Diarrhoea, malnutrition, and dehydration associated with school water, sanitation, and hygiene in Metro Manila, Philippines: A cross-sectional study

Water insecurity may exacerbate food insecurity even in water-rich environments: Evidence from the Bolivian Amazon

Globally, challenges with water and food are two of the most pressing problems people face. Yet hydrologically water-rich environments and rural environments are often overlooked in these discussions due to abundance of natural water resources. Here we test the relationship between water and food insecurity among 270 Tsimane' households in the Bolivian Amazon. Water challenges were evaluated with the Household Water Insecurity Experiences Scale (HWISE), water quality perception, objective water quality analyses, and water access via the JMP drinking water ladder. Food insecurity was measured with the Household Food Insecurity Access Scale (HFIAS), and quantitative measures of food frequency recall were used to further test the water and food insecurity relationship. Using multilevel mixed-effects linear regression, each point increase in HWISE score was associated with 0.47 point (95 % CI: 0.30, 0.62, p < 0.001) higher food insecurity, and households with access to improved water sources had between 1.25 and 1.36 points (95 % CI: -2.61, -0.01, p < 0.05) lower food insecurity compared to households reliant on surface water. These relationships held true independent of quantitative measures of both fish and meat consumption. Using mixed-effects logistic regression analyses, each point increase in HWISE score was associated with 43 % (95 % CI: 1.25-1.66, p < 0.001) increased odds of experiencing severe food insecurity. Households changing what was eaten due to experienced water problems was associated with 2.33 points (95 % CI: 0.41, 4.25, p < 0.05) higher food insecurity. This relationship held true independent of perceived water quality, indicating other structural water problems may be important here in the household water and food insecurity relationship. These results demonstrate that even in water-rich environments, like the Amazon, water and food insecurity are interconnected. Further, despite the challenging conditions, equitable structural interventions, like the development of improved water infrastructure, are critical for the provision of clean drinking water and may simultaneously help alleviate food insecurity.

Forecasting of diarrhea disease using ARIMA model in Kendari City, Southeast Sulawesi Province, Indonesia

Background

In Indonesia, diarrhea is one of the endemic diseases that often leads to death. The high number of diarrhea cases has the potential to become an extraordinary event, thus requiring more serious attention. This research aims to analyze the data on recorded cases of diarrhea in the Health Department of Kendari City from January 2016 to June 2022.

Methods

The ARIMA model, commonly referred to as ARIMA (p, d, q), is used, where p represents the autoregressive terms, d indicates the non-seasonal differences required for achieving stationarity, and q denotes the lagged forecast errors in the prediction equation. To determine the order of the autoregressive (AR) and moving average (MA) components included in the ARIMA model, the patterns of the plot of the auto-correlation function (ACF) and the partial auto-correlation function (PACF) were utilized. Data analysis was carried out using Minitab Release 16 software.

Results

The forecast using this model indicates a decrease in diarrhea cases over the next two years, from July 2022 to June 2024. The forecast estimates a total of 1.971 diarrhea cases from July 2022 to June 2023 and 1.255 cases from July 2023 to June 2024.

Conclusions

The incidence of diarrhea in Kendari City fluctuates every year. This forecast provides an early warning to the government to take preventive measures against diarrhea. It is hoped that this system will reduce the negative impact of diarrhea in Kendari City.

Quantitative evaluation of water, sanitation, and hygiene measures on COVID-19 pandemic peak reduction in the Philippines

New cases of coronavirus disease 2019 (COVID-19) are continually being recorded worldwide, despite global efforts in implementing non-pharmaceutical interventions and establishing vaccination programs. This trend highlights the need to identify the factors associated with the continued spread of COVID-19. The World Health Organization recommends hand washing as a cost-effective intervention for preventing COVID-19, indicating that water, sanitation, and hygiene (WaSH) are central to the prevention of the disease. However, low- and middle-income countries lack adequate access to WaSH, which increases the risk of contracting COVID-19. The aim of this study was to identify the WaSH factors associated with the incidence of COVID-19 and quantitatively estimate the effects of improvements in WaSH on reducing the incidence of COVID-19 during the peak of the pandemic. Lasso regression and extreme gradient boosting models were used to identify the WaSH factors. Distinct estimation models were developed to assess the effect of WaSH in rural regions under two assumptions: increasing regional basic sanitation coverage up to 25 % and 50%. The reduction in the incidence of COVID-19 during the peak of the pandemic was calculated for each rural region. The results of the analyses indicated that basic sanitation is important for reducing the incidence of COVID-19 in rural regions compared to urban regions in the Philippines. In addition, the results suggested that increasing basic sanitation coverage could reduce the incidence of COVID-19 by 2-66 %, alleviating the burden on healthcare facilities. This study indicates that improved basic sanitation infrastructure are needed in rural Philippines. The results of this study emphasise the significance of WaSH as an indicator of COVID-19 incidence, highlighting the need for its enhancement to enable the achievement of sustainable disease prevention and pandemic preparedness goals.

Levels of handwashing and vaccine uptake in Kenya, Uganda, and Tanzania to prevent and control COVID-19: a systematic review and meta-analysis

Introduction

Coronavirus Disease 2019 (COVID-19) presents a massive challenge in Africa due to overwhelmed and underresourced health systems, as well as the existing burden of communicable and non- communicable diseases. Self-inoculation may occur when an individual touches their mucous membrane following direct contact between their hands and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-contaminated surfaces. Therefore, handwashing can be used along with COVID-19 vaccines to reduce the spread of SARS-CoV-2 and the burden of COVID-19. We were interested in investigating the levels of handwashing and vaccine uptake to control and prevent COVID-19 in Kenya, Uganda and Tanzania using a systematic review and meta-analysis.

Methods

We searched PubMed, African Index Medicus and African Journals Online for studies published since inception to 31st January 2023. We included all studies that assessed: the levels of COVID-19 vaccine acceptance and hesitance as indicators of vaccine uptake; and studies on the levels of handwashing to prevent and control COVID-19 in Kenya, Uganda and Tanzania. Study findings were synthesized by meta-analysis to get the pooled effect measure. Three studies were synthesized qualitatively due to high level of heterogeneity in effect measure precluding a quantitative meta-analysis.

Results

Our search identified 128 articles of which 17 studies with 18,305 participants and 622 vaccination sites were reviewed with 14 of them being meta-analyzed. This systematic review and meta-analysis reports high levels of COVID-19 vaccine acceptance and handwashing in Kenya, Uganda and Tanzania at 67% (95% CI: 55, 78) and 88% (95% CI: 73, 97), respectively. Vaccine hesitance among the participants was low at 31% (95% CI: 15, 49).

Discussion

Despite their importance in the control and prevention of COVID-19, some countries do not implement handwashing and vaccination effectively. There is a need for public health strategies to raise awareness about the importance of handwashing and the uptake of the COVID-19 vaccine.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, PROSPERO ID CRD42023394698.

School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines

BACKGROUND

The impacts of multicomponent school water, sanitation, and hygiene (WaSH) interventions on children's health are unclear. We conducted a cluster-randomized controlled trial to test the effects of a school WaSH intervention on children's malnutrition, dehydration, health literacy (HL), and handwashing (HW) in Metro Manila, Philippines.

METHODS

The trial lasted from June 2017 to March 2018 and included children, in grades 5, 6, 7, and 10, from 15 schools. At baseline 756 children were enrolled. Seventy-eight children in two clusters were purposively assigned to the control group (CG); 13 clusters were randomly assigned to one of three intervention groups: low-intensity health education (LIHE; two schools, n = 116 children), medium-intensity health education (MIHE; seven schools, n = 356 children), and high-intensity health education (HIHE; four schools, n = 206 children). The intervention consisted of health education (HE), WaSH policy workshops, provision of hygiene supplies, and WaSH facilities repairs. Outcomes were: height-for-age and body mass index-for-age Z scores (HAZ, BAZ); stunting, undernutrition, overnutrition, dehydration prevalence; HL and HW scores. We used anthropometry to measure children's physical growth, urine test strips to measure dehydration, questionnaires to measure HL, and observation to measure HW practice. The same measurements were used during baseline and endline. We used multilevel mixed-effects logistic and linear regression models to assess intervention effects.

RESULTS

None of the interventions reduced undernutrition prevalence or improved HAZ, BAZ, or overall HL scores. Low-intensity HE reduced stunting (adjusted odds ratio [aOR] 0.95; 95% CI 0.93 to 0.96), while low- (aOR 0.57; 95% CI 0.34 to 0.96) and high-intensity HE (aOR 0.63; 95% CI 0.42 to 0.93) reduced overnutrition. Medium- (adjusted incidence rate ratio [aIRR] 0.02; 95% CI 0.01 to 0.04) and high-intensity HE (aIRR 0.01; 95% CI 0.00 to 0.16) reduced severe dehydration. Medium- (aOR 3.18; 95% CI 1.34 to 7.55) and high-intensity HE (aOR 3.89; 95% CI 3.74 to 4.05) increased observed HW after using the toilet/urinal.

CONCLUSION

Increasing the intensity of HE reduced prevalence of stunting, overnutrition, and severe dehydration and increased prevalence of observed HW. Data may be relevant for school WaSH interventions in the Global South. Interventions may have been more effective if adherence was higher, exposure to interventions longer, parents/caregivers were more involved, or household WaSH was addressed.

TRIAL REGISTRATION NUMBER

DRKS00021623.