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PubMed1996

Impact of oral rehydration and selected public health interventions on reduction of mortality from childhood diarrhoeal diseases in Mexico.

Reported are the results of an analysis of mortality trends from diarrhoeal diseases among under-5-year-olds in Mexico between 1978 and 1993 in relation to the impact of education, basic sanitation, and selected medical care practices. The study period was divided into three stages; the first pre-dated the widespread application of oral rehydration therapy (ORT); the second, covered the implementation of a nationwide programme promoting ORT; and the third included additional measures, such as immunization and improvements in basic sanitation. Mortality rates decreased progressively, at an average of 1.8% per year in the first stage, 6.4% in the second, and 17.8% in the third. The importance of literacy campaigns for women and the promotion of ORT was confirmed. Both of these measures reduced mortality; however, a greater reduction resulted from a massive immunization campaign against measles and improvements in sanitation (expansion of the drainage and piped water systems, improved water chlorination procedure, and effective prohibition of the use of sanitary sewage for vegetable irrigation).

Adult↗
PubMed1995

Changing hygiene behaviour in Papua New Guinea.

Sanitation and water supplies are critical to health and an adequate standard of living. In Papua New Guinea water supplies in both rural and urban areas are installed with no attention to the social and cultural aspects of water use and personal hygiene. This paper argues that improved hygiene and sanitation could be achieved if sufficient resources were focused on the people who use water and sanitation systems and not simply on the systems themselves.

Adolescent↗
PubMed2005

The global distribution of risk factors by poverty level.

OBJECTIVE: To estimate the individual-level association of income poverty with being underweight, using tobacco, drinking alcohol, having access only to unsafe water and sanitation, being exposed to indoor air pollution and being obese. METHODS: Using survey data for as many countries as possible, we estimated the relative risk association between income or assets and risk factors at the individual level within 11 medium- and low-income subregions of WHO. WHO and The World Bank data on the prevalence of risk factors and income poverty (defined as living on < US$ 1.00 per day, US$ 1-2.00 per day and > US$ 2.00 per day) were analysed to impute the association between poverty and risk factors for each subregion. The possible effect of poverty reduction on the prevalence of risk factors was estimated using population-attributable risk percentages. FINDINGS: There were strong associations between poverty and malnutrition among children, having access only to unsafe water and sanitation, and being exposed to indoor air pollution within each subregion (relative risks were twofold to threefold greater for those living on < US$ 1.00 per day compared with those living on > US$ 2.00 per day). Associations between poverty and obesity, tobacco use and alcohol use varied across subregions. If everyone living on < US$ 2.00 per day had the risk factor profile of those living on > US$ 2.00 per day, 51% of exposures to unimproved water and sanitation could be avoided as could 37% of malnutrition among children and 38% of exposure to indoor air pollution. The more realistic, but still challenging, Millennium Development Goal of halving the number of people living on < US$ 1.00 per day would achieve much smaller reductions. CONCLUSION: To achieve large gains in global health requires both poverty eradication and public health action. The methods used in this study may be useful for monitoring pro-equity progress towards Millennium Development Goals.

Health Services Accessibility↗
PubMed2000

Breastfeeding and growth in rural Kenyan toddlers.

Research has not provided unequivocal support for the recommendation to continue breastfeeding until children reach at least age 24 months. In many circumstances, breastfeeding duration is chosen or conditioned by factors other than scientific evidence and recommendations. Even in communities where breastfeeding into the second year is the norm, a significant number of toddlers are weaned before the recommended age. The research reported here was conducted in a rural community of western Kenya. We prospectively followed a cohort of 264 children for 6 months (mean age at baseline, 14.1 +/- 2.4 months) to examine the effect of variable breastfeeding duration on length and weight gain. We found that breastfeeding was positively associated with growth in a manner that we inferred to be causal, the effect being stronger on linear growth than on weight gain. This was despite the fact that in a cohort where 95% were breastfeeding at baseline, the prevalence of stunting (height-for-age below -2 standard deviations of the WHO-NCHS reference) was already 48%. The present paper examines the socioeconomic characteristics, sanitation, morbidity, and complementary feeding practices that define the context of this apparently contradictory relationship. The population was poor, no household had running water, and malaria is endemic in the study area. Complementary feeding was initiated for 93% of the cohort before age 3 months. The weaning diet was bulky (77% energy from carbohydrate), and high in phytate content ([phytate]:[zinc] molar ratio, 28). Diet quality, judged by diversity and animal source food intake, was low. Several micronutrient intakes were below current recommendations, including riboflavin (63%), niacin equivalents (64%), calcium (72%), iron (74%) and zinc (33%). Based on a locally defined socioeconomic status scale, children in higher SES households were breastfed for a shorter duration than were children from poorer households. Sanitation and water consumption modified the effect of breastfeeding duration on growth: the effect was stronger in the absence of a pit latrine and at low water consumption. Our results support the recommendation to sustain breastfeeding in the second year, particularly in economically depressed environments with inadequate sanitation and water supplies.

Age Factors↗
PubMed1996

Inactivation of virus during anaerobic digestion of manure in laboratory scale biogas reactors.

Reduction of porcine parvovirus, bovine enterovirus and faecal enterococci were measured in biogas reactors continuously run on manure and manure supplemented with household waste at 35 degrees C and 55 degrees C and in batch test run at 70 degrees C. The aim of the experiments was to study the sanitation effect of anaerobic digestion and to evaluate the use of faecal enterococci as an indicator of sanitation. Parallel studies on the reduction of virus and faecal enterococci were done in physiological saline solution. Heat inactivation was found to be an important factor in thermophilic biogas plants and the overall dominant factor at 70 degrees C. However, other environmental factors with a substantial virucidal and bactericidal effect were involved in inactivation. The death rates for faecal enterococci were generally higher than for porcine parvovirus and lower than for bovine enterovirus. For faecal enterococci, a logarithmic reduction of 4 (corresponding to the recommended minimum guaranteed retention time) was obtained after 300 hours at 35 degrees C and after 1-2 hours at 55 degrees C. In continuously-fed reactors, a high reduction rate was initially seen for the virus tested, followed by a reduction in the rate. For porcine parvovirus, a minimum guaranteed retention time of 11-12 hours is necessary at 55 degrees C in the initial phase (0-4 hours) and 54 hours hereafter (4-48 h). Correspondingly, for bovine enterovirus a MGRT of 23 hours was necessary at 35 degrees C and < 0.5 hours at 55 degrees C. The data indicate that faecal enterococci measurements give a good indication of inactivation of enterovirus and other more heat sensitive virus, especially under thermophilic conditions. Parvovirus is very suitable for comparative investigations on inactivation in the temperature range of 50-80 degrees C, due to the extreme thermal resistance of this virus. However, in stipulating sanitation demands for biogas reactors it seems more reasonable to use less resistant virus, such as a reovirus or picornavirus, which better represents the pathogenic animal virus.

Anaerobiosis↗
PubMed2004

Outbreaks of Gastrointestinal Diseases on Cruise Ships: Lessons from Three Decades of Progress.

Dramatic improvements in sanitary engineering and, especially, operational procedures aboard cruise ships began in the mid-1970s after several large outbreaks of acute gastroenteritis. The US Centers for Disease Control and Prevention's Vessel Sanitation Program, working with the cruise industry, conducts ship inspections, provides public access to ship sanitation scores, and reports outbreak investigations. The significant increase in median ship sanitation scores over the past decade has been concomitant with a reduction in outbreak frequency to 3.7 per 1000 cruises. Most outbreaks of the past decade were linked to noroviruses (Norwalk-like viruses), enterotoxigenic Escherichia coli, or the residual "unknown" causes. Although norovirus outbreaks may begin as foodborne or waterborne disease, easy person-to-person transmission occurs through fecal- or vomitus-splattered surfaces, other items, clothing, and especially, hands. Control of person-to-person spread of illness among crew and passengers becomes the major objective. Rigorous handwashing, environmental disinfection, and other food service job-related restrictions are required to prevent multiple outbreaks on the same ship. Vigilance by public health and industry officials has prevented many thousands of illnesses and some associated deaths. Clinicians providing pretravel health advice and post-travel diagnoses and care can benefit from and contribute to epidemiologic investigations and thereby enhance the health of cruise passengers individually and collectively.

Journal Article↗
PubMedDate not supplied

The epidemiology and control of hookworm infection in the Burma Valley area of Zimbabwe.

An integrated hookworm control programme, involving mass chemotherapy and improvements in public health, was conducted in the Burma Valley and Vumba areas of Zimbabwe between 1985 and 1990. Three sequential annual mass chemotherapy programmes were implemented. Infection status was monitored annually throughout. Initial observations indicated asymptotic age prevalence and intensity profiles, with peak infection levels in adults. Mass chemotherapy was shown to have immediate and medium term benefits for community health. Reinfection was slow to develop, and average intensity had not returned to pre-intervention levels 39 months after the cessation of chemotherapy. The results support the existence of age-dependency in reinfection. Despite a marked increase in the number of sanitation units, no relationship was found between latrine availability and reinfection intensity on individual farms. This result is consistent with observations that the effect of sanitation is slow to develop, and indicates that repeated anthelmintic intervention should be maintained until sanitation has an impact on transmission.

Adolescent↗
PubMed2006

Correlation between national income, HIV/AIDS and political status and mortalities in African countries.

OBJECTIVES: To investigate associations between mortalities in African countries and problems that emerged in Africa in the 1990s (reduction of national income, HIV/AIDS and political instability) by adjusting for the influences of development, sanitation and education. METHODS: We compiled country-level indicators of mortalities, national net income (the reduction of national income by the debt), infection rate of HIV/AIDS, political instability, demography, education, sanitation and infrastructure, from 1990 to 2000 of all African countries (n=53). To extract major factors from indicators of the latter four categories, we carried out principal component analysis. We used multiple regression analysis to examine the associations between mortality indicators and national net income per capita, infection rate of HIV/AIDS, and political instability by adjusting the influence of other possible mortality determinants. RESULTS: Mean of infant mortality per 1000 live births (IMR); maternal mortality per 100,000 live birth (MMR); adult female mortality per 1000 population (AMRF); adult male mortality per 1000 population (AMRM); and life expectancy at birth (LE) in 2000 were 83, 733, 381, 435, and 51, respectively. Three factors were identified as major influences on development: education, sanitation and infrastructure. National net income per capita showed independent negative associations with MMR and AMRF, and a positive association with LE. Infection rate of HIV/AIDS was independently positively associated with AMRM and AMRF, and negatively associated with LE in 2000. Political instability score was independently positively associated with MMR. CONCLUSIONS: National net income per capita, HIV/AIDS and political status were predictors of mortality indicators in African countries. This study provided evidence for supporting health policies that take economic and political stability into account.

Africa↗
PubMed2005

Ozonated water extends the shelf life of fresh-cut lettuce.

The use of ozonated water as a sanitizer to extend the shelf life of fresh-cut lettuce and the effect on the antioxidant constituents (polyphenols and vitamin C) were investigated. Fresh-cut iceberg lettuce (Lactuca sativa L.) was washed at 4 degrees C using three different ozonated water dips [10, 20, and 10 activated by ultraviolet C (UV-C) light mg L(-1) min total ozone dose], and the dips were compared with water and chlorine rinses. Treated lettuce was packaged in air or active modified atmosphere packaging (MAP) (4 kPa of O2 + 12 kPa of CO2 balanced with N2) and stored for 13 days at 4 degrees C. Despite its strong oxidizing activity, ozonated water did not stimulate the respiratory activity of fresh-cut lettuce. Moreover, ozonated water maintained the initial visual appearance of fresh-cut lettuce and controlled browning during storage in air. Initially, ozonated water and chlorine reduced the total mesophilic population by 1.6 and 2.1 log, respectively, when compared with water. Active MAP was effective in controlling total microbial growth, achieving 2.0 log reduction in relation to samples stored in air at the end of storage. On the other hand, active MAP caused a 2.0-3.5 reduction of coliforms on sanitized samples compared with water-washed samples. The most efficient treatments were ozone 20 and ozone 10 activated by UV-C, which were as effective as chlorine. Changes in individual phenolic compounds were independent of the washing treatments. In air, chlorogenic and isochlorogenic acid contents increased noticeably after 13 days while monocaffeoyltartaric and dicaffeoyltartaric acids remained unchanged. MAP effectively suppressed accumulation of caffeoylquinic derivatives, whereas caffeoyltartaric derivatives decreased during MAP storage to reach similar levels. The content of vitamin C (ascorbic acid and dehydroascorbic acid) decreased during storage, particularly under MAP. Ozonated water could be an alternative sanitizer to chlorine for fresh-cut lettuce due to good retention of sensorial quality and browning control with no detrimental reduction in the antioxidant constituents.

Ascorbic Acid↗
PubMed2003

Non-conventional methods for the control of post-harvest pear diseases.

Pears are highly perishable products, especially during the post-harvest phase, when considerable losses can occur. Among the fungal diseases, blue mold caused by Penicillium expansum, grey mould caused by Botrytis cinerea, Mucor rot caused by Mucor piriformis are common on pear fruits. Other (weak) pathogens like Phialophora malorum, Alternaria spp., and Cladosporium herbarum tend to infect wounds and senescent fruits. A post-harvest fungicide treatment can reduce decay but effectiveness decreases with the appearance of resistant strains. There is a clear need to develop new and alternative methods of controlling post-harvest diseases. The emerging technologies for the control of post-harvest fungal diseases are essentially threefold: application of antagonistic microorganisms, application of natural antimicrobial substances and application of sanitizing products. Two biological control products, Aspire (Candida oleophila I-182) (Ecogen, Langhorne, PA, USA) and Bio-Save 110 (Pseudomonas syringae) (EcoScience, Worcester, MA, USA; formerly Bio-Save 11) are currently registered in the USA for post-harvest application to pears. Other potential biocontrol agents have been isolated from fruit and shown to suppress post-harvest decay in pear. It is important that evaluation of these microorganisms be carried out in a product formulation because the formulation may improve or diminish antagonistic efficacy depending on the concentration of chemical product and the duration of exposure to the treatment. Plants produce a large number of secondary metabolites with antimicrobial effects on post-harvest pathogens. Detailed studies have been conducted on aromatic compounds, essential oils, volatile substances and isothiocyanates, with encouraging results. In particular, allyl-isothiocyanate used as a volatile substance, controls blue mould in 'Conference' and 'Kaiser' pear inoculated with a thiabendazole-resistant strain. Sanitizing products such as chlorine dioxide, peracetic acid and ozone have considerable fungicidal activity against P. expansum and M. piriformis, depending on the concentration of chemical product and the duration of exposure to the treatment. Sanitizing solutions can be integrated easily with current handling and storage practices; however, further research is required to define the effective procedures better.

Antibiosis↗
PubMed2001

The importance of pathogenic organisms in sewage and sewage sludge.

Deficient sanitation poses a serious threat to human and animal health, involving complex relationships between environments, animals, refuse, food, pathogens, parasites, and man. However, by sanitizing and stabilizing the organic matter of sewage sludge, agriculture can utilize it to maintain soil, water, and air quality. As ingredients in soil amendments, such bioresidues are a source of nutrients for plants. Stabilization and sanitation of sewage sludge safely couple its recycling and disposal. This coupling becomes increasingly important as economic and environmental constraints make strategies for waste disposal more difficult to apply. The occurrence of viruses, bacteria, yeasts, fungi, and zooparasites in sewage sludge is reviewed in this article, and consequential epidemiologic concerns that arise from sewage sludge recycling is also addressed.

Agriculture↗
PubMed2000

Isolation technology for research and development applications: from concept to production.

A prototype parenteral manufacturing facility based on isolation technology was designed, constructed, and commissioned at Warner-Lambert Co., Morris Plains, NJ, with emphasis on its application to research and development (R&D) settings. The facility contains closed isolators for holding, transferring, and manufacturing sterile products. Vaporized hydrogen peroxide (VHP) was used for sanitization of the isolators. Various factors were evaluated to ensure complete distribution of VHP inside the isolators. VHP sanitization validation of the isolators was performed using chemical and biological indicators, and by swab testing the inside surfaces of the isolators. On the basis of these studies, operating conditions for routine VHP sanitization of the various isolators were established. Performance qualification of the manufacturing facility was conducted via media fills, which demonstrated sterile integrity of the manufacturing process. The media fills revealed certain deficiencies in handling procedures of filled product, which were subsequently corrected. The Warner-Lambert isolation technology-based parenteral facility proved to be a reliable and cost-effective alternative to standard clean room technology. The facility is ideally suited for manufacturing small batches. Closed isolator technology has its limitations when used for production-size batches involving automated processing.

Hydrogen Peroxide↗
PubMed2001

Response of foodborne Salmonella spp. marker strains inoculated on egg shell surfaces to disinfectants in a commercial egg washer.

The objective of this study was to determine the effectiveness of an iodine based disinfectant (IBD, Iocide, Biomedical Development Corporation, San Antonio, TX) on Salmonella enteritidis and S. typhimurium inoculated on egg shell surfaces under simulated industry egg processing conditions with a commercial egg washer used as the sanitizer delivery system. Re-circulated egg washer water containing 1.40-2.85 g/l total dissolved solids was obtained from a commercial egg processing. Sanitizing treatments consisted of distilled deionized water (DDW), IBD, and chlorine (CL; 200 ppm). All treatments (DDW, IBD and CL) significantly (p < 0.05) decreased Salmonella spp. populations on the shell compared to dry (no spray) egg controls. However, efficacy of egg sanitizers appeared to be dependent on the level of total dissolved solids in the egg wash water.

Animals↗
PubMed1976

Treatment of intestinal parasitic disease.

Although improved sanitation in the United States has resulted in a general diminution in the prevalence of intestinal parasitic infections, some, such as enterobiasis, are not reduced by improved environmental or water sanitation and others, such as amebiasis and hookworm infection, persist in foci. Other infections, notably giardiasis, have increased due to the travels of American tourists in other countries where environmental sanitation is poor. North American physicians, therefore, may expect at some time to have to treat parasitic infections. Favored chemotherapeutic agents currently are: for amebiasis--metronidazole and diiodohydroxyquin; for giardiasis--metronidazole; for tapeworm infections--niclosamide; for enterobiasis--pyrantel pamoate, piperazine citrate, or pyrvinium pamoate; for ascariasis--piperazine citrate; for stronglyoidiasis--thiabendazole; for trichuriasis--mebendazole; for hookworm infection--pyrantel pamoate; for schistosomiasis japonica--tartar emetic; and for schistosomiasis mansoni--niridazole.

Amebiasis↗
PubMed1997

Acid adaptation sensitizes Salmonella typhimurium to hypochlorous acid.

Acid adaptation of Salmonella typhimurium at a pH of 5.0 to 5.8 for one to two cell doublings resulted in marked sensitization of the pathogen to halogen-based sanitizers including chlorine (hypochlorous acid) and iodine. Acid-adapted S. typhimurium was more resistant to an anionic acid sanitizer than was its nonadapted counterpart. A nonselective plating medium of tryptose phosphate agar plus 1% pyruvate was used throughout the study to help recover chemically stressed cells. Mechanisms of HOCl-mediated inactivation of acid-adapted and nonadapted salmonellae were investigated. Hypochlorous acid oxidized a higher percentage of cell surface sulfhydryl groups in acid-adapted cells than in nonadapted cells, and sulfhydryl oxidation was correlated with cell inactivation. HOCl caused severe metabolic disruptions in acid-adapted and nonadapted S. typhimurium, such as respiratory loss and inability to restore the adenylate energy charge from a nutrient-starved state. Sensitization of S. typhimurium to hypochlorous acid by acid adaptation also involved increased permeability of the cell surface because nonadapted cells treated with EDTA became sensitized. The results of this study establish that acid-adapted S. typhimurium cells are highly sensitized to HOCl oxidation and that inactivation by HOCl involves changes in membrane permeability, inability to maintain or restore energy charge, and probably oxidation of essential cellular components. This study provides a basis for improved practical technologies to inactivate Salmonella and implies that acid pretreatment of food plant environments may increase the efficacy of halogen sanitizers.

Acids↗
PubMed2004

Testing disinfectants in the food factory: phenol coefficient method.

Contamination of foods by the environment has direct public health and keeping quality significance. The food factory environment (with raw materials and processing) governs the numbers and types of microorganisms in finished products. Use of the appropriate sampling procedures permits us to discover the magnitude and type of contamination. Microbiological sampling allows objective evaluation of the disinfectants and the sanitation practices and procedures used in the food factory.Disinfectants are antimicrobial pesticides that are primarily used on inanimate surfaces (such as floors, walls, and countertops) to kill infectious bacteria, fungi, and viruses. Antimicrobial pesticides are substances used to kill or suppress the growth of harmful microorganisms on inanimate objects and surfaces. Products intended for the control of microorganisms in or on people or animals are considered drugs, not pesticides, and are therefore regulated by the Food and Drug Administration (FDA). Antimicrobial pesticides are divided into two broad use categories: 1. Non-public health products include those used to control the growth of algae, odor-causing bacteria, and microorganisms causing spoilage, deterioration, and fouling of materials. Examples include antimicrobials used in cooling towers, paints, and paper products. 2. Public health products are intended to control microorganisms infectious to people. Examples include sterilants, which are used to destroy or eliminate all forms of microbial life including fungi, viruses, and all forms of bacteria and their spores; disinfectants, which are used to destroy or irreversibly inactivate infectious fungi and bacteria, but not necessarily their spores; and sanitizers, which are used to reduce, but not necessarily eliminate microorganisms. Examples range from sterilants used to treat surgical instruments to disinfectants applied to hospital floors, walls, and bed linens and sanitizers used on carpets or in laundry additives.

Disinfectants↗
PubMed2003

Palaeoparasitology in Japan--discovery of toilet features.

The development of palaeoparasitology in Japan has occurred in recent decades. Despite the fact that archaeology in Japan has been slow to develop techniques for excavating ancient toilets, important information about the development of sanitation has been derived from the analysis of a few sites. This shows that the earliest people had very simple methods of sanitation. As populations increased, sanitation became more complex. Ditches surrounding early towns were used for excrement disposal. Eventually distinct toilets were developed followed by cesspit type toilets and flushing toilets. The parasites recovered from these toilets include many species that infect humans today. These parasite spectra reflect local use of aquatic, marine, and land animals. Fecal borne disease was an increasing problem as represented by whipworm and ascarid roundworm eggs. Interestingly, ascarid roundworms were absent in the earliest cultures and only became common with rice agriculture. Finds of pollen and seeds in toilet sediments reveal the use of medicinal plants to control the emerging problem of parasites.

Animals↗
PubMed1996

[Immigration and epidemics in the State of São Paulo].

The article discusses sanitation issues as aspects of the process of foreign immigration into São Paulo state during the first decade after the Proclamation of the Republic. The text also shows the relationships between this wave of immigration and the structuring of state sanitation services and the devising of the techno assistance model adodpted by these services as of the 1890's. At a time when yellow fever was the most common and lethal of the epidemics plaguing that state--killing mainly foreigners--one of the lodestars of public health actions was the defense of this inflow of immigrants. The interests of coffee growers, expansion of the railroads, immigration, and yellow fever all came into play when the oligarchies then in power in São Paulo defined what direction sanitation measures would take. The Brazilian government's authoritarian organization left no room for individual health assistance initiatives. Long a demand of both urban and rural populations, forms of individual health assistance became widespread only in the 1930's, when Brazil developed its social health-care system.

Brazil↗