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Effect of water supply and sanitation on the prevalence and intensity of Ascaris lumbricoides among pre-school-age children in Ajebandele and Ifewara, Osun State, Nigeria.

The relationship between Ascaris lumbricoides infection and provisions for safe water supply and excreta disposal was investigated in Ajebandele and Ifewara, 2 peri-urban communities near Ile-Ife, Osun State, Nigeria, from September 1998 to December 1999. Although there were more facilities for safe water supply (pipe-borne and shallow wells) and sanitation (flush toilets and pit latrines) in Ajebandele than in Ifewara, they were not evenly distributed and only a few families, mainly in Ajebandele, were well provided for. Our results indicated that the prevalence of A. lumbricoides was significantly higher in Ifewara (21.2%) than in Ajebandele (13.1%), and within villages was much lower in houses with tap water and flush toilets. However, the mean intensity of infection was unexpectedly higher in Ajebandele (166.5 +/- 692.0) than in Ifewara (153.1 +/- 485.8) suggesting that the present level of investment in Ajebandele is probably not sufficient to reduce morbidity. These findings confirm suggestions that there is a threshold level of investment below which interventions on water supply and sanitation may not significantly improve human health. Sustainable ascariasis control in the study communities will require significant improvements to existing water supplies and sanitation facilities and any future interventions should incorporate a programme of health education to ensure that the facilities provided are properly used and hygienically maintained.

Age Distribution↗
PubMed2002

Balancing responsibility for sanitation.

In response to the failure of existing means of service provision, environmental health policy is increasingly adopting a framework of governance for providing sanitation. Governance refers to the patterns of interaction between civil society and government. It is viewed here in terms of four dimensions: political, institutional, technical and cultural. The interactions are often described as partnerships and imply a balancing of joint responsibility. A number of issues can be identified in the literature as requiring consideration when adopting a joint responsibility for environmental health issues. These include, the need to distinguish between community and individual rights; the extent to which there is a shared interest in a community rights issues; the institutional framework for upholding the rights of citizens and the need to guard against new inequalities. The research question was: what are the factors that may inhibit or promote the involvement of community-based organisations (CBOs) in the sanitation provision process? From October 1996 to March 1997, an exploration of these factors was conducted in Cape Town, South Africa. A multiple-case study, with an embedded design, of two CBOs was conducted. This paper focuses on the extent to which there was a shared responsibility between local government and CBOs towards sanitation provision in the context of a bill rights which provides people with a right to a healthy living environment. It was found that institutional and technical capacity, political will and cultural diversity will impact on the balance between rights and responsibility. The four dimensional framework of governance is thus a useful tool for exploring the dynamic and diverse nature of environmental health.

Attitude to Health↗
PubMed2005

Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis.

Many studies have reported the results of interventions to reduce illness through improvements in drinking water, sanitation facilities, and hygiene practices in less developed countries. There has, however, been no formal systematic review and meta-analysis comparing the evidence of the relative effectiveness of these interventions. We developed a comprehensive search strategy designed to identify all peer-reviewed articles, in any language, that presented water, sanitation, or hygiene interventions. We examined only those articles with specific measurement of diarrhoea morbidity as a health outcome in non-outbreak conditions. We screened the titles and, where necessary, the abstracts of 2120 publications. 46 studies were judged to contain relevant evidence and were reviewed in detail. Data were extracted from these studies and pooled by meta-analysis to provide summary estimates of the effectiveness of each type of intervention. All of the interventions studied were found to reduce significantly the risks of diarrhoeal illness. Most of the interventions had a similar degree of impact on diarrhoeal illness, with the relative risk estimates from the overall meta-analyses ranging between 0.63 and 0.75. The results generally agree with those from previous reviews, but water quality interventions (point-of-use water treatment) were found to be more effective than previously thought, and multiple interventions (consisting of combined water, sanitation, and hygiene measures) were not more effective than interventions with a single focus. There is some evidence of publication bias in the findings from the hygiene and water treatment interventions.

Child↗
PubMed2003

Water, sanitation and hygiene: a situation analysis paper for Lao PDR.

The Lao People's Democratic Republic (Lao PDR) is located in the Greater Mekong sub-region in East Asia, neighbouring with China, Cambodia, Myanmar, Thailand and Vietnam, with a land area of 236,800 square kilometres, and an average population density of 22 persons per square kilometre. The population of Lao PDR is 5.5 million with 49 ethnic groups. Most of the population is located in rural areas, with a significant number of the neediest villages in remote localities. In the past decade, there have been many positive developments in the rural water supply and sanitation (RWSS) sector. Despite improved coverage in latrine and water supply services, health remains a serious problem. The improved services were often not sustained or poorly maintained, while hygiene received inadequate attention. In Lao PDR, as in many other countries, the provision of a safe and reliable water supply and appropriate sanitation services, based on sustainable approaches, therefore, remains a challenge. This paper will provide an overview of the Lao PDR's RWSS Sector. Special emphasis is placed on actual field level application of informed choices for water supply, sanitation and hygiene awareness.

Community-Institutional Relations↗
PubMed2003

Sanitation in the developing world: current status and future solutions.

More than a third of the world's population (2.4 billion people) lacks access to adequate excreta disposal. Four in five of these unserved people are in Asia, with approximately one in five in both India and China, respectively. Even in large Asian cities, less than half of those served are using sewerage systems; the others use on-site systems, from pit latrines to septic tanks. Most have been installed by householders or builders employed by them, rather than by government or municipal agencies. Governments, international agencies and municipalities can never hope to meet the immense gap in provision unless they promote sanitation with a marketing approach. A latrine is a consumer durable which must be sold. It is often considered that the constraint to increasing sanitation coverage is a lack of demand, but there is often a lack of supply of appropriate products, and latrine designs are often too expensive for the poor, requiring subsidies which are captured by the better-off. More market research is needed to define the right product and how best to stimulate demand. Where subsidies are used, the promotion, not the production of the latrines must be subsidised to prevent middle-class capture of the subsidy. Promotion is probably best performed by different agencies from those that build latrines. The expertise and marketing capacity of the private sector needs to be brought into play, and public bodies must learn to assist it effectively in bringing sanitation to all.

Communicable Disease Control↗
PubMed2003

Health and social benefits from improving community hygiene and sanitation: an Indian experience.

India is a country where Atomic Age and near Stone Age people co-exist. On one hand India has achieved development in many areas, but on the other hand there is still the practice of open defecation and manual cleaning of human excreta from bucket privies by scavengers. National sanitation coverage is only about 34% meaning that 66% of the population practises open defecation. Such unhygienic conditions lead to infections and high mortality and morbidity in the community. Low sanitation coverage could be due to lack of affordable sanitation technology and awareness or motivation. Although the sewerage system was introduced in India long ago, high operational and maintenance costs have prohibited it from being implemented in most towns and cities. Similarly, the cost of a septic tank is beyond most people, and disposal of undigested sludge from septic tanks remains a problem. In contrast, the pour-flush two-pit toilet (known as Sulabh Shauchalaya) is a low cost, socially acceptable and appropriate technology that does not require scavengers to clean the pits. Sulabh has converted and constructed over 1.2 million such toilets throughout India, making 240 towns scavenger-free. Liberated scavengers are thereby available to take up vocational training in various market-oriented trades enabling self-employment. The on-site/ decentralised systems of waste management has improved community health and hygiene, particularly in socially deprived groups, and reduced the financial burden of local government.

Defecation↗
PubMed2006

The impact of water supply and sanitation on area differentials in the decline of diarrhoeal disease mortality among infants in Stockholm 1878-1925.

This study analyses the impact of improved water supply and sanitation on the level and rate of decline of child diarrhoea mortality in Stockholm 1878-1925. Previous studies have failed to demonstrate an effect of improved water supply on the risk of diarrhoea mortality at the individual level. Using data on access to water and sanitation from a household survey in 1895 and mortality rates and sociodemographic information from individual data 1878-1925 to analyse area differentials in diarrhoea mortality, it was found that the proportion having their own latrine in the household was associated with lower mortality risk in 1895-1900, while the proportion having water in the household was associated with lower diarrhoea mortality risk during the mortality decline until 1925. Population effects of improved water and sanitation on diarrhoea mortality may be better measured at area level than at individual level.

Diarrhea, Infantile↗
PubMed1985

Effects of components of sanitation on nutritional status: findings from South Indian settlements.

The provision of sanitary facilities to a community neither guarantees they will be used nor that they will provide health benefits if they are used. This study, conducted in three urban communities in Madras, India, follows pre-school children over the course of approximately one year to determine the relative effects on growth of sanitation factors. These factors were defined as being under the control of children, those controlled by parents, and factors not under the direct discretionary control of any family member. Data were also collected on other variables suspected to affect nutritional or health status. A statistical technique was used that accounts for the effects of non sanitation-related variables. Children from 18 to 36 months of age benefit most from their own and their parents sanitary behaviour. Older children benefit from availability of resources for hygiene. Children under 18 months of age tend to be unaffected by any of the sanitation-related variables considered.

Child Nutritional Physiological Phenomena↗
PubMed2003

Evaluation of a method of ultraviolet light sanitation of broiler hatching eggs.

Sanitation of hatching eggs is an important area of research due to the need for an effective, economical, and safe method of egg sanitation. Improved hatching egg sanitation is an important part of an overall pathogen reduction program within integrated poultry operations. This must be accomplished without disturbing the cuticle of the egg, which can decrease hatchability. The ability of ultraviolet (UV) light to kill bacteria on eggshell surfaces has been well documented. To accomplish the task of treating the eggs in a method that could be commercially implemented, a cabinet was constructed in which ultraviolet lamps were placed. A conveyor system was used to carry a plastic hatching egg flat containing 42 eggs through the cabinet for a period of 3 or 4 min. Ultraviolet intensities within the cabinet reached a maximum of 14 mW/cm2. Experiments were conducted to test the impact of UV light (254 nm) exposure of hatching eggs on aerobic plate counts (APC), inoculated Salmonella typhimurium and inoculated Escherchia coli. In the first three experiments, seven eggs were sampled from a flat passed through the UV chamber. Ultraviolet-treated eggs compared to untreated eggs had APC reductions of 1.3 log, S. typhimurium had a 4 log reduction, and E. coli had a 4 to 5 log reduction. Laboratory trials were also conducted to test the effects of UV irradiation on the cuticle of the egg and hatchability. No significant differences for eggshell conductance or hatchability were found between UV-treated and control eggs. From these trials, it can be concluded that UV irradiation of hatching eggs in a prototype irradiation cabinet can effectively reduce aerobic and pathogenic bacteria on eggshell surfaces without affecting eggshell conductance or hatchability.

Animals↗
PubMed1988

A case-control study of the effect of environmental sanitation on diarrhoea morbidity in Malawi.

A case-control design has been applied in the evaluation of improved environmental sanitation on diarrhoeal diseases in rural Malawi. The study demonstrates the feasibility of using such an approach to evaluate two levels of water supply and sanitation service quickly and at moderate cost. Sample sizes would need to be increased substantially to evaluate multiple levels of service or to investigate interactions between water supply and sanitation. The results indicate that children living in families who use good quality water supplies and latrines experience 20% less diarrhoea as reported to the health clinics during the warm, rainy season.

Child, Preschool↗
PubMed1999

The impact of water supplies and sanitation on growth in Chinese children.

In many developing countries, improvement in water supplies has not been supplemented by improvement in sanitation facilities. Moreover, health education is rarely included in environmental hygiene programmes. Community health workers need to know if water supplies and sanitation have independent or complementary effects on health. This study analysed the weight data of 1,045 Chinese children aged 60 months or below. Regression models with interaction terms were tested against a model with main effects only. There was no evidence of interaction between water supplies and sanitation measures. The results show that water supplies and toilet facilities had independent associations with growth. Improved water source (P = 0.01) and flush-toilet (P = 0.06) were found positively associated with the children's weight. Presence of excreta in the home had a negative, but not statistically significant, association with weight.

Body Weight↗
PubMed2002

Rapid determination of sanitizer concentration using impedance-based methods.

Chlorine, iodophor, and quaternary ammonium solutions of various concentrations were assayed with rapid test kits and with three Bactometer impedimetric test codes (the impedance, conductance, and capacitance test codes). An initial study was conducted to determine which test code was most suitable for each sanitizer. Impedance was shown to be the best for sodium hypochlorite solutions, conductance for iodophor solutions, and capacitance for quaternary ammonium solutions. When Bactometer results were compared with test kit results, linear regression revealed strong correlations for all three sanitizer solutions. For sodium hypochlorite concentrations of 0 to 100 ppm and 100 to 1,000 ppm, R2 values of 0.87 and 0.99, respectively, were obtained. For iodophor concentrations between 25 to 150 ppm, an R2 value of 0.95 was obtained. For quaternary ammonium compound concentrations of 100 to 1,000 ppm, an R2 value of 0.94 was obtained. The impedimetric methods proved to be simple and rapid (6 min) alternatives for measuring concentrations of the sanitizer solutions with a high level of certainty (P < 0.0002). The Bactometer will save time when multiple samples are tested.

Bacteria↗
PubMed2006

Effects of cell surface charge and hydrophobicity on attachment of 16 Salmonella serovars to cantaloupe rind and decontamination with sanitizers.

Adherence of bacteria to cantaloupe rind is favored by surface irregularities such as roughness, crevices, and pits, thus reducing the ability of washing or sanitizer treatments to remove or inactivate attached cells. In this study, we compared the surface charge and hydrophobicity of two cantaloupe-related outbreak strains of Salmonella Poona (RM2350 and G-91-1595) to those of 14 additional Salmonella strains using electrostatic and hydrophobic interaction chromatography. The relative abilities of the 16 strains to attach to cantaloupe surfaces and resist removal by washing with water, chlorine (200 ppm), or hydrogen peroxide (2.5%) for 5 min after a storage period of up to 7 days at 5 to 20 degrees C also were determined. Whole cantaloupes were inoculated with each pathogen at 8.36 log CFU/ml, dried for 1 h inside a biosafety cabinet, stored, and then subjected to the washing treatments. Only the positive surface charge of the two cantaloupe-related strains of Salmonella Poona was significantly higher (P < 0.05) than that of the other strains. Initial bacterial attachment to cantaloupe surfaces ranged from 3.68 to 4.56 log CFU/cm2 (highest values for Salmonella Michigan, Newport, Oranienburg, and Mbandaka). The average percentage of the total bacterial population strongly attached to the cantaloupe surface for the Salmonella serovars studied ranged from 0.893 to 0.946 at 5 degrees C and from 0.987 to 0.999 at 25 degrees C. Washing inoculated melons with water did not produce a significant reduction in the concentration of the pathogens (P > 0.05). Chlorine and hydrogen peroxide treatments caused an average 3-log reduction when applied 20 to 40 min postinoculation. However, sanitizer treatments applied 60 min or more postinoculation were less effective (approximately 2.5-log reduction). No significant differences were noted in sanitizer efficacy against the individual strains (P > 0.05). The two cantaloupe-related outbreak Salmonella Poona strains did not significantly differ from the other Salmonella strains tested in negative cell surface charge or hydrophobicity, were not more effective in attaching to whole melon surfaces, and were not more resistant to the various washing treatments when present on rinds.

Bacterial Adhesion↗
PubMed1976

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

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

Agriculture↗
PubMed2000

Breast-feeding, diarrhoea and sanitation as components of infant and child health: a study of large scale survey data from Ghana and Nigeria.

Using Demographic and Health Survey datasets from Ghana and Nigeria, this study examined whether the protective effects of breast-feeding are greatest where the poorest sanitation conditions prevail. It was found that mixed-fed infants aged between 0 and 11 months tend to have a higher risk of diarrhoea than fully breast-fed children, while the risk of diarrhoea among weaned infants is twice that of mixed-fed infants. The probit regression models employed in the analysis were used to predict the probability of diarrhoea associated with each breast-feeding pattern for both 'poor' and 'good' sanitation areas. It was found that the risk of diarrhoea among mixed-fed infants in the poor sanitation areas tends to be high while the same risk among fully breast-fed infants tends to be minimal. In essence, the health risks of mixed feeding are real, particularly for infants aged less than 7 months, and are even worse for those weaned before 6 months of age.

Breast Feeding↗
PubMed2000

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

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

Community Participation↗
PubMed2004

Dealing with gastrointestinal illness on a cruise ship--Part 1: Description of sanitation measures. Part 2: An isolation study.

BACKGROUND: Recent outbreaks of gastrointestinal illness (GI) on passenger ships have caused cruise companies to expand their sanitation programs. OBJECTIVES: To describe sanitation procedures and measures involving the medical staff of one cruise ship (Part 1), and to show how one of the new measures, isolation, influenced medical practice (Part 2). METHODS: Consecutive GI logs were reviewed from 17 cruises of a ship with an average of 590 passengers and 611 crew per day. RESULTS: During a 250-day period 207 persons were isolated for a total of 419 days: 113 passengers (75 with GI, 38 asymptomatic contacts) and 94 crew (57 with GI, 37 contacts). The percentage of GI cases per 7 days varied between 0.10% and 0.43% among passengers and between 0 and 0.39% among crew, except for one cruise when the percentage per 7 days reached 2.16% among passengers and 0.61% among crew. CONCLUSIONS: A detailed operational directive for all aspects of sanitation is helpful for prevention and control of GI outbreaks on ships. A strict isolation policy is an expensive, but critical measure, which in particular challenges the medical staff.

Diarrhea↗
PubMed2004

Development of an evaluation criteria for rural water supply and environmental sanitation programme in project and non-project villages--a case study.

The Rural Water Supply and Sanitation (RWSS) in project and non-project villages of Mysore Taluk has been evaluated and discussed in this paper. The study area covered two villages (Yelwala and Kadakola) where Integrated Water Supply Scheme (IRWSS) was implemented under World Bank Project and two non-project villages (Belwadi and Byathahalli) closer to them. Pre and post scenarios of the project and non-project villages were investigated in terms of water quality analysis and also grading of villages has been done on the basis of water supply, sanitation, hygienic awareness and practices. Matrix methodology was used to evaluate the indicators from the survey data gathered from all studied villages. Finally, the villages were graded on the basis of cumulative value obtained for each village. Water quality analysis depicted turbidity, total dissolved solids and hardness being high and iron deficiency was also observed in water samples of all the villages. It was concluded that the present method of evaluation of rural water supply and sanitation project could be effectively applied to different upcoming projects.

Community Participation↗