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PubMed2005

Environmental sanitary interventions for preventing active trachoma.

BACKGROUND: Trachoma is the second or third major cause of blindness. It is responsible for about six million blind people worldwide, mostly in the poor communities of developing countries. One of the major strategies advocated for the control of the disease is the application of various environmental sanitary measures to such communities. OBJECTIVES: To assess the evidence for the effectiveness of environmental sanitary measures on the prevalence of active trachoma in endemic areas. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 4, 2004), MEDLINE (1966 to January 2005), EMBASE (1980 to January 2005), LILACS (April 2004), the reference list of trials and the Science Citation Index. We also contacted agencies, experts and researchers in trachoma control. SELECTION CRITERIA: This review included randomised and quasi-randomised controlled trials comparing any form of environmental hygiene measures with no measure. These hygienic measures included fly control, provision of water and health education. Participants in the trials were people normally resident in the trachoma endemic areas. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed the quality of trials. Study authors were contacted for additional information. Three trials met the inclusion criteria but meta-analysis was not conducted due to heterogeneity of the studies. MAIN RESULTS: Two studies that assessed insecticide spray as a fly control measure found that trachoma is reduced by at least 55% to 61% with this measure compared to no intervention. One study found that another fly control measure, latrine provision, reduced trachoma by 29.5% compared to no intervention; this was, however, not statistically significantly different. Another study revealed that health education on personal and household hygiene reduced the incidence of trachoma such that the odds of reducing trachoma in the health education village was about twice that of the no intervention village. However, all the studies have some methodological concerns relating to concealment of allocation and non-consideration of clustering effect in data analysis. AUTHORS' CONCLUSIONS: There is evidence that insecticide spray as a fly control measure reduces trachoma significantly. Latrine provision as a fly control measure has not demonstrated significant trachoma reduction. Health education may be effective in reducing trachoma. There is a dearth of data to determine the effectiveness of all aspects of environmental sanitation in the control of trachoma.

Animals↗
PubMed1981

Environmental sanitation infection and nutritional status of infants in rural St. Lucia, West Indies.

About 75 babies in each of three valleys were followed up for two years. The valleys had different levels of water supplies and latrine facilities, whereas socio-economic conditions and feeding patterns were similar. Results show that the prevalence of diarrhoea and intestinal helminths reduced as sanitation improved. Ascaris and Trichuris infections dropped 30 and 50% respectively after water supplies and latrines were installed. The growth of the children was significantly better in the improved areas. The possibility of malnutrition being secondary to illness, rather than primary, is included in the discussion.

Ascariasis↗
PubMed1982

Role of water and sanitation in the incidence of cholera in refugee camps.

The purpose of this study was to determine the prevalence of cholera in two groups: (i) people using covered latrine and piped water; (ii) people using uncovered surface latrine and pond and tubewell water. The study population consisted of cholera cases admitted to the ICDDR, B hospital from three refugee camps. In the one camp with sanitation facilities, the cholera rate was 1.6 per 1,000, whereas in the two camps without facilities the rates were 4.0 and 4.3 per 1,000. Following demolition of the camps, the cholera rates decreased significantly in the camps geographical zones. Cholera was not totally eliminated, even in the one camp with sanitation facilities, suggesting that health education, as well as proper sanitation, is necessary to eradicate cholera.

Bangladesh↗
PubMed1983

Excreta disposal facilities and intestinal parasitism in urban Africa: preliminary studies in Botswana, Ghana and Zambia.

The relationships between intestinal parasitism and excreta disposal technologies in Gaborone (Botswana), Ndola (Zambia) and Kumasi (Ghana) were investigated. Parasitic prevalence and intensity rates amongst groups of urban residents having similar socio-economic status and housing, but different excreta disposal technologies, were compared. In Gaborone, there was no evidence of a difference in intestinal parasitism between those using aqua privies and having access to public taps and those in identical houses enjoying flush toilets, in-house water connections and showers. In Ndola, the group with sewered aqua privies had larger houses, cleaner toilets, better water supplies, longer residence and more people in paid employment than the groups using pit latrines or communal flush toilets. Despite this, the sewered aqua privy users were not found to be different from the other groups with regard to hookworm and protozoal infection but had significantly higher Ascaris infection rates. In Kumasi, despite the differences in toilet type--from squalid communal aqua privies, through often fouled bucket latrines to well-maintained flush toilet systems--and despite also the differences in water provision, no evidence was obtained of any differences in intestinal parasitism between the groups studied. These findings suggest that the provision of superior water and sanitation facilities to a small cluster of houses, or to houses scattered through an area, may not protect those families from infection if the over-all level of faecal contamination of the environment is high. The sample sizes and response rates achieved in this study were low and follow-up studies, employing the same methodology but with larger samples, are recommended.

Adolescent↗
PubMedDate not supplied

Strongyloides stercoralis in an urban slum community in Bangladesh: factors independently associated with infection.

Stool samples from 880 residents in an urban slum in Dhaka, Bangladesh, were collected on 3 occasions over one year, and examined for intestinal parasites. Information on many potential risk factors for infection was obtained by questionnaire from a respondent in each household studied. In a crude univariate analysis of the data, several of the factors were found to be significantly associated with Strongyloides stercoralis infection. Most of these factors were co-variate with one another, and with poverty generally. Using Mantel-Haenszel chi 2 tests to control for confounding effects of each variable individually, the following 4 factors remained independently associated with S. stercoralis infection: respondent's use of a community latrine rather than a private latrine, living in a house with an earth floor rather than a cement floor, being of Bihari ethnicity, and being 7-10 years of age. Implications of these results for the epidemiology and control of strongyloidiasis are briefly discussed.

Adolescent↗
PubMed1985

Infant mortality in Sri Lankan households: a causal model.

The infant mortality rate in Sri Lanka has fallen precipitiously since World War II, to 44 per 1000 births, a rate that is similar to a number of Western Countries. Yet the aggregated country rate masks wide variations across districts, from a low 21 per 1000 in Jaffna District to a high of 100 per 1000 in Nuwara Eliya District. Such regional variations in infant mortality rates have been shown to be related to a number of social, demographic and intitutional characteristics of each area. To specify such linkages we move, in this paper, from the aggregate level of analysis to the level of individual households in order to look for social, economic and other characteristics associated with infant deaths. Data are derived from a systematic interview of 480 household heads in 12 villages of Sri Lanka, collected in 1980. The most proximate factors, public health or medical variables, that predict infant death in particular households include quality of family nutrition, supervised childbirth, immunization of children and, most significant, whether the family has a sanitary latrine. Yet these medical variables are strongly associated with educational and economic characteristics of the family which, in turn, are predictive of infant mortality. Poor families and poorly educated mothers are less likely to go to hospital for childbirth, have a latrine, etc., and more likely to have had an infant die. Underlying the variations in education and economic status are variations in ethnic group; families with poor sanitation, least education and few economic resources are most likely to be members of the minority communities, Ceylon or Indian Tamils and Muslims. Minority group membership is significantly associated with infant mortality as well. When a set of medical, educational, economic and cultural variables are examined simultaneously within a path model we show that the best causal explanation of infant death in Sri Lankan households says, "Minority group status results in poverty which prevents families from having safe sanitary facilities which causes infant death". Infant mortality in Sri Lanka is thus not simply a medical problem to be dealt with by public health programs, nor is it solely an economic problem that can be solved with creation of jobs, but it is better seen as a problem of the structure of the whole society.

Adult↗
PubMed2001

Impact of urbanization on hydrochemical evolution of groundwater and on unsaturated-zone gas composition in the coastal city of Tel Aviv, Israel.

The coastal city of Tel Aviv was founded at the beginning of the 20th century. The number of its inhabitants and its water consumption increased rapidly. This study analyses a 15-year record (1934-1948) of pre-industrial development of groundwater chemistry in the urban area. Archive data on concentrations of major ions, dissolved gases (CO2 and O2), organic matter, and pH were available for each half-year during the period of 1934-1948. The major factors causing changes in the chemistry of groundwater flowing in three sandy sub-aquifers have been seawater encroachment due to overpumping, and infiltration of effluents from pit-latrine collectors. Influence of these factors decreases with depth. Landward-penetrating seawater passed through clayey coastal sediments, interbedded among sands and calcareous sandstones, and spread into the Kurkar Group aquifer. This has led to exchange of sodium (dominant in seawater) with calcium adsorbed on clay particles, enriching groundwater with calcium. Intensity of cation exchange decreases inland and with depth. Infiltration of pit-latrine effluents has introduced large amounts of ammonium into the unsaturated zone. Its rapid oxidation in unsaturated sediments has caused massive nitrate production, accompanied by pore-water acidification. This process induces dissolution of vadose carbonate, resulting in enrichment of groundwater recharge in calcium. Anthropogenically induced dissolution of calcite in the unsaturated zone has been the major factor for the increase of Ca2+ concentration in groundwater, accounting for about 80% of this increase. In the interface zone, an additional 20% of calcium has been supplied by cation exchange. Owing to pH increase caused by denitrification in the aquifer, Ca(2+)-rich waters supersaturated with calcite could be formed, especially in the capillary fringe of the uppermost sub-aquifer, which could induce calcite precipitation and ultimately lead to the cementation of sandy aquifers. Urban development has caused drastic changes in the gas content in the unsaturated zone and in groundwater. Carbon dioxide was intensively generated by nitrification-denitrification processes, by hydration of urea, to a lesser degree by oxidation of organic matter, and probably by anoxic biodegradation of organics. Between 1934 and 1948, concentrations of CO2 in unsaturated sediment air rose from 3.2% to 7.6%. In the unsaturated zone, oxygen consumption for oxidation of ammonium and organic matter lowered O2 concentrations in sediment air to unusually low values of 3.9-12.9%. Nitrification in the urban unsaturated zone could thus serve as a pump, sucking in atmospheric oxygen at a rate of about 0.3-0.5 g m-2 day-1. The extreme concentrations of CO2 and O2 in unsaturated sediments have been preserved due to production and consumption of gas under conditions of diminishing areas open to the atmosphere, uncovered by buildings and by roads.

Calcium↗
PubMed1983

Studies on well water and possible health risks in Katsina, Nigeria.

Well water was sampled from all four major wards in Katsina town. All 20 samples taken showed high coliform counts. Sixty-five per cent contained greater than or equal to 2400 coliforms per 100 ml while the remainder had counts ranging from 79 to 920. Faecal coliforms and non-cholera vibrios were detected in all samples. There was no significant relationship between the coliform counts and the distances of latrines to wells, water table to ground level, slope relationship between wells and latrines, the pH of water and whether the wells were left permanently open or not. Salmonella sp., Enterobacter sp. and Pseudomonas sp. were each isolated from about 10% of the samples, while Proteus sp. was isolated from 40%, Citrobacter sp. 15%, Alcaligenes sp. 5% and an unidentified Gram-negative rod from 5%. Only 2 (10%) of the sampled households, representing 23 (9.6%) of the 239 people exposed to well-water had pipeborne water in addition. It was concluded that well water in Katsina town could be a human health hazard.

Bacteria↗
PubMed1993

Field trials in the control of Opisthorchis viverrini with an integrated programme in endemic areas of northeast Thailand.

A control programme of opisthorchiasis was carried out for three years in three villages of northeast Thailand in order to compare the effectiveness of two intervention measures. The intervention measures employed were to give praziquantel treatment to all infected people either once (village I) or twice (village II) per year with the integration of regular health education and sanitation improvement. A control village (village III) received no intervention during the study. Sampling of the population in these villages to estimate prevalence, intensity, reinfection and incidence of infection as well as knowledge of opisthorchiasis and number of latrines was performed at 6 monthly intervals throughout the duration of the study. At the initial assessment, there were no significant differences in the prevalence and intensity of infection of villages I and II. Both values were greatly reduced when assessed 6 months after the initiation of treatment, and the decrease in prevalence and intensity of infection did not differ between village I and II. The control village (village III), during the first 2 years, exhibited slight variation in the prevalence and intensity, and these decreased considerably in the third year of the study. The reinfection rate per 6 months in villages I and II was nearly equal. The incidence rate per 6 months in the two treated villages was lower than that of the control village. Marked improvement in knowledge of opisthorchiasis, behavioural changes of eating raw fish and increased numbers of latrines was evident in all of the villages during this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Risk factors for typhoid fever in a slum in Dhaka, Bangladesh.

We systematically investigated risk factors for typhoid fever in Kamalapur, a poor urban area of Bangladesh, to inform targeted public health measures for its control. We interviewed patients with typhoid fever and two age-matched controls per case about exposures during the 14 days before the onset of illness. The municipal water supply was used by all 41 cases and 81of 82 controls. In multivariate analysis, drinking unboiled water at home was a significant risk factor [adjusted odds ratio (aOR) 12.1, 95% CI 2.2-65.6]. Twenty-three (56%) cases and 21 (26%) controls reported that water from the primary source was foul-smelling (aOR 7.4, 95% CI 2.1-25.4). Eating papaya was associated with illness (aOR 5.2, 95% CI 1.2-22.2). Using a latrine for defecation was significantly protective (aOR 0.1, 95% CI 0.02-0.9). Improved chlorination of the municipal water supply or disinfecting drinking water at the household level may dramatically reduce the risk of typhoid fever in Kamalapur. The protective effect of using latrines, particularly among young children, should be investigated further.

Adolescent↗
PubMed2000

Review of the evidence base for the 'F' and 'E' components of the SAFE strategy for trachoma control.

Community control of trachoma as a blinding disease is based on the SAFE strategy of Surgery, Antibiotic therapy, Facial cleanliness and Environmental improvement. Surgery and antibiotic therapy currently dominate most programmes. Blindness from trachoma results from frequent infections repeated over many years, so ultimate success requires the reduction of transmission. This is only likely to be sustainable through the F and E components of SAFE. Environmental improvement with access to water, enhanced hygiene and better sanitation reduces trachoma transmission and the blinding sequelae eventually disappear. Transmission routes and factors that cause this are not known and consequently no single specific tool for F and E is in place. Evidence from intervention studies shows that the promotion of face-washing gave modest gains for intense effort and a pilot study showed that trachoma transmission was reduced in the absence of eye-seeking flies. Other studies have shown that latrines and improved access to water are associated with a lower prevalence of active trachoma. There is likely to be a long-term beneficial effect of a combination of improved water supplies, provision of latrines, facial hygiene promotion through established infrastructure and control of eye-seeking flies. Each of these interventions offers additional public health and other benefits in its own right. Further research on the routes of transmission, the role of hygiene and means of sustainable fly control should be a priority.

Animals↗
PubMed2004

Raccoon roundworm encephalitis.

The raccoon roundworm, Baylisascaris procyonis, is increasingly recognized as a cause of zoonotic visceral, ocular, and neural larva migrans and, in particular, of devastating encephalitis in young children. Exposure occurs mainly at raccoon latrines, where large numbers of infective eggs may be accidentally ingested. Risk factors for infection include contact with raccoon latrines, pica/geophagia, age of <4 years, and male sex. The severity of central nervous system (CNS) disease depends on the number of eggs ingested, the extent and location of larval migration, and the severity of ensuing inflammation and necrosis. Diagnosis of Baylisascaris encephalitis is based on clinical CNS disease, peripheral and cerebrospinal fluid eosinophilia, deep white matter lesions visible by magnetic resonance imaging, and positive results of serologic tests. Treatment efficacy in clinical cases is poor, but albendazole prevents disease if given promptly after infection. Considering the seriousness of this disease and limitations of diagnosis and treatment, prevention of infection with eggs is of utmost importance.

Animals↗
PubMed1992

Risk factors for the transmission of diarrhoea in children: a case-control study in rural Malaysia.

In response to a recorded increasing incidence of diarrhoea in Tumpat District, Malaysia, a case-control study was performed to identify modifiable risk factors for the transmission of diarrhoea, in children aged 4-59 months. Ninety-eight pairs of children, matched on age and sex, were recruited prospectively from health centres. Exposure status was determined during a home visit. Interviewers were 'blinded' as to the disease status of each child. Odds ratios were measured through matched pair analysis and conditional logistic regression. Risk factors for diarrhoea identified were: reported--drinking of unboiled water, storage of cooked food before consumption and bottle feeding; and observations--animals inside the house and absence of washing water in latrines. Water quality, source of drinking water, reported hand washing behaviour, indiscriminate defecation by children, cup use and the absence of a functional latrine were not associated with diarrhoea. Nonsignificant associations were found for: accessibility of washing water source, type of water storage container and use of fly covers for food.

Acute Disease↗
PubMed1996

Water, waste, and well-being: a multicountry study.

Data collected in the late 1980s from eight countries in Sub-Saharan Africa (Burundi, Ghana, Togo, and Uganda), Asia/North Africa (Sri Lanka and Morocco), and the Americas (Bolivia and Guatemala) were combined and analyzed to test whether incremental health effects regarding diarrhea and nutritional status result from incremental improvements in water and sanitation conditions. Rural (n = 11,992) and urban (n = 4,888) samples were analyzed separately. Optimal (i.e., on the premises) and intermediate (improved public water) water supplies were compared with unimproved water conditions. Optimal (flush toilets or water-seal-latrines) and intermediate (latrines) sanitation levels were compared with unimproved sanitation. Nationally representative (random) samples of ever-married women age 15-49 years, with or without children, were interviewed in all countries, and children aged 3-36 months with available weight and height data were included in the analyses. Multiple linear regression controlled for household, maternal, and child-level variables; in addition, dummy variables were included for each country. Improvements in sanitation resulted in less diarrhea and in taller and heavier children with each of the three levels of water supply. Incremental benefits in sanitation were associated with less diarrhea and with additional increases in the weights and heights of children. The effects of improved sanitation were greater among urban dwellers than among rural dwellers. Health benefits from improved water were less pronounced than those for sanitation. Benefits from improved water occurred only when sanitation was improved and only when optimal water was present. These findings suggest that public health intervention should balance epidemiologic data with the cost of services and the demand for water. There should be efforts to develop compatible technologies so that incremental improvements in service can be made.

Adolescent↗
PubMed1998

Contamination of weaning foods: organisms, channels, and sequelae.

A study was carried out to identify the microbial contaminants of weaning foods in an Egyptian village and the sources of contamination. All 300 households containing infants (< 24 months) were visited. Information regarding food preparation and household sanitation was gathered. Samples of weaning foods (270) were collected and analysed for the presence of Escherichia coli, Bacillus cereus, Shigella and parasites. The first two pathogens were detected in 43.7 per cent and 21.4 per cent of samples respectively. The others were not detected in any sample. The risk of contamination by E. coli and B. cereus was significantly associated with the presence of dung and/or refuse in the house, lack of indoor latrine, non-use of latrine by children, weaning foods not freshly prepared, uncovered storage of foods, and the presence of a case of diarrhoea in the house.

Bacillus cereus↗
PubMed2000

Female adolescents and their sexuality: notions of honour, shame, purity and pollution during the floods.

This paper explores the experiences of female adolescents during the 1998 floods in Bangladesh, focusing on the implications of socio-cultural norms related to notions of honour, shame, purity and pollution. These cultural notions are reinforced with greater emphasis as girls enter their adolescence, regulating their sexuality and gender relationships. In Bangladeshi society, adolescent girls are expected to maintain their virginity until marriage. Contact is limited to one's family and extended relations. Particularly among poorer families, adolescent girls tend to have limited mobility to safeguard their 'purity'. This is to ensure that the girl's reputation does not suffer, thus making it difficult for the girl to get married. For female adolescents in Bangladesh, a disaster situation is a uniquely vulnerable time. Exposure to the unfamiliar environment of flood shelters and relief camps, and unable to maintain their 'space' and privacy from male strangers, a number of the girls were vulnerable to sexual and mental harassment. With the floods, it became difficult for most of the girls to be appropriately 'secluded'. Many were unable to sleep, bathe or get access to latrines in privacy because so many houses and latrines were under the water. Some of the girls who had begun menstruation were distressed at not being able to keep themselves clean. Strong social taboos associated with menstruation and the dirty water that surrounded them made it difficult for the girls to wash their menstrual cloths or change them frequently enough. Many of them became separated from their social network of relations, which caused them a great deal of anxiety and stress. Their difficulty in trying to follow social norms have had far-reaching implications on their health, identity, family and community relations.

Adaptation, Psychological↗
PubMedDate not supplied

Morbidity patterns in a new paediatric hospital in Juba, Sudan.

A study of morbidity patterns in a new paediatric hospital in Juba, Sudan, showed malaria, gastroenteritis, pneumonia, dysentery and infections of the eye, ear, and skin to be the commonest conditions. During the entire period of the study, these conditions constituted more than 90% of the outpatient load. In a group of inpatients interviewed, immunization coverage was 22%, 46% of the mothers had been enrolled in school at some time, and only 17% of the families had a latrine at home. The mean number of living children per family was four and of those not surviving was two. These findings are related to an inadequate environment, lack of public health information, and low socioeconomic status. Immediate and long-term strategies are necessary to provide safe water, adequate latrines, better immunization coverage, income-generating practices, increase in female education, and general health education of females, children and youth.

Child↗
PubMed1995

Mosquito control in Dar es Salaam. II. Impact of expanded polystyrene beads and pyriproxyfen treatment of breeding sites on Culex quinquefasciatus densities.

In two contrasting areas of Dar es Salaam (Ilala and Mikocheni) all enclosed breeding sites of Culex quinquefasciatus, such as latrines and septic tanks, were treated with a floating layer of expanded polystyrene beads. 7 months later checks in both study areas revealed only one site (from which the polystyrene had been removed during emptying) containing immature stages of Cx quinquefasciatus. Open breeding sites such as areas of flooded land and blocked drains were treated with pyriproxyfen (an insect growth regulator) at a concentration of 0.1 ppm. Emergence of Cx quinquefasciatus adults from these sites was inhibited for 4 weeks during the rainy season and for up to 11 weeks during the dry season. The problem of mosquito breeding sites caused by bathroom sullage water was addressed through a combination of health education and indirect pressure from the Urban Malaria Control Project (UMCP) via local community leaders. Households responsible for these sites were encouraged to eliminate them by diverting the water into an enclosed drainage structure, usually a pit latrine. After two weekly visits 64.7% of households had complied and 93.4% had complied after five visits. 5 months later, only 15.7% had reverted to allowing sullage water to collect into puddles. Densities of Cx quinquefasciatus adults dropped by 76.7% in Mikocheni and by 46.2% in Ilala following intervention, but increased by 84.9% and 25.6% in two untreated comparison areas. The reasons for differential success of the combined interventions in the two treated areas are discussed.

Animals↗