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PubMed2004

Risk factors for diarrhoea and upper respiratory tract infections among children in a rural area of Uganda.

This study explored risk factors associated with diarrhoea and upper respiratory tract infections (URTIs) among children in Sembabule district, Uganda. Data were collected from 300 women with children aged less than two years using the WHO 30-cluster sampling technique. The prevalence of diarrhoea among children was 40.3%. A child not immunized (odds ratio [OR] 2.8, p < 0.001), absence of latrine in a house (OR 1.4, p < 0.03), low knowledge of mixing oral rehydration salts (OR 1.7, p < 0.01), garbage thrown anywhere around the house (OR 2.6, p < 0.001), not washing hands after using latrine (OR 1.8, p < 0.03), and not washing hands before preparing food (OR 1.4, p < 0.04) were risk factors for diarrhoea. The prevalence of URTIs among children was 37.4%. A child not immunized (OR 2.4, p < 0.001), children aged 6-11 months (OR 2.1, p < 0.03), and previous episode of diarrhoea (OR 2.5, p < 0.001) were risk factors for URTIs. The results showed that low immunization status was an important risk factor for diarrhoea and URTIs among children in the study district of Uganda. For 75% of the children, care for fever was obtained from drug shops, while 9.2% were taken to health units. This is in contrast to diarrhoea cases where 49.5% of children were taken to health units for care. To reduce the burden of disease among children in this district, an integrated package of immunization services and other childcare programmes need to be implemented in addition to improved personal and environmental hygiene. There is also a need to design well-focused health-education messages to improve treatment-seeking behaviour for childhood diseases.

Adolescent↗
PubMed2004

Typhoid fever outbreak in Madaya Township, Mandalay Division, Myanmar, September 2000.

In September 2000, an outbreak of typhoid fever was reported in a rural village of Central Myanmar. The authors investigated the outbreak in the affected village. A suspected case was a person suffering from fever with either constipation, abdominal pain, diarrhoea/bloody diarrhoea. A probable case was a suspected case who had positive result on the diazo urine test or widal test. Based on probable cases, the authors conducted a case-control study comparing history of contact with the cases, water source, and personal hygiene. Control was a person living in the village was not ill and having a negative result for diazo urine test. Among 49 suspected cases, 33 were probable. Attack rate was 1.2%. Three cases had a positive culture for Salmonella typhi and were not drug resistant. The following risk factors were identified: drinking unboiled river water (adjusted OR 12.5, 95%CI 2.8-75.3), history of contact with other patients before the illness (adjusted OR 22, 95%CI 3.5-76.2), no hand washing with soap after defecation (adjusted OR 0.15, 95% CI 0.03-0.81). Environmental investigation result showed that most of the households had unsanitary latrine and some latrines were constructed near the edge of a river. The outbreak subsided quickly after intervention.

Adolescent↗
PubMed2004

Intestinal parasitic infections and socioeconomic status in Prek Russey Commune, Cambodia.

OBJECTIVE: Possible relationships were explored between socioeconomic status (SES) and intestinal parasitic infections among residents of Prek Russey, a commune in a rural area near Phnom Penh. METHODS: An epidemiological study was conducted in Prek Russey Commune, consisting of the following three villages: Kroppeu Ha (KH), Prek Russey (PR), and Prek AngChanh (PA), with respective populations of 3,401, 1,350, and 1,044. Examinations of intestinal parasitic infections and the interview survey were performed. RESULTS: Among the residents of KH, PR, and PA, respectively, the prevalence rates of three major species of parasites were as follows: 17%, 27%, and 34% had hookworm; 14%, 17%, and 19% had Ascaris lumbricoides; and 13%, 17%, and 18% had Strongyloides stercoralis. The prevalence of each parasitic group tended to increase in the order of KH, PR, and PA. The greatest differences between the villages were in the prevalence of hookworm infection. Our epidemiological survey revealed three SES-related factors whose proportions increased or decreased in the order of KH, PR, and PA. First, the percentages of households purchasing relatively safe drinking water were 96%, 63%, and 2%, respectively. Second, whereas 82% and 78% of houses in KH and PR were equipped with a latrine, only 41% of houses in PA were so equipped. Third, the proportion of households whose main income was from farming increased in the order of KH, PR, and PA. CONCLUSION: The present study thus suggests that greater latrine use and less dependence on farming activity are related to a lower prevalence of intestinal parasitic infections, although the results are not conclusive due to the ecological nature of the study.

Adolescent↗
PubMed2005

Utility of expanded polystyrene (EPS) beads in the control of vector-borne diseases.

The use of chemicals or bio-larvicides for the control of Culex quinquefasciatus and Anopheles stephensi breeding in pit latrines and overhead tanks (OHT) respectively is discouraged owing to many undesirable impacts in the environment. Due to faecal contamination and poor survival, use of predatory fish in OHTs is not feasible. The use of expanded polystyrene (EPS) beads is a potential alternative in these habitats. EPS beads not only prevent oviposition but also kill the immature by forming a thick blanket on the water surface. A thick layer of 2 cm with beads of 2 mm is sufficient to suppress and prevent mosquito breeding. These are cheap, environmentally safe and do not need frequent application since they remain on the surface for quiet a long time. Successful trials against C. quinquefasciatus breeding in pit latrines, soakage pits, septic tanks, etc., have been carried out in Kenya, Zimbabwe and Tanzania. Certain trials with EPS indicated reduction in microfilaria (mf) rate besides decline in biting density. In India, EPS beads have also been used on small scale for the control of A. stephensi and A. culicifacies breeding in OHTs and unused wells respectively. The polystyrene beads have also been reported to be effective in the control of mosquito breeding in biogas plants and other industrial situations. The practical utility of EPS beads in the control of vector-borne diseases has been discussed in the present review.

Animals↗
PubMed1990

Sanitation in rural communities in Bangladesh.

Household sanitation in developing countries, especially in the rural areas, is poor. An evaluation of what was achieved in this regard during the 1980-90 decade of safe water supply for all was carried out in the present study. It was observed that even where a safe water supply and sanitary latrines were provided, people did not always use them. While 23% of the studied households had sanitary latrines, children in about 11.5% of these households did not use them and women in about 6% of households did not use them for micturition at night. Not a single house in the study area could fulfil all the criteria of sanitary housing in a strict sense; for example, although 34.5% of the households had tubewells, only 11.5% of them had a satisfactory level of water usage. Since socioeconomic conditions and education influence the level of sanitation, improvements in both are required.

Bangladesh↗
PubMed1989

Lack of impact of a water and sanitation intervention on the nutritional status of children in rural Bangladesh.

The nutritional impact of a water and sanitation intervention in a rural community of Bangladesh, comprising the provision of handpumps, construction of latrines and hygiene education was assessed. During 3 years, the quarterly anthropometric measures of about 200 children aged 12-35 months from the intervention community were compared with those of a similar number of children from a control area. The interventions reduced the incidence of diarrhoea by 25 per cent among the children less than 5 years of age. There was no significant difference in nutritional status, however, between the two groups of children. Moreover, within the intervention area, indicators of water and latrine use were not significantly related to the children's nutritional status. This suggests that either the obtained reduction of diarrhoea was not large enough to have an impact on nutritional status or that diarrhoea is not an important cause of malnutrition in this community.

Bangladesh↗
PubMed1987

Longitudinal study on the health status of children in Kikwawila village, Tanzania: study area and design.

The paper describes the study area and the project design of a longitudinal study on the health status of children undertaken in Kikwawila village in southeastern Tanzania from 1982 to 1984. This rural village is situated in the Kilombero river plain (270 m above sea level) and extends over 50 km2. A census in 1982 (repeated in 1984) revealed that 1152 (1406) people lived in 260 (299) households of the nucleated roadside settlements of the sectors Kikwawila and Kapolo. The vital statistics showed an infant mortality rate estimate of 198/1000 which was far above the regional (140%) and the national (137%) averages. Over 30 tribes were recorded but 6 tribes formed 84% of the population. The population was predominantly muslim (75%). Most adult inhabitants (90%) were subsistence farmers cultivating an average of 3.7 acres per household. Rice, maize and cassava were the main crops of the area. At the beginning of the study, the village had no village health post, dispensary or health centre and it lacked an adequate and safe water supply. A great proportion of the population (67%) had to rely on water from unprotected hand dug wells and from rivers for domestic purposes. Only half of the households had a simple pit latrine. Even when latrines were present, they collapsed after heavy rains due to loose, unconsolidated soils, termites and the high water table. These difficulties affected the sustained success of sanitation campaigns. The study area represented a typical settlement of the Kilombero valley and was, with regard to most demographic, ethnic, agricultural and health characteristics, considered a suitable pilot area. A primary health care programme based on village health workers was implemented in parallel with complementary community based studies on the causes, interrelations and control measures of the major health problems faced by the community, and possible control measures.

Age Factors↗
PubMed1987

Longitudinal study on the health status of children in a rural Tanzanian community: parasitoses and nutrition following control measures against intestinal parasites.

Three repeated cross-sectional surveys were undertaken among children (1 month to 15 years) of a rural community in southeastern Tanzania. The study was part of a longitudinal project on the interactions among nutrition, parasitic infections and immunity within a primary health care programme emphasizing village health workers. All children underwent interviews and parasitological, anthropometric, anamnestic and clinical examinations. Out of 550-590 children examined each year, a cohort of 170 children could be followed for three consecutive years. Malaria was holo- to hyperendemic in the community, P. falciparum accounting for greater than 90% of the infections. The parasite and spleen rates were 88% and 67%, respectively, and the average enlarged spleen index was 2.0 among children from 2-9 years in 1982. Transmission of malaria was high and stable as indicated by a parasite rate of 80% among infants between 1 month and 1 year during the whole period of study. G. lamblia, hookworm (N. americanus), Strongyloides spp. and Schistosoma haematobium were highly prevalent and annual incidence rates were high, while Entamoeba histolytica, Ascaris and Trichuris were of minor importance. Prevalence and incidence of parasitic infections did not differ by sex. Multiparasitism was very frequent and less than 11% of all children were parasite-free in each year. Not a single child remained parasite-free for three consecutive years. An anthropometric assessment showed a high degree of stunting (35-71%) and a substantial proportion of wasting (3-20%). The growth potential was normal in girls and boys during the whole period of study. There were indications that malaria was the main contributory factor to growth retardation among young children. Hookworm infection did not significantly affect the packed-cell volume of the children, probably owing to the low intensity of infection. Due to the multiparasitism and the lack of parasite-free individuals, single-parasite and single-nutrient effects were difficult to unravel. A latrine campaign followed by a single mass treatment against hookworm (single oral dose of albendazole, 400 mg) and/or G. lamblia (single oral dose of ornidazole, 40 mg/kg) only temporarily affected the prevalence and incidence of G. lamblia, and only resulted in a decrease in the intensity of hookworm infections up to six months after the interventions. As the effects of the latrine campaign and a single mass treatment on the parasite load were only transient, no sustained impact on nutritional variables was observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1970

Summary of field trials in 1964-69 in Rangoon, Burma, of organophosphorus larvicides and oils against Culex pipiens fatigens larvae in polluted water.

In tests in Rangoon, Burma, of the larvicidal activity of various organophosphorus compounds against C. p. fatigans, it was found that the activity usually lasted much longer in septic tanks and pit latrines than in open drains. Dursban, Abate, fenthion and several other emulsifiable concentrates caused high larval mortality at a concentration of 0.05 ppm but 0.5 ppm was normally required to obtain a minimum of 1-2 weeks of complete larval control. For the desired residual activity, dosages about 40-400 times the laboratory LC(95) values were normally required, depending on the compound used.The most effective formulation was Dursban emulsifiable concentrate, which, at a concentration of 0.5 ppm, was effective for 3, 7 and 12 weeks in concrete drains, pit latrines and septic tanks, respectively. Petroleum oils applied at rates of 25-40 US gal/ac (approx. 237 l/ha-380 l/ha) and a pyrethrum derivative at a concentration of 1.0 ppm were toxic to larvae but not highly residual. Some emulsifiable-concentrate/oil mixtures appeared to be outstandingly effective, although inconsistent results also occurred. Granular formulations were normally less effective than the emulsifiable concentrates.

Animals↗
PubMed1966

The epidemiology of Schistosoma haematobium and S. mansoni infections in the Egypt-49 project area. 3. Prevalence of bilharziasis in relation to certain environmental factors.

The influence of the size and location of communities in relation to the different types of watercourse, the availability of a protected water supply, types of housing and the presence of other sanitary facilities on the prevalence of bilharziasis in the Egypt-49 project area has been studied. There is no direct relationship between the size of village and the prevalence of bilharziasis. Main drains and distributaries are potent sources of infection and, in terms of the total population exposed, distributaries play the most significant role in the transmission of infection. Of the other factors, the availability of a protected water supply seems to have the greatest effect on the prevalence. Although the presence of a latrine in the dwelling does not of itself influence the extent of schistosome infection, which is caught from polluted water, the installation of latrines assists in the cultivation of healthy habits, thereby lessening the prevalence not only of bilharziasis but also of certain other infections.

Adolescent↗
PubMed1967

Observations on the habits and control of Culex pipiens fatigans in Guyana.

Investigations in Guyana in 1961-63 showed that Wuchereria bancrofti was the only filarial parasite causing elephantiasis and that Culex pipiens fatigans was the primary vector. Mansonia titillans and Anopheles aquasalis were found to be secondary vectors.C. p. fatigans bred primarily in pit latrines and secondarily in the clean, confined water of drums and barrels near latrines. No breeding occurred in the relatively clean open water of trenches, ditches and drains.Of 21016 mosquitos collected from houses, 39.9% were found resting on walls, 34.9% on clothing and other hanging objects, and 23.4% on or under furniture. Of 15 622 female mosquitos caught, 9.6% contained W. bancrofti parasites and 0.5% contained infective larvae. The flight range was found to be about half a mile (0.8 km).Control was achieved by a combination of antimosquito (spraying with gas-oil) and antiparasitic (chemotherapy with diethylcarbamazine) measures, which reduced the average infection rates in the Buxton control area from 17.7% to 2.2%. Over the same period, breeding in drums dropped from 14%-25% to 4.7%, even though the drums were not treated or covered.

Adolescent↗
PubMed1982

The distribution and frequency of Culex pipiens quinquefasciatus Say 1823 (Diptera, Culicidae) breeding places on the Kenya Coast in relation to human sociological factors.

In rural settlements of the Kenya Coast C. p. quinquefasciatus develops in three major types of breeding-places. These are pit latrines, cesspools and small cement cisterns which man builds to improve his sanitary facilities. All three types are present in Moslem villages. At present only latrines have been recorded in non-Moslem villages. Building of such facilities is an established practice in Moslem villages while it is recent in non-Moslem ones. The proportion of houses with potential breeding-places is increasing with the standard of living of the inhabitants and with the size of the settlements. Since the building of sanitary facilities will probably increase in the future the mosquito breeding situation will tend to worsen accordingly. Thus there is an urgent need to curb such breeding by developing low cost technology which can easily be implemented.

Animals↗
PubMed1994

Personal and domestic hygiene and its relationship to the incidence of diarrhoea in south Sumatera.

The association of risk factors and diarrhoeal disease incidence among children less than 3 years of age in District Rambutan, South Sumatera, was investigated by a 20-week case-control study of 48 households with a high incidence of diarrhoeal diseases and 111 households with low incidence. Among sociodemographic characteristics, television ownership had a significant negative association with diarrhoeal disease incidence (odds ratio [OR] 3.22). The hygiene behaviour significantly associated with diarrhoeal diseases were: disposing of children's faeces in open places rather than in a latrine (OR > 10.47); bathing children in rivers rather than at wells (OR 2.88); children eating with their hands rather than with spoons (OR 5.6); household members defecating in open places rather than a latrine (OR 2.56); house without sewage system (OR 6.98). To control diarrhoeal disease in the study area, we suggest targeting three groups of behaviour for modification: those related to a) faeces disposal, b) sanitary drainage, and c) handwashing with soap and using spoons for eating.

Child Care↗
PubMed1997

Sanitation for rural communities: first win the people's support.

A latrine project in an Indian village which failed because the inhabitants were scarcely brought into its planning and execution is contrasted with a moderately successful scheme in another village where a concerted effort was made to educate the community about the value of latrines and to obtain the people's participation.

Community Participation↗
PubMed1990

Archaeoparasitology in North America.

The study of prehistoric parasitism through analysis of coprolites, mummies, skeletons, and latrine soils is rapidly growing. Its development in North America is interdisciplinary and is derived from the fields of physical anthropology, parasitology, and archaeology. The various parasite finds from North America are reviewed. The data show that prehistoric peoples in North America suffered from a variety of parasitic diseases. The validity of the findings are then considered. Although most finds of parasites from prehistoric contexts result from human infections, some finds cannot be verified as such. However, in combination with data from South America, it is clear that prehistoric peoples in the Americas were host to a variety of human parasites, some of which were not previously thought to be present before historic times.

History, Ancient↗
PubMed2005

Analysis of incidence rates in cluster-randomized trials of interventions against recurrent infections, with an application to trachoma.

A method is developed for the Bayesian analysis of rate ratios of repeated events in matched cluster-randomized trials, and applied to the Flies and Eyes trial against trachoma in The Gambia. A non-mechanistic analysis estimates the incidence rate ratio for insecticide spray, relative to no intervention, as 0.59 (95 per cent credible interval 0.37--0.92), and for latrine provision as 0.67 (0.41--1.01). The method also yields incidence and clearance rate ratios for age. In the Flies and Eyes trial, the former rates are estimated to decrease with age, although no clear pattern is seen in the latter. Using clinical active trachoma as a marker of infection, and net catches to measure fly density, a mechanistic model is developed to estimate the proportion of transmission due to flies. However, it was not possible to estimate this proportion accurately, and a lack of association was noted between the magnitudes of reductions in fly density and in trachoma. The lack of knowledge on the relative importance of different transmission routes is a constraint on the current global programme for the elimination of trachoma.

Adolescent↗
PubMed2002

Impact of water supply and sanitation on diarrheal morbidity among young children in the socioeconomic and cultural context of Rwanda (Africa).

This project studied the frequency and intensity of water contamination at the source, during transportation, and at home to determine the causes of contamination and its impact on the health of children aged 0 to 5 years. The methods used were construction of the infrastructure for three sources of potable water, administration of a questionnaire about socioeconomic status and sanitation behavior, anthropometric measurement of children, and analysis of water and feces. The contamination, first thought to be only a function of rainfall, turned out to be a very complex phenomenon. Water in homes was contaminated (43.4%) with more than 1100 total coliforms/100 ml due to the use of unclean utensils to transport and store water. This socioeconomic and cultural problem should be addressed with health education about sanitation. The latrines (found in 43.8% of families) presented a double-edged problem. The extremely high population density reduced the surface area of land per family, which resulted in a severe nutritional deficit (15% of the children) affecting mainly young children, rendering them more susceptible to diarrhea (three episodes/child/year).

Adolescent↗
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↗