Female children in urban households were less likely to be seen by a licensed allopath, adj OR 0.73 (95% CI 0.57, 0.94). Among rural households gender disparities were limited to females being less likely to receive an antibiotic, adj OR 0.74 (95% CI 0.65, 0.86). CONCLUSION: Households seeking help from a health provider overwhelmingly utilize the private sector in Bangladesh. Gender inequities in the utilization of licensed providers and purchase of antibiotics, favouring males were identified. Findings suggest that higher income, urban households tend to practice greater gender discrimination. In order to better understand health dynamics in urban populations, in particular slum-dwellers, there is a need to disaggregate survey data by household location.

Anti-Infective Agents↗