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Entomological studies of on-site sanitation systems in Botswana and Tanzania.

A survey of various types of on-site sanitation systems in Dar es Salaam and Gaborone showed that many were infested with larvae of flies (mainly Chrysomya putoria) and Culex mosquitoes (mainly Cx quinquefasciatus). The mosquitoes only occurred where the pit contents had a free water surface but the flies were found in both wet and scum covered pits. The infestation rate was much higher where the latrine vent pipe had no insect-proof screen. Exit traps were placed on the vent pipes and drop holes to determine by which route the emerging flies and mosquitoes left the pit. Provided that the latrine door was kept closed (thus producing a relatively greater light intensity in the vent pipe), over 90% of flies went up the vent pipe. In most cases about 80% of Cx quinquefasciatus did the same, but in two pits very dense mosquito infestations were found and over 1000 mosquitoes per night were caught leaving the pit through the drop hole. In such cases traps on the drop holes might be used as a semi-permanent control method. Entry traps were placed on the vent pipe and drop hole to catch females attempting to enter to lay eggs. All the flies and the majority of the mosquitoes caught were trying to enter the vent pipe which indicates that odour from this source is attractive to these insects. Various possible modifications to the methods of using latrines to minimize associated insect problems are discussed; the simplest and most important is to ensure that all vent pipes are effectively screened.

Animals↗

Demonstration of anaerobic stabilization of black water in accumulation systems under tropical conditions.

The anaerobic digestion of "human waste" was studied at Mlalakuwa residential settlement in Dar-es-Salaam, Tanzania at ambient tropical temperatures (24-31 degrees C). This settlement experiences a high water table with flooding during the rainy season, resulting in a very costly emptying of the latrines once per month. To improve the situation, two plastic tanks (while one is in use, the other one is on stand-by) of 3000 l capacity each, named as Improved Pit-Latrines Without Urine Separation (IMPLWUS), were used as latrine pits. They received faeces+urine+wash water; basically, an accumulation system. Septic tank seed sludge was used. The dissolved chemical oxygen demand (COD(dis)) remaining when the reactor was closed after 380 days was about 8 g COD/l, volatile fatty acids were 100 mg COD/l and total ammonium nitrogen was about 2.8 g N/l, implying the possibility of methanogenesis inhibition. Stability results indicated a need for more degradation time after reactor closure. Estimated biogas production from wastewater generated by 10 people was 544 g COD-CH(4)/day, not enough for cooking purposes.

Ammonia↗

Risk factors for the prevalence of porcine cysticercosis in Mbulu District, Tanzania.

To estimate prevalence of and risk factors for the prevalence of porcine cysticercosis in Mbulu District, Tanzania, 770 live pigs were examined by lingual examination in 21 villages. Structured observations and questionnaire interviews were used to assess pig rearing practices and household use of latrines. Associations between factors were analyzed using a Bayesian hierarchical model to obtain prevalence odds ratio (OR) and 95% Bayesian Credible Intervals (95% BCI). Prevalence was 17.4% (village-specific range 3.2-46.7%). Prevalence of porcine cysticercosis was considerably higher in pigs reared in households lacking latrines than in those reared in households that were using latrines (OR = 2.04; 95% BCI = 1.25, 3.45). About 96% of the pigs were kept under free-range conditions. This study suggests the need for further studies in order to design and implement effective prevention and control measures for porcine cysticercosis in Mbulu District, Tanzania.

Animal Husbandry↗

Assessing nutrient flows in septic tanks by eliciting expert judgement: a promising method in the context of developing countries.

Simple models based on the physical and biochemical processes occurring in septic tanks, pit and urine diversion latrines were developed to determine the nutrient flows in these systems. Nitrogen and phosphorus separation in different output materials from these on-site sanitation installations were thus determined. Moreover, nutrient separation in septic tanks was also assessed through literature values and by eliciting expert judgement. Use of formal expert elicitation technique proved to be effective, particularly in the context of developing countries where data is often scarce but expert judgement readily available. In Vietnam, only 5-14% and 11-27% of the nitrogen and phosphorus input, respectively, are removed from septic tanks with the faecal sludge. The remaining fraction leaves the tank via the liquid effluent. Unlike septic tanks, urine diversion latrines allow to immobilize most of the nutrients either in form of stored urine or dehydrated faecal matter. These latrines thus contribute to reducing the nutrient load in the environment and lowering consumption of energy and non-renewable resources for fertiliser production.

Developing Countries↗

Predictors for the risk of hookworm infection: experience from endemic villages in southern Thailand.

To assess the role of defaecation pattern in predicting the level of risk for hookworm infection in southern Thailand, 4 villages in different geographical settings in endemic areas were studied. Close observation and stool examinations for hookworm were carried out. The first village was used for exploring the risk factors for hookworm infection. The resultant statistical model was then tested using the other 3 villages. Only 23-40% of the sample regularly defaecated in a latrine. The pattern of defaecation did not differ between the sexes, but was associated with age and site of residence. In the first village, the following variables were not statistically significant: sex, age, level of past education, household income, having neighbouring houses within 20 m, latrine availability, site of defaecation. The only statistically significant protective factor was shoe wearing, which showed an exposure-outcome severity relationship. Similar results were obtained in the other 3 villages. These results refute the protective effect of latrine use on the individual user, who may still get infection from the faeces of other community members. Promotion of shoe-wearing, which provides individual protection, should be an important supplementary strategy for hookworm control programmes in such areas.

Adolescent↗

Defecation practices of young children in a Peruvian shanty town.

Little is known about feces disposal practices, their determinants and feasibility for change, despite their importance in the control of diarrheal diseases. We report here the results of formative research for the development of an intervention to promote sanitary disposal of feces of young children. The study was conducted in a densely populated shanty town area of Lima, where water and sanitation systems are scarce. In-depth interviews were undertaken with mothers, husbands and community leaders. Group discussions were held with mothers in order to validate findings from the interviews, investigate particular topics further and explore reactions to possible intervention strategies. The principal defecation sites for young children were diapers, potties, the ground in or near the home, the hill, latrines and flush toilets. The main determinants found were the age of the child, the effort required by the method, perceptions of dirtiness and the availability of resources. Almost all children under one year of age use diapers but the high resource cost of diaper washing is a strong motivation for mothers to move their children on as early as possible. Potties were considered the most socially acceptable and 'hygienic' defecation method for children between one and three years of age. Nevertheless, defecation directly onto the ground is common at this age. Potty training is deemed to be quite difficult and the long term achievements are determined by the initial training success. In most cases, the training process is authoritative and inconsistent. The use of latrines and flush toilets is not considered appropriate for children until they are three to four years old. Based on these initial findings, a micro-trial was conducted to assess the feasibility and acceptability of promoting greater use of potties and associated practices. The results of the trial were very encouraging and provided valuable information for the design of a community-wide intervention. Our findings help explain why the emphasis given in most sanitation projects, where efforts have been concentrated on the promotion of latrines, has failed to induce their utilization by small children. Sanitation projects should incorporate interventions that will promote hygienic defecation and stool clearance practices for infants and small children.

Child↗

Porcine cysticercosis in village pigs of North-West Cameroon.

A study was carried out in two villages and one marketplace of the Batibo sub-division in North-West Cameroon to determine the prevalence of porcine cysticercosis. The results showed that 4.44% of 383 pigs were positive at tongue examination whereas ELISA detected circulating antigens in 27.7% of 271 pig sera. A questionnaire survey in 140 pig-raising households indicated that 59.3% of them lacked latrines while in 75.7% of the households members defecated directly into pigpens. The seroprevalence of porcine cysticercosis was significantly higher in households without latrines than in those with latrines. Similarly, significantly more seropositive pigs were present in households that defecated in the pig pens (35.5%) than in those that did not (14.4%). Although 91.4% of pig raising households did know of pig cysticercosis, only 28.6% were aware of the link with human taeniasis and only 10.7% were aware of human cysticercosis.

Animal Husbandry↗

A participatory approach to sanitation: experience of Bangladeshi NGOs.

This study assesses the role of participatory development programmes in improving sanitation in rural Bangladesh. Data for this study came from a health surveillance system of BRAC covering 70 villages in 10 regions of the country. In-depth interviews were conducted with one adult member of a total of 1556 randomly selected households that provided basic socioeconomic information on the households and their involvement with NGO-led development programmes in the community. The findings reveal that households involved with credit programmes were more likely to use safe latrines than others who were equally poor but not involved in such programmes. The study indicates that an unmet need to build or buy safe and hygienic latrines existed among those who did not own one. Such latent need could be raised further if health education at the grassroots level along with supervised credit supports were provided to them. Unlike conventional belief, the concept of community-managed jointly owned latrines did not seem a very attractive alternative. The study argues that social and behavioural aspects of the participatory development programmes can significantly improve environmental sanitation in a traditional community.

Bangladesh↗

Sociodemographic, hygienic and nutritional correlates of Helicobacter pylori infection of young Bangladeshi children.

BACKGROUND: By the age of 10 years most children in developing countries have been infected by Helicobacter pylori Identification of clues to modes of transmission of this organism to children, as well as evaluation of the sequelae of childhood infections, constitute important research priorities for developing countries. OBJECTIVES: To evaluate demographic, socioeconomic and hygienic factors associated with acquisition of infection by H. pylori early in childhood among Bangladeshi children ages 2 to 5 years and to assess whether infection by H. pylori was associated with poor nutritional status in these children and in an older group ages 6 to 9 years. METHODS: A random population-based survey of 257 rural Bangladeshi children ages 2 to 5 years and 312 children ages 6 to 9 years. Seropositivity for H. pylori, as manifested by the presence of serum IgG anti-H. pylori antibodies, was correlated with nutritional status of the sampled children and with sociodemographic features and access to clean water and latrine facilities among families of the children. RESULTS: Among children ages 2 to 5 years, the 123 (48%) who were infected by H. pylori were similar to the 134 noninfected children with respect to socioeconomic level, family access to tube well water and family ownership of a latrine. However, families of infected children had more persons per sleeping room in the home (3.8 vs. 3.2, P < 0.05) and were more likely to be Hindu (20% vs. 10%, P < 0.05). Infected children did not differ significantly from noninfected children in Z scores for weight-for-age (-2.66 vs. -2.78), weight-for-height (-1.17 vs. -1.28) or height-for-age (-3.58 vs. -3.56). Analysis of survey children ages 6 to 9 years also revealed similar nutritional indexes among infected vs. noninfected children. CONCLUSIONS: Household crowding and behaviors that differ between Hindus and Muslims, but not lack of access to clean water and latrines, may enhance the transmission of H. pylori to rural Bangladeshi children. Although confirming the high frequency of infections in young Bangladeshi children, our findings do not support the notion that H. pylori is responsible for the high prevalence of malnutrition in this setting.

Age Distribution↗

Questionnaire survey and prevalence of intestinal helminthic infections in Barru, Sulawesi, Indonesia.

A questionnaire survey with parasitological study was carried out on the inhabitants of 4 villages in Barru district, Sulawesi, Indonesia from 1994 to 1995. The questionnaire dealt with life style and sanitary conditions. In 482 houses in the 4 villages, interviews for the items of the questionnaire were conducted with the owner, housekeeper and children of the same family. In Pancana and Lalolang, 37.7% and 50% respectively of man inhabitants surveyed were fishermen, while in Lompo Riaja and Pattappa, 38.6% and 65.5% respectively were farmers. The highest proportion of official workers was 33.7% in Lompo Riaja. Educational level was low; 88.4% in Pancana, 90.4% in Lalolang, 62.1% in Lompo Riaja and 91.2% in Pattappa had elementary or below elementary school education. In Lompo Riaja, 30.8% of the inhabitants graduated from senior high school or university. The percentage of families having their own latrine was 30.3% in Pancana, 13.2% in Lalolang, 31.9% in Pattapa and 60% in Lompo Riaja. The people without latrines usually defecated in rice fields, seaside or riverside. A total of 654 fecal samples was examined by the modified Kato-Katz thick smear method. Five nematode species, Ascaris lumbricoides, Trichuris trichiura, Necator americanus, Strongyloides stercoralis and unidentified Rhabditoids of free-living nature were detected. Cestode, Hymenolepis nana infection was confirmed. All the hookworms examined by the modified Harada-Mori culture technic were Necator americanus. Trichuris infection was most common, followed by hookworm and Ascaris infections, both in young (aged 4-14) and older (aged over 15) age groups. The prevalence of hookworm infection was significantly higher in males than in females of older age. Among the older age group, the prevalence of Trichuris infection was significantly lower in Lompo Riaja, while hookworm infection was the highest in Pattappa. Among all the inhabitants examined for parasite infection, 17.4% had 3 kinds of nematode, Ascaris, Trichuris and hookworm. However, egg counts revealed that most of the inhabitants with Trichuris or hookworm had light infections. The inhabitants with higher education background had significantly lower infection rates of Ascaris and Trichuris. The prevalence of hookworm infection was not significantly different between the inhabitants owning latrine and without it, but the prevalence of Ascaris and Trichuris, differed significantly.

Adolescent↗

[Ecology of Culex pipiens fatigans larvae in an area of high endemicity of Bancroftian filariasis (author's transl)].

Culex pipiens fatigans in the main vector of bancroftian filariasis in the Mayotte island (Comores) where it imposes an important health problem. The breeding-sites of C. p. fatigans are either man-made (latrines, cesspools, various containers), or natural (polluted water of estuaries of some rivers). The man-made breeding-sites are not similarly distributed in the different localities of the island. Their distribution varies according to the customs of the inhabitants, size and site of the community. They are mainly represented by latrines, where Anjouan ethnic group is predominent; by cesspools in localities inhabited by Sakalava (a Malagasian ethnic group) and by other latrines and cesspools in mahoraises (inhabitants of Mayotte) and cosmopolitan localities. In rural areas, the percentage of habitations with cesspools usually increases with the size of the villages. The various breeding-sites are primarily productive when they are built on a ground with poor permeability. The importance of the present information is further discussed with relation to the population dynamics of C.p. fatigans and to the measures which may be useful for a control program of this mosquito.

Animals↗

Studies on Schistosoma japonicum infection in the Philippines. III. Preliminary control experiments.

Among the measures used in attempts to control the snail host of S. japonicum in Leyte Province, Philippines, where the terrain is unsuited to the application of molluscicides, have been removal of vegetation in and around infested streams, drainage of water-logged areas, filling low-lying areas with earth or flooding them, and digging fishponds in sluggish streams. Each of these measures is described in detail.Experiments carried out in rice-fields, which harbour great numbers of snails, have shown that improvements in rice-growing methods will not only markedly reduce the snail population but also double the rice yield.A campaign to promote the use of pit latrines encountered the serious difficulty that such latrines were not acceptable to the people. However, there is evidence that use of pit latrines does bring about a reduction in snail infection rates.No single control measure is recommended for all snail habitats, the choice of method depending on local circumstances; in many areas a combination of methods proved advantageous. It is felt that mass treatment of infected persons would not be fully effective until transmission is more thoroughly under control.

Animals↗

Sero-epidemiological study of hepatitis A virus infection among hill-tribe youth and household environmental sanitation, a hill-tribe community in northern Thailand.

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.

Adolescent↗

Mechanical transmission of pathogenic organisms: the role of cockroaches.

BACKGROUND & OBJECTIVES: Cockroaches (Diploptera punctata) are basically tropical insects and will do their best to find a home that is both warm and moist. Their involvement in the transmission of tropical diseases is poorly investigated in Africa. METHODS: A study on the bacterial, fungal and parasitic profile of cockroaches trapped in and around houses in Ekpoma was carried out using standard microbiological techniques. RESULTS: Of a total of 234 cockroaches trapped from different sites (toilets, parlours, kitchens and bedrooms) in houses with pit latrines and water system, the bacterial, fungal and parasitic isolates were identical irrespective of the site, these included: E. coli, Klebsiella pneumoniae, Proteus vulgaris, Proteus mirabilis, Citrobacter freundii, Enterobacter cloacae, Salmonella sp, Pseudomonas aeruginosa, Serretia marcescens, S. aureus, S. feacalis, S. epidermidis, Aeromonas sp, Candida sp, Rhizopus sp, Aspergillus sp, Mucor sp, cysts of E. hystolitica, oocysts of C. parvum, C. cayetenensis and Isospora belli, cysts of Balantidium coli, ova of Ascaris lumbricoides, Anchylostoma deodunalae, Enterobius vermicularis, ova Trichuris trichura, larva of Strongyloides stercoralis. Cockroaches trapped in the toilets of houses with pit latrines had a mean bacterial and parasites count of 12.3 x 10(10) org/ml and 98 parasites/ml respectively, while those trapped in the houses with water system had a mean bacterial and parasitic count of 89.5 x 10(7) org/ml and 31 parasites/ml respectively. A bacterial count of 78.9 x 10(7) org/ml was recorded from cockroaches trapped from the kitchens of houses with pit latrines. On the other hand a mean bacterial and parasitic count of 23.7 x 10(6) org/ml and 19 parasites/ml were recorded from kitchens of houses with water system. INTERPRETATION & CONCLUSION: Cockroaches represent an important reservoir for infectious pathogens, therefore, control of cockroaches will substantially minimise the spread of infectious diseases in our environment.

Animals↗

Prevalence of intestinal helminthic infections in Kao District, north Halmahera, Indonesia.

A parasitological survey was conducted on the inhabitants of six villages of Kao District, Halmahera Island, North Maluku, Indonesia, in July 1993. A total of 422 fecal samples were examined by using Kato-Katz thick smear, modified Harada-Mori culture and formalin ether concentration techniques. Seven nematode species, ie Ascaris lumbricoides, Trichuris trichiura, Necator americanus, Ancylostoma duodenale, Strongyloides stercoralis, Enterobius vermicularis and unidentified rhabditoids of free-living nature, were detected. Trematode and cestode infection was not proven. Necator americanus was the predominant species of hookworm. Soil-transmitted nematode infections were highly prevalent. Among the young inhabitants aged less than 15, positive rates of Ascaris, Trichuris and hookworm infections were 32.7, 52.7 and 68.6%, respectively. Among the people aged 15 or more, the positive rate for hookworm (85.9%) was much higher than that for Ascaris and Trichuris (13.5 and 40.5%, respectively). Egg count revealed that more than 90% of inhabitants with Trichuris or hookworm had light infections. The latrines in the surveyed area seemed to have only limited effects on the improvement of the parasitological status because the prevalence of Trichuris infections was much higher in a village where most houses were provided with latrines. These conflicting conditions were considered to have been caused by many factors including the inadequate structure of the latrines.

Adolescent↗

Evaluation of hookworm control program in southern Thailand.

An intensive hookworm control program providing the rural population of southern Thailand with mass treatment with 300 mg Mebendazole and health education commenced in 1989 with a yearly budget of over US$ 1.2 million. The current research aimed to evaluate the coverage of health education and mass treatment, the effectiveness of mass treatment and the administrative process of the control program, two years after its commencement. This evaluation consisted of three studies. In the first study, 120 villages were randomly selected, from which 840 school children, 843 adults aged between 15-59 and 844 subjects aged over 60 years were interviewed to assess awareness of hookworm, latrine availability, receipt of and compliance with antihelminthics provided, and self-treatment. In the second study, 8 villages from each of the 14 provinces were randomly chosen. Stool samples from randomly selected 4,434 subjects were examined. The third study consisted of interviewing key health planners in Bangkok and 71 health officers/workers from 32 samples villages of 8 sampled provinces. Latrine availability was 80%. Percentages of subjects who had ever heard of hookworm ranged from 70 to 95 in school children, 55 to 80 in adults and 25 to 58 in the older age group. While 63 to 85% had latrines in their homes, 27% to 47% admitted defecation outside in the past month. Percentages of coverage of drug treatment ranged from 82 to 91 in school children, 68 to 80 in adults and 54 to 59 in the older age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Promoting sanitation in Bangladesh.

A community-level survey was made in Bangladesh to assess the effectiveness of a health promotion campaign on sanitation. The data collected showed that the mobilization of schoolchildren to promote the construction and use of sanitary latrines had a significant impact on local practices. Poorer families appeared to be more responsive to the idea of building their own sanitary latrines than those who were slightly better off, who sometimes saw the homemade latrine as a symbol of low status. In several cases the woman of the household did the construction work rather than the man, and this aspect of women's participation could usefully be emphasized in future campaigns.

Adult↗

Sustainability of a water, sanitation and hygiene education project in rural Bangladesh: a 5-year follow-up.

An integrated water supply, sanitation and hygiene (WSH) education intervention project was run by the International Centre for Diarrhoeal Disease Research, Bangladesh, over the period 1983-87. In the intervention area the project provided handpumps, pit latrines, and hygiene education to about 800 households. The control population did not receive any interventions, but had access to the usual government and private WSH facilities. After 1987 no external support was provided to maintain these provisions. A cross-sectional follow-up survey, which was carried out in 1992, involved about 500 randomly selected households from the intervention and control areas. In 1992 about 82% of the pumps were still in good functional condition and of these, 94% had been functioning well in 1987. Fewer latrines were functional in 1992 (64%) than at the end of 1987 (93%). In the former intervention area about 84% of the adults were using sanitary latrines in 1992 compared with only 7% in the control area. Knowledge related to disease transmission, however, was poor and similar in both areas. People claimed that they used the WSH facilities to improve the quality of their lives. The prevalence of diarrhoeal diseases in the 1992 survey among the control population was about twice that among those in the intervention area.

Adolescent↗