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Rapid assessment survey of earthquake affected Bhuj block of Kachchh District, Gujarat, India.

RESEARCH QUESTIONS: How much human loss would have caused by the earthquake in Bhuj block? What is the environmental sanitation status? OBJECTIVES: (1) To assess human loss and injuries after the earthquake in Bhuj block.(2) To study the status of some relief activities.(3) To study the environmental sanitation status of the earthquake affected Bhuj block. STUDY DESIGN: Cross-sectional study. SETTINGS: Bhuj block. PARTICIPANTS: All villages excluding Bhuj city of Bhuj block. STATISTICAL ANALYSIS: Proportions, chi-square test, chi-square for trend. RESULTS: Survey was done in 144 villages; there were total 541 deaths with death rate of 3.18 per 1000 population. Death rate was significantly associated with distance of village from epicenter (chi-square for trend significant, P < 0.001). Among victims, majority were children 171 (45.4%) and women 107 (28.4%). Relief work was significantly associated with accessibility of village (P < 0.001) and few interior pockets were deprived of help. Total 56 (38.9%) villages were entirely dependent on water tanker for water supply and in 61 (42.4%) villages drinking water was used without chlorination. In 142 (98.6%) villages open-air defecation was practiced. Diseases such as URTIs, diarrheal diseases, fever and conjunctivitis were commonly observed in the field area.

Adolescent↗

Health care utilization patterns in developing countries: role of the technology environment in "deriving" the demand for health care.

Health care services, in combination with several intermediate (proximate) determinants of health such as environmental sanitation and nutrition, directly influence health status. In the economics literature, this is referred to as the health production technology. Although many studies recognize that demand for health care depends on the health production technology, otherwise known as a "derived" demand, this review indicates that few of them have so far been able to fully incorporate this technology in estimating significant determinants of health care use. Understanding the technology environment could help explain why substantial portions of the population do not gain access to care even when financial factors do not appear to be a barrier. Also, low utilization of health services may simply reflect the low productivity of these services when other complementary factors such as nutrition or clean water and sanitation are lacking. Finally, since health-producing technology is often a multistep (multivisit) process, health care demand studies generally offer an incomplete picture of health care utilization patterns because they focus on a single event such as the first visit of an illness episode. Researchers should obtain more complete information on the interaction between all health production inputs, their availability and access to them. Multidisciplinary methodologies are likely to be useful.

Developing Countries↗

Emerging issues in water and health research.

In the less developed nations, hygiene and sanitation remain overriding factors in population health and the burden of waterborne disease. Both morbidity and mortality from diseases, such as cholera, remain high, but the overwhelming burden of diarrhoeal diseases inevitably goes undiagnosed. Enterotoxic E. coli, shigellosis and campylobacteriosis are prevalent amongst bacterial diseases and giardiasis is often diagnosed among protozoan diseases. In terms of viral diseases, hepatitis A is frequently associated with water and rotavirus, and more recently norovirus, infections are suspected to be major causes of gastroenteritis, although they are seldom diagnosed. From the perspective of research and training, and despite the efforts of major international organizations, effective programs that teach basic hygiene and sanitation remain elusive.

Communicable Diseases, Emerging↗

[Factors contributing to endemic cholera in Douala, Cameroon].

Cholera has been endemic in Douala, Cameroon since 1971. A number of environmental factors favourize the survival of the Vibrio in Douala including location at the mouth of Wouri delta on the Atlantic Ocean, sandy clay soil, shallow dirty polluted foul-smelling groundwater, presence of vast expanses of swamp, streams/drainage ditches infested with algae, and high temperatures with low rainfall and drought during certain periods of the year. Most outbreaks have started in Bepanda, a slum area built on a garbage dump in a swampy zone fed by drainage ditches carrying the faecal pollution from neighbouring upstream districts. It is a densely overcrowded area of uncontrolled urbanization generated by the influx of poor city new-comers who live without adequate access to clean water or basic sanitary facilities. The most affected areas are those resulting from recent unregulated urban sprawl in polluted swamp zones or garbage dumps. Since access to the public water system is inadequate with only 65000 persons connected for 3 million inhabitants, dwellers in most areas must take water from the 70000 urban wells (estimated in 2004) that are often not more than 1.5 m deep. Sewage facilities are insufficient to provide complete evacuation of solid and liquid waste. The network of rivers, streams and man-made ditches waste are poorly maintained and often overflow during the rainy season. The contents of latrines are often discharged directly into the environment. Social factors such as the reformation of urban tribes and persistence of traditional attitudes toward waste disposal and water use have not only led to high-risk behaviour but also created barriers to sanitation and hygiene education. With an inadequate sanitation inspection system, a large but purely accessible public health system and a highly disorganized private health sector exists, effective preventive measures are difficult to implement. The combination of these factors probably account for the endemicity of cholera in Douala.

Cameroon↗

[Socioeconomic status and hygiene habits of the members of a rural community from the province of Habana].

A study is made of the socioeconomic conditions, environmental sanitation, and hygienic habits in the members of a rural community in Havana province. This was compared with the results of a stool culture analysis made to all inhabitants of this locality in order to determine the degree of infestation by intestinal parasites. It was found that sanitation conditions are good, which explains the low prevalence of helminths. The greatest proportion of parasitized people show inappropriate habits of personal hygiene, which explains that most of them are due to protozoa.

Adolescent↗

Infant mortality and socioeconomic development: evidence from Malaysian household data.

Household data from Malaysia are used to assess the roles of a number of mortality correlates in explaining the inverse relationship between the infant mortality rate (IMR) and socioeconomic development. Increases in mothers' education and improvements in water and sanitation are the most important household-level changes that accompany regional and temporal development and contribute to the inverse relationship between the IMR and development. One concomitant of development--reduced reduced breastfeeding--has kept the relationship from being even stronger. Continued prevalence of extended breastfeeding in the poorer states of Peninsular Malaysia and a narrowing of educational and sanitation differentials helped close the IMR gap between the richer and the poorer states.

Adult↗

Amebic liver abscess in children: clinical and epidemiologic features.

Amebiasis, that is, infection with Entameba histolytica, continues to be endemic in the United States, with liver abscess occurring as an infrequent but constant complication. Seven cases are reported, with epidemiologic investigation of two. Reliable findings in hepatic abscess include fever, abdominal pain, respiratory distress, tender abdomen, and large, tender liver. Anemia, elevated white count with left shift, and the radiographic findings of an elevated right hemidiaphragm are constant. Epidemiologically, amebiasis occurs in clusters in the United States with person-to-person transmission predominant in spread. Infection is associated with poor sanitation and crowding. Investigation of the families of two patients documented 9/21 carriers and an additional 3/21 who were seropositive, as well as crowding and poor sanitation. In this country, treatment of a patient with amebic disease should include investigation of his home and family.

Adolescent↗

Hospital dietetics and food service in developing countries: III. Bangladesh.

A survey of 11 hospitals in Bangladesh revealed that most heads of hospital food service had little or no training in nutrition and dietetics, hospital diets were usually inadequate, therapeutic diets were seldom used, and kitchen sanitation was poor. However, in three hospitals in which the heads of food service had some education in nutrition, conditions were markedly better. Even though the results of this survey suggest that major improvements are needed in hospital food service and dietetics in Bangladesh, extensive training programs are probably unrealistic because of the limited economic base of the country. Short-term inservice training programs could result in marked improvement in the quality of food service, sanitation, and the use of therapeutic diets.

Bangladesh↗

Urban planning and vector control in Southeast Asian cities.

A large and growing proportion of the population in many Southeast Asian cities live in slums and squatter settlements and they suffer from excessive exposure to insect and rodent vectors which transmit disease from one host to another. In such settlements, the quality of life, which is poor anyway, is made even worse by the high incidence of vector-borne diseases. Vector proliferation in high-density, low-income urban settlements is the consequence of a number of factors, such as lack of adequate housing, water supply, sanitation, drainage, and solid waste management facilities. There is an urgent need to rethink intersectoral and integrated approaches to the design and planning of healthy urban environments, covering such matters as basic infrastructure and services, urban land use planning and waste management, health-promoting housing and architecture, and the control of all other factors that determine human health and well-being. With cooperation between and among the communities, local governments, and nongovernmental organizations as the basis, the installation of low-cost sanitation and drainage systems, the organization of collection services for the disposal of garbage, the provision of house screening and other protective measures, and the removal of breeding sites can greatly reduce the threat of most urban vectors.

Animals↗

Measuring the interactions of the determinants of health.

Considering environmental sanitation and health care services as most important determinants of health, this study was undertaken to know their impacts in an urban slum area of Calcutta. The families were studied in-depth and detail in relation to their health status in the form of morbidities and utilisation of preventive and promotive services. The health service impact was mainly assessed through comparative study between these who availed the services and to these who did not. Similarly, environmental sanitation services impact on health was measured through comparing the slum group with those who lived in Pucca houses. The criteria of priority decision on determinants was attempted through analysis of cost of these services and comparing their beneficial effects on health.

Adolescent↗

Contaminated weaning food: a major risk factor for diarrhoea and associated malnutrition.

Infections and the malnutrition associated with them are responsible for a significant proportion of the 13 million deaths among infants and children under 5 years of age worldwide each year. After respiratory infections, diarrhoeal diseases are the commonest illnesses and have the greatest negative impact upon the growth of infants and young children. The causes of diarrhoeal diseases have traditionally been ascribed to water supply and sanitation. In attempts to prevent such diseases, efforts by governments and nongovernmental organizations have been focused on and sometimes limited to improving water supply and sanitation as well as promoting and protecting breast-feeding. Based on studies reported in the literature, this review article demonstrates that weaning foods prepared under unhygienic conditions are frequently heavily contaminated with pathogens and thus are a major factor in the cause of diarrhoeal diseases and associated malnutrition. In the light of the evidence presented, it appears that current efforts are not sufficient to prevent diarrhoeal diseases: education of mothers in food safety principles, particularly weaning food, must also receive high priority. Educational programmes based on the hazard-analysis-critical-control-point approach, taking into consideration also sociocultural factors, should be integrated into all national infant feeding or food and nutrition programmes.

Adult↗

Hookworm infection and disease: advances for control.

Advances in epidemiology and in control strategies of hookworm infection and associated disease were reviewed. Recent estimates indicate that hookworms infect approximately 1.3 billion people worldwide, and 96 million suffer from associated morbidity, including also insidious effects on nutritional status and on physical and intellectual development. Recent research studies on iron loss and iron-deficiency anaemia associated to hookworm infection were irondeficiency anemia associated to hookworm infection were reviewed. Recommendations for planning strategies for the control of hookworm infection were addressed and epidemiology, targets, chemotherapy, health education, sanitation, monitoring and evaluation in helminth control programmes were discussed. Special relevance was given to chemotherapy with new, single dose broad spectrum, safe anthelminthic drugs as the mainstay of control strategy to reduce intensity of infection, iron-deficiency anaemia and other morbidity indicators associated with hookworm infections. For the control of transmission of hookworm infection, periodic chemotherapy should be implemented in the context of ongoing improvement of sanitation and promotion of health education. These elements should be integrated into the prevailing system of primary health care and must be based on multisectoral collaboration to ensure sustainability of control programmes.

Ancylostoma↗

[Guidelines for prevention and therapy in ecological animal farms as in the example of bovine mastitis].

In ecological farming mastitis is the dominating disease in dairy cattle. The regular prophylactic use of antibiotics in farm animals is forbidden, in therapy antibiosis is restricted. A solution of this problem could be a program of systematic homeopathic prophylaxis as well as a standardised homeopathic treatment. The example of chronic catarrhal staph.-aureus-mastitis shows that there is only a certain expectancy of success by homeopathy as well as by any other medication, if the medication is combined with necessary sanitation measures. The prognosis for a homeopathic treatment is less favourable if the sanitation measures are realised incompletely. The possible negative effects of a false homeopathic medication are described.

Animal Husbandry↗

Diarrhoea in children of Nigerian market women: prevalence, knowledge of causes, and management.

A cross-sectional survey was carried out among mothers of children aged less than five years in two markets in Ibadan, one with poor environmental sanitation and the other clean and well maintained. The study took place between September 1996 and March 1997. The questionnaire used for this survey sought information about the occurrence of diarrhoea among children aged less than five years, their mothers' knowledge about the management of diarrhoea and their practices, including care-seeking practices, and the use of oral rehydration solutions. Two hundred and sixty-six mothers were interviewed in the first market (Bodija) and 260 in the other (Gbagi). Thirty-seven percent of the children in the cleaner market (Gbagi) were said to have had diarrhoea within the last 3 months compared to 33% of the children in the unhygienic Bodija market (p > 0.05). These results suggest that environmental sanitation may not be a major determinant of diarrhoea among children of the two groups of market women. When their children had diarrhoea, 44% (Bodija) and 40% (Gbagi) of the mothers attended health centres, 33% (Bodija) and 32% (Gbagi) gave ORT at home, and 12% (Bodija) and 19% (Gbagi) purchased drugs at a chemist. The study further showed that, while only one-third of all respondents resorted to home-treatment of diarrhoea with ORS, more than 80% of them knew the components and composition of ORS solution. There is a need to continue to encourage mothers to use ORS and, thus, bridge the knowledge-practice gap in mothers' management of diarrhoea at home.

Adult↗

Oyster-associated hepatitis. Failure of shellfish certification programs to prevent outbreaks.

During October and November 1973, outbreaks of hepatitis A associated with consumption of raw oysters occurred in Houston and in Calhoun, Ga. The oysters implicated in both outbreaks had been harvested in two Louisiana bays. Although the bays had been contaminated with polluted Mississippi River water two months before the oysters were harvested, at the time of harvesting the bays met national sanitation standards for shellfish growing and were certified for oyster fishing. These epidemics raise serious questions about the adequacy of shellfish sanitation monitoring systems currently in use.

Certification↗

Contribution of genetic and environmental factors in the pathogenesis of Crohn's disease in a large family with multiple cases.

BACKGROUND: A large family of Moroccan immigrants was investigated. In this family the father developed Crohn's disease (CD) after moving from Morocco to Belgium and successively 4 of his 8 children subsequently developed CD. There was no previous history of familial CD. METHODS: The family was interviewed at their home and an elaborated questionnaire was completed. The food and sanitation characteristics of the family were investigated. Moreover, serological markers were tested in all family members, including ASCA, ASCAg, ALCA, ACCA, Omp, and ANCA, using enzyme-linked immunosorbent assay and indirect immunofluorescence. Genetic variants in CARD15, TLR4, NOD1, CARD8, and DLG5 associated with CD were tested as well. The complete medical history of all patients was reviewed. RESULTS: There were no known genetic variants associated with CD in this family. None of the serological antibodies could discriminate between patients and unaffected family members, although the antibody titers were higher in diseased family members as compared with the healthy family members. CONCLUSION: The occurrence of 5 new cases of CD within 1 Moroccan family after immigration to Belgium cannot be explained by the known genetic susceptibility factors, and thus suggests a major environmental factor probably not related to sanitation in childhood.

Adolescent↗

A descriptive follow-up study on Helicobacter pylori infection before and after exposition to a war area.

One hundred and thirty asymptomatic Irish soldiers were studied before and after a 6-month peace duty in Lebanon (UNIFIL), to assess the overall prevalence of Helicobacter pylori infection, relation with age, rank and education, and any increased risk of developing H. pylori infection in a cohort of asymptomatic people temporarily exposed to low levels of sanitation. Enzyme linked immunosorbent assays (ELISA) of specific IgG were performed, at the end of the research, on blood samples taken 1 month before service abroad and within 3 months after the mission. At entry, 41 people were found to have positive H. pylori serology (31.5%), while 89 subjects (68.5%) were H. pylori negative. After 6 months of service in Lebanon, 37 people had H. pylori positive serology (28.5%), while 93 subjects (71.5%) were H. pylori negative. Therefore, no significant change occurred. The prevalence of H. pylori infection increased with age and was more prevalent in lower ranks and in those with non-tertiary education. This study shows that a 6 month long stay in poor sanitation conditions does not imply any increased risk of developing H. pylori infection, which is, however, related to age, lower rank, and non-tertiary education.

Adult↗

Considerations of HAV vaccine in India.

Currently available evidence indicates that most parts of India still quality to be hyper-endemic regions and hence recommendations for vaccinations developed for low endemicity regions are not applicable. There are however, some pockets which showed evidence of distinct epidemiologic shift. There is need to identify geographic regions like Kerala which have potential for epidemic outbreaks through cyclic sero-epidemiological surveys. With economic development and consequent improvements in the levels of sanitation and quality of water supplies, more such areas will be identified. Efforts to improve sanitation and personal hygiene will remain as the most important and efficient intervention to retard the transmission of HAV. Unless a critical improvement in the living standards of our population is achieved, aim of eradicating HAV infection from the community is not realistic. Presently, the cost of three doses of HAV is exorbitant and the focus of HAV vaccination will have to be restricted to individual protection who are likely to remain unexposed till adulthood and can afford to pay for it. HAV Infection below 5 years is mostly asymptomatic. The most efficient use of resources will therefore be to offer HAV vaccine to high risk individuals beyond this age after screening for antibodies against HAV.

Adult↗