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Maniragaba F, Nzabona A, Lwanga C, Ariho P, Kwagala B. Factors that influence safe water drinking practices among older persons in slums of Kampala: Analyzing disparities in boiling water. PLoS One 2023; 18:e0291980. [PMID: 37738226 PMCID: PMC10516437 DOI: 10.1371/journal.pone.0291980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Safe drinking water practice is a key public health promotion strategy for reducing the spread of waterborne diseases. The purpose of this study was to investigate the factors that influence boiling water practice among older persons in informal settlements of Kampala. METHODS We collected primary data on "Access to safe water and health services among older persons in informal settlements of Kampala in October 2022. The study interviewed 593 men and women aged 60 years and older. The Complementary log-log multivariable technique was used to establish the association between boiling water practice and selected independent variables. RESULTS The results show that nearly 8% of the respondents did not boil their water for drinking. The findings show that the female older persons had increased odds of boiling water to make it safe for drinking compared to their male counterparts (OR = 1.859, 95% CI = 1.384-2.495). Other factors associated with boiling water practice among older persons in the informal settlements of Kampala were; living alone, quality of house, and type of water source. CONCLUSION Basing on our findings, we find that older women are more likely to use safe drinking water practice (boiling) compared to the male older persons. Health education majorly targeting older men about the importance and health benefits associated with safe water drinking practices should be prioritized by policy makers. There is need to improve housing conditions of older persons to minimize typhoid, diarrhea and other health risks associated with drinking unsafely managed water.
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Affiliation(s)
- Fred Maniragaba
- Department of Population Studies, Makerere University, Kampala, Uganda
| | | | - Charles Lwanga
- Department of Population Studies, Makerere University, Kampala, Uganda
| | - Paulino Ariho
- Department of Population Studies, Makerere University, Kampala, Uganda
| | - Betty Kwagala
- Department of Population Studies, Makerere University, Kampala, Uganda
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Calderón-Villarreal A, Alamo-Hernández U, Terry B, Salgado-de-Snyder N. Popular education to improve water quality and hygiene in a Mexican indigenous community. Glob Health Promot 2023; 30:39-48. [PMID: 37067026 DOI: 10.1177/17579759231152875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Long-term research has identified significant water contamination and associated poor health outcomes in the indigenous community of Alpuyeca, located in south-central Mexico. We set out to develop a popular education initiative in this community to improve water, sanitation and hygiene (WaSH) knowledge and practices. In order to avoid recreating hierarchical power dynamics in this vulnerable community, a participatory action research (PAR) design was used, wherein the community took leadership and facilitation roles in each stage of the research process. In qualitative interviews and design sessions, community members identified unsatisfied WaSH needs in households and community institutions and articulated a clear worldview of the spiritual role of water, which guided the development of a series of popular education-based workshops and discussions. The popular education initiative process was documented with a mixed methods framework, using before-and-after surveys, semi-structured interviews and participatory observation. Increases in knowledge and practices related to water purification, water consumption and hand hygiene were noted in the community. The community identified locally installed and managed ecotechnologies as a key opportunity for sustainable development, community participation and the adoption of water and sanitation systems, compatible with public imaginaries of the role of water.
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Affiliation(s)
- Alhelí Calderón-Villarreal
- Department of Family and Preventive Medicine, University of California, USA
- School os Public Health, San Diego State University (SDSU), USA
- National Institute of Public Health of Mexico (INSP), Mexico
| | | | - Brendan Terry
- Department of Environmental Analysis, Pomona College, USA
- Epigenetics Programme, Babraham Institute, Cambridge, UK
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Zhu Y, Jiao X, Meng W, Yu X, Cheng H, Shen G, Wang X, Tao S. Drinking Water in Rural China: Water Sources, Treatment, and Boiling Energy. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:6465-6473. [PMID: 37040484 DOI: 10.1021/acs.est.2c09344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Access to safe drinking water is a major public concern in China. A national survey of 57 029 households was conducted to fill major knowledge gaps on drinking water sources, end-of-use treatment methods, and energy used to boil water. Herein, we show that surface water and well water were frequently used by >147 million rural residents living in low-income inland and mountainous areas. Driven by socioeconomic development and government intervention, the level of access to tap water in rural China increased to 70% by 2017. Nevertheless, the rate was considerably lower than that in cities and unevenly distributed across the country. Approximately 90% of drinking water was boiled, an increase from 85% a decade ago. The contribution of electricity, mainly electric kettles, to the boiling of water was 69%. Similar to cooking, living conditions and heating requirements are the main influencing indicators of energy used to boil water. In addition to socioeconomic development, government intervention is a key factor driving the transition to safe water sources, universal access to tap water, and clean energy. Further improvement in drinking water safety in poor and remote rural areas remains challenging, and more intervention and more investment are needed.
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Affiliation(s)
- Yaqi Zhu
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Xiaoqiao Jiao
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Wenjun Meng
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Xinyuan Yu
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Hefa Cheng
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Guofeng Shen
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Xuejun Wang
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
| | - Shu Tao
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
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Jesus FOD, Bentes VDS, Segura-Muñoz SI, Meschede MSC. [Efficacy of household methods for disinfecting water for human consumption: focus on the context of Santarém, state of Pará, Brazil]. CAD SAUDE PUBLICA 2023; 39:e00205322. [PMID: 36820740 DOI: 10.1590/0102-311xpt205322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/13/2023] [Indexed: 02/22/2023] Open
Abstract
In the Amazon region, cities such as Santarém, in the state of Pará, Brazil, still lack Water Treatment Stations to serve the entire population. In these places, household methods of water disinfection are important to preserve potability and avoid undesirable health effects. Our study experimentally evaluated the effect of household methods for eliminating Escherichia coli in water samples. The techniques evaluated for this study were: (i) sodium hypochlorite 2.5%; (ii) boiling; (iii) ceramic filter, and (iv) sun exposure. Samples were tested, combining different concentrations of E. coli (from 3 to 100 colony forming units/100mL). The results showed that household disinfection methods were effective in eliminating E. coli; except for the ceramic filter, the water of which was still positive for their growth, even after filtration. Considering that the distribution of treated water does not reach most of the population living in Santarém and in peri-urban areas, such as the quilombola and riverside communities, the use of such methods as sodium hypochlorite 2.5%, boiling, and sun exposure may favor health promotion and reduce the occurrence of outbreaks of dysentery transmitted by water.
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Environmental factors related to children diagnosed with stunting 3 years ago in Salatiga City, Central Java, Indonesia. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2023. [DOI: 10.1016/j.toxac.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Rahmat ZS, Zubair A, Abdi I, Humayun N, Arshad F, Essar MY. The rise of diarrheal illnesses in the children of Pakistan amidst COVID-19: A narrative review. Health Sci Rep 2023; 6:e1043. [PMID: 36620511 PMCID: PMC9811062 DOI: 10.1002/hsr2.1043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023] Open
Abstract
Background In Pakistan, 74 children out of 1000 lose their lives annually due to diarrheal illness. This commentary addresses the contributing factors aggravating this growing dilemma and the effect of a simultaneous rise in COVID-19 cases in a healthcare system ready to collapse, along with providing recommendations to alleviate the problems causing this spike in diarrheal cases. Methods This narrative review has emphasized the causes of the spike in pediatric diarrheal illnesses in Pakistan as well as recommendations offered to lessen the burden by incorporating recent literature (n = 68). Tactics to tackle COVID-19 alongside diarrheal illnesses were also included. Pakistan was chosen to be assessed due to its high burden of child and infant mortality due to preventable causes. Results The provision of safe drinking water, the proper use of Integrated Management of Newborn and Childhood Illnesses (IMNCI), adequate awareness of the benefits of breastfeeding, the use of correct rehydration techniques such as Oral Rehydration Therapy, and the crucial implementation of the EPI vaccination schedule can curb this increase in diarrheal cases. Conclusion The increased prevalence of diarrheal diseases amongst the pediatric population of Pakistan can be attributed largely due to unsanitary drinking water. Emphasis must be put in the provision of safe drinking water. During the first years of life, children can be kept safe from deadly pathogens just by adequate breastfeeding. IMNCI and EPI must also be properly implemented.
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Affiliation(s)
- Zainab Syyeda Rahmat
- Faculty of Medicine, Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Amraha Zubair
- Faculty of Medicine, Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Ikran Abdi
- Faculty of Medicine, Sindh Medical CollegeJinnah Sindh Medical UniversityKarachiPakistan
| | - Narmil Humayun
- Faculty of Medicine, Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Fatima Arshad
- Faculty of Medicine, Dow Medical CollegeDow University of Health SciencesKarachiPakistan
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Zhou M, Zeng Y, Xi Y, Luo S, Qi J, Zhao G, Sun Y, Guo Y, Cheng F. School-based Hygiene Intervention to Prevent HelicObacter Pylori infection among childrEn (SHIP HOPE): protocol for a cluster-randomised controlled trial. BMJ Open 2022; 12:e064207. [PMID: 36600426 PMCID: PMC9772681 DOI: 10.1136/bmjopen-2022-064207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Helicobacter pylori infection rates are high in China and worldwide, and maintaining good hygiene is effective in preventing H. pylori infection. Childhood is a critical stage for developing good hygiene practices. Therefore, in this study, we aimed to explore whether a comprehensive hygiene intervention can prevent H. pylori infection in primary schools in China. METHODS AND ANALYSIS The School-based Hygiene Intervention to Prevent HelicObacter Pylori infection among childrEn study is a cluster-randomised controlled trial, which will include approximately 2400 children in grades 2-4 from 60 classes in 10 primary schools of Linqu County, Shandong Province. Schools will be randomly assigned (1:1) via a computer-generated list, to receive either comprehensive hygiene intervention (intervention) or the usual health education lessons (control), with stratification by area (urban or rural). The interventions will include the following: (1) Children's education: lessons and cartoon books designed to provide basic knowledge about hygiene, H. pylori, hand hygiene, diet and oral hygiene will be provided to children; (2) Caregiver's education: children will be empowered to share hygiene-related knowledge with their caregivers as homework; caregivers will be also invited to the school for hygiene lessons; (3) School hygiene promotion: suggestions will be provided for improving the hygienic environment. Children in control schools will receive usual health education lessons according to the arrangements of each school. The primary outcome is the prevalence and incidence of H. pylori infection among children at 1-year follow-up. The secondary outcomes are H. pylori and hygiene knowledge, family eating customs and hygiene practices among children and their caregivers, as well as school absences owing to diarrhoea. Additionally, growth in children is set as an exploratory outcome. General linear mixed models will be used to analyse differences between the intervention and control schools. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Institution Review Board of Tsinghua University (No: 20220020). Written informed consent will be obtained from each child and one of their caregivers. The findings of this study will be actively disseminated through scientific publications and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2200056191.
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Affiliation(s)
- Mengge Zhou
- Vanke School of Public Health, Tsinghua University, Beijing, People's Republic of China
- Institute for Healthy China, Tsinghua University, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People's Republic of China
| | - Yuhong Zeng
- Department of Epidemiology, College of Preventive Medicine, Army Medical University, Chongqing, People's Republic of China
| | - Yu'e Xi
- Vanke School of Public Health, Tsinghua University, Beijing, People's Republic of China
- Institute for Healthy China, Tsinghua University, Beijing, People's Republic of China
| | - Sitong Luo
- Vanke School of Public Health, Tsinghua University, Beijing, People's Republic of China
- Institute for Healthy China, Tsinghua University, Beijing, People's Republic of China
| | - Jing Qi
- School of Management, Weifang Medical University, Weifang, Shandong, People's Republic of China
| | - Guanqi Zhao
- Center for Coronary Artery Disease, Capital Medical University Affiliated Anzhen Hospital, Beijing, People's Republic of China
| | - Yamei Sun
- Department of Gastroenterology, Capital Medical University Affiliated Anzhen Hospital, Beijing, People's Republic of China
| | - Yang Guo
- Department of Dermatology, Institute of Dermatology, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, People's Republic of China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, People's Republic of China
- Institute for Healthy China, Tsinghua University, Beijing, People's Republic of China
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Singh M. Subjective selection and the evolution of complex culture. Evol Anthropol 2022; 31:266-280. [PMID: 36165208 DOI: 10.1002/evan.21948] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/30/2021] [Accepted: 05/28/2022] [Indexed: 12/27/2022]
Abstract
Why is culture the way it is? Here I argue that a major force shaping culture is subjective (cultural) selection, or the selective retention of cultural variants that people subjectively perceive as satisfying their goals. I show that people evaluate behaviors and beliefs according to how useful they are, especially for achieving goals. As they adopt and pass on those variants that seem best, they iteratively craft culture into increasingly effective-seeming forms. I argue that this process drives the development of many cumulatively complex cultural products, including effective technology, magic and ritual, aesthetic traditions, and institutions. I show that it can explain cultural dependencies, such as how certain beliefs create corresponding new practices, and I outline how it interacts with other cultural evolutionary processes. Cultural practices everywhere, from spears to shamanism, develop because people subjectively evaluate them to be effective means of satisfying regular goals.
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Affiliation(s)
- Manvir Singh
- Institute for Advanced Study in Toulouse, Université de Toulouse 1 Capitole, Toulouse, France
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Liu X, Pei Z, Zhang Z, Zhang Y, Chen Y. Associations of Boiled Water and Lifespan Water Sources With Mortality: A Cohort Study of 33,467 Older Adults. Front Public Health 2022; 10:921738. [PMID: 35832269 PMCID: PMC9271665 DOI: 10.3389/fpubh.2022.921738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background: There were few studies to report whether drinking water sources and habits affected health outcomes. Therefore, this study aimed to examine how boiled water and lifespan water sources affected the risks of cardiovascular disease (CVD) and all-cause mortality in the elderly. Methods This study was a 20-year cohort study. All participants aged ≥60 years were eligible. Exposures of interest included lifespan drinking water sources and habits, which were collected using a validated questionnaire. Drinking water sources included wells, surface water, spring, and tap water in childhood, around the age of 60 years, and at present. Drinking habits included boiled and un-boiled water. The main end events included CVD and all-cause mortality. Results There were 33,467 participants in this study. Compared to tap water, drinking well and surface water around the age of 60 years were associated with a higher risk of all-cause mortality (HR: 1.092, 95% CI: 1.051–1.134, P < 0.001; and HR: 1.136, 95% CI: 1.081–1.194, P < 0.001, respectively). However, only drinking spring around aged 60 years and drinking well at present were associated with a lower CVD mortality (HR: 0.651, 95% CI: 0.452–0.939, P = 0.022; and HR: 0.757, 95% CI: 0.665–0.863, P < 0.001, respectively). Boiled water was not associated with mortality. Conclusions Drinking water from well and surface water around the age of 60 years were associated with increased all-cause mortality. Drinking water from spring around the age of 60 years and well at present was associated with a decreased CVD mortality. However, boiled water was not associated with mortality.
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Affiliation(s)
- Xun Liu
- Department of Ultrasonics, Tianjin Fifth Central Hospital, Tianjin, China
| | - Zheng Pei
- Dean's Office, Tianjin Fifth Central Hospital, Tianjin, China
| | - Zifan Zhang
- Dean's Office, Tianjin Fifth Central Hospital, Tianjin, China
| | - Yan Zhang
- Department of Nutrition, Tianjin Fifth Central Hospital, Tianjin, China
| | - Yongjie Chen
- Department of Epidemiology and Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
- *Correspondence: Yongjie Chen
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Improved Water and Waste Management Practices Reduce Diarrhea Risk in Children under Age Five in Rural Tanzania: A Community-Based, Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074218. [PMID: 35409904 PMCID: PMC8998175 DOI: 10.3390/ijerph19074218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022]
Abstract
Diarrhea remains a significant cause of morbidity and mortality among children in developing countries. Water, sanitation, and hygiene practices (WASH) have demonstrated improved diarrhea-related outcomes but may have limited implementation in certain communities. This study analyzes the adoption and effect of WASH-based practices on diarrhea in children under age five in the rural Busiya chiefdom in northwestern Tanzania. In a cross-sectional analysis spanning July-September 2019, 779 households representing 1338 under-five children were surveyed. Among households, 250 (32.1%) reported at least one child with diarrhea over a two-week interval. Diarrhea prevalence in under-five children was 25.6%. In per-household and per-child analyses, the strongest protective factors against childhood diarrhea included dedicated drinking water storage (OR 0.25, 95% CI 0.18−0.36; p < 0.001), improved waste management (OR 0.37, 95% CI 0.27−0.51; p < 0.001), and separation of drinking water (OR 0.38, 95% CI 0.24−0.59; p < 0.001). Improved water sources were associated with decreased risk of childhood diarrhea in per-household analysis (OR 0.72, 95% CI 0.52−0.99, p = 0.04), but not per-child analysis (OR 0.83, 95% CI 0.65−1.05, p = 0.13). Diarrhea was widely treated (87.5%), mostly with antibiotics (44.0%) and oral rehydration solution (27.3%). Targeting water transportation, storage, and sanitation is key to reducing diarrhea in rural populations with limited water access.
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Chirgwin H, Cairncross S, Zehra D, Sharma Waddington H. Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1194. [PMID: 36951806 PMCID: PMC8988822 DOI: 10.1002/cl2.1194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Background Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vulnerable populations, especially for women and girls. The hardest hit regions are sub-Saharan Africa and South Asia. Sustainable Development Goal (SDG) 6 calls for the end of open defecation, and universal access to safely managed water and sanitation facilities, and basic hand hygiene, by 2030. WASH access and use also underpin progress in other areas such as SDG1 poverty targets, SDG3 health and SDG4 education targets. Meeting the SDG equity agenda to "leave none behind" will require WASH providers prioritise the hardest to reach including those living remotely and people who are disadvantaged. Objectives Decision makers need access to high-quality evidence on what works in WASH promotion in different contexts, and for different groups of people, to reach the most disadvantaged populations and thereby achieve universal targets. The WASH evidence map is envisioned as a tool for commissioners and researchers to identify existing studies to fill synthesis gaps, as well as helping to prioritise new studies where there are gaps in knowledge. It also supports policymakers and practitioners to navigate the evidence base, including presenting critically appraised findings from existing systematic reviews. Methods This evidence map presents impact evaluations and systematic reviews from the WASH sector, organised according to the types of intervention mechanisms, WASH technologies promoted, and outcomes measured. It is based on a framework of intervention mechanisms (e.g., behaviour change triggering or microloans) and outcomes along the causal pathway, specifically behavioural outcomes (e.g., handwashing and food hygiene practices), ill-health outcomes (e.g., diarrhoeal morbidity and mortality), nutrition and socioeconomic outcomes (e.g., school absenteeism and household income). The map also provides filters to examine the evidence for a particular WASH technology (e.g., latrines), place of use (e.g., home, school or health facility), location (e.g., global region, country, rural and urban) and group (e.g., people living with disability). Systematic searches for published and unpublished literature and trial registries were conducted of studies in low- and middle-income countries (LMICs). Searches were conducted in March 2018, and searches for completed trials were done in May 2020. Coding of information for the map was done by two authors working independently. Impact evaluations were critically appraised according to methods of conduct and reporting. Systematic reviews were critically appraised using a new approach to assess theory-based, mixed-methods evidence synthesis. Results There has been an enormous growth in impact evaluations and systematic reviews of WASH interventions since the International Year of Sanitation, 2008. There are now at least 367 completed or ongoing rigorous impact evaluations in LMICs, nearly three-quarters of which have been conducted since 2008, plus 43 systematic reviews. Studies have been done in 83 LMICs, with a high concentration in Bangladesh, India, and Kenya. WASH sector programming has increasingly shifted in focus from what technology to supply (e.g., a handwashing station or child's potty), to the best way in which to do so to promote demand. Research also covers a broader set of intervention mechanisms. For example, there has been increased interest in behaviour change communication using psychosocial "triggering", such as social marketing and community-led total sanitation. These studies report primarily on behavioural outcomes. With the advent of large-scale funding, in particular by the Bill & Melinda Gates Foundation, there has been a substantial increase in the number of studies on sanitation technologies, particularly latrines. Sustaining behaviour is fundamental for sustaining health and other quality of life improvements. However, few studies have been done of intervention mechanisms for, or measuring outcomes on sustained adoption of latrines to stop open defaecation. There has also been some increase in the number of studies looking at outcomes and interventions that disproportionately affect women and girls, who quite literally carry most of the burden of poor water and sanitation access. However, most studies do not report sex disaggregated outcomes, let alone integrate gender analysis into their framework. Other vulnerable populations are even less addressed; no studies eligible for inclusion in the map were done of interventions targeting, or reporting on outcomes for, people living with disabilities. We were only able to find a single controlled evaluation of WASH interventions in a health care facility, in spite of the importance of WASH in health facilities in global policy debates. The quality of impact evaluations has improved, such as the use of controlled designs as standard, attention to addressing reporting biases, and adequate cluster sample size. However, there remain important concerns about quality of reporting. The quality and usefulness of systematic reviews for policy is also improving, which draw clearer distinctions between intervention mechanisms and synthesise the evidence on outcomes along the causal pathway. Adopting mixed-methods approaches also provides information for programmes on barriers and enablers affecting implementation. Conclusion Ensuring everyone has access to appropriate water, sanitation, and hygiene facilities is one of the most fundamental of challenges for poverty elimination. Researchers and funders need to consider carefully where there is the need for new primary evidence, and new syntheses of that evidence. This study suggests the following priority areas:Impact evaluations incorporating understudied outcomes, such as sustainability and slippage, of WASH provision in understudied places of use, such as health care facilities, and of interventions targeting, or presenting disaggregated data for, vulnerable populations, particularly over the life-course and for people living with a disability;Improved reporting in impact evaluations, including presentation of participant flow diagrams; andSynthesis studies and updates in areas with sufficient existing and planned impact evaluations, such as for diarrhoea mortality, ARIs, WASH in schools and decentralisation. These studies will preferably be conducted as mixed-methods systematic reviews that are able to answer questions about programme targeting, implementation, effectiveness and cost-effectiveness, and compare alternative intervention mechanisms to achieve and sustain outcomes in particular contexts, preferably using network meta-analysis.
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Affiliation(s)
- Hannah Chirgwin
- International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
| | | | | | - Hugh Sharma Waddington
- London School of Hygiene and Tropical Medicine and International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
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Knowledge, Practice of Personal Hygiene, School Sanitation, and Risk Factors of Contracting Diarrhea among Rural Students from Five Western Provinces in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189505. [PMID: 34574432 PMCID: PMC8468795 DOI: 10.3390/ijerph18189505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diarrhea is a global public health issue and a leading cause of childhood malnutrition, growth disturbances, and mortality. The spread of diarrhea is closely linked to the knowledge and maintenance of personal hygiene and quality of drinking water and sanitation facilities. However, there are few such investigations and analysis in rural areas of China. This study aims to determine the association between the risk of contracting diarrhea and knowledge and practices of personal hygiene and school sanitation among rural students as well as provide a scientific basis for preventing the spread of diarrhea and other infectious diseases. A stratified cluster sampling method was used to randomly select 12 rural primary schools in each of 5 counties where the Water, Sanitation and Hygiene (WASH) Plus Program has been implemented. The counties are located in the Guangxi Zhuang autonomous region, Chongqing municipality, Guizhou province, Yunnan province, and Xinjiang Uygur autonomous region. A single fourth-grade class was randomly chosen from each of the 60 schools for observation and a questionnaire survey. The study involved a total of 2330 students. The logistic regression method was adopted to determine the factors contributing to diarrhea in rural students. The results show that male students accounted for 49.40% (n = 1151) of the 2330 research subjects; the average age of the students was 9.9 ± 0.3 years. Approximately 33.09% of the students suffered from diarrhea in the three months leading up to the survey. The odds ratios (ORs) of students who did not know that "diarrhea can be prevented by washing fruits before eating them raw and not drinking untreated water" (OR: 1.303, 95% confidence interval [CI]: 1.063, 1.597) and that "the disease can be prevented by washing hands before meals and after going to the toilet" (OR: 1.522, 95% CI: 1.207, 1.920) were higher than those who knew the above stated facts. Students who "have drunk untreated water at school" (OR: 1.584, 95% CI: 1.268, 1.978), "have drunk untreated water at home" (OR: 1.643, 95% CI: 1.319, 2.048), and "did not wash hands before every meal" (OR: 1.490, 95% CI: 1.120, 1.983) were at a higher risk of contracting diarrhea than those who drank treated water at school and at home and washed their hands before every meal. Diarrhea was more likely to affect students who attended schools with unclean and poorly maintained toilets (OR: 1.586, 95% CI: 1.261, 1.995) or toilets with flies (OR: 1.383, 95% CI: 1.114, 1.717) and without adequate drinking water facilities (OR: 1.407, 95% CI: 1.009, 1.962). The knowledge of methods to maintain personal hygiene, general hygiene practices, and school sanitation are the three major risk factors that account for the spread of diarrhea among rural students from five western provinces (municipalities and autonomous regions) of China. Therefore, to prevent such diseases and maintain health, it is important to provide students with health education, help them develop good hygiene habits, ensure the provision of clean water at schools, and improve the overall school environments.
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Rashid M, Khan MN, Jalbani N. Detection of Human Adenovirus, Rotavirus, and Enterovirus in Tap Water and Their Association with the Overall Quality of Water in Karachi, Pakistan. FOOD AND ENVIRONMENTAL VIROLOGY 2021; 13:44-52. [PMID: 33180282 DOI: 10.1007/s12560-020-09448-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/10/2020] [Indexed: 06/11/2023]
Abstract
Drinking water supplies in the developing world often serve as a biosphere for various organisms. Viral gastroenteritis is a neglected area of research in Pakistan, there are no data for the prevalence of enteric viruses in drinking water of the largest city of Karachi. The present study aimed to provide a survey of the existence of enteric viruses: human adenovirus (HAdV), human enteroviruses (hEV), and genotype A rotavirus (GARV) in tap water. Using a simple PCR approach, we detected 20%, 43%, and 23% of HAdV, hEV, and GARV in tap water samples, respectively. We have also shown an overall quality deficit of tap water at the pumping station and consumer tap. We have found no sample free from bacterial contaminations. The ranges for a total number of the heterotrophic plate count and coliform were found 8.7 × 102-4.5 × 106 CFU/mL and 210 to uncountable coliforms/100 mL, respectively. Moreover, we assessed the efficiency of small-scale water treatment methods for the removal of viruses.
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Affiliation(s)
- Muhammad Rashid
- National Institute of Virology, Dr. Panjwani Center for Molecular Medicine and Drug Research, (PCMD) International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan.
| | - Muhammad Naseem Khan
- Pakistan Council of Scientific and Industrial Research (PCSIR) Laboratories Karachi, Karachi, Pakistan
| | - Nusrat Jalbani
- Pakistan Council of Scientific and Industrial Research (PCSIR) Laboratories Karachi, Karachi, Pakistan
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Soboksa NE, Gari SR, Hailu AB, Donacho DO, Alemu BM. Effectiveness of solar disinfection water treatment method for reducing childhood diarrhoea: a systematic review and meta-analysis. BMJ Open 2020; 10:e038255. [PMID: 33310791 PMCID: PMC7735112 DOI: 10.1136/bmjopen-2020-038255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE This study aimed to pool out the available evidence on the effectiveness of the solar disinfection water treatment method for reducing childhood diarrhoea. DESIGN Systematic review and meta-analysis. SETTING Global. METHODS Searches were conducted in Medline/PubMed, Scopus, Google Scholar, Cochrane Library databases and references to other studies. The review included all children living anywhere in the world regardless of sex, ethnicity and socioeconomic status published in English until December 2019. Studies that compared the diarrhoea incidence between the intervention group who were exposed to solar disinfection water treatment and the control group who were not exposed to such water treatment were included. The outcome of interest was the change in observed diarrhoea incidence and the risk from baseline to postintervention. Two independent reviewers critically appraised the selected studies. Effect sizes were expressed as risk ratios, and their 95% CIs were calculated for analysis. RESULTS We identified 10 eligible studies conducted in Africa, Latin America and Asia that included 5795 children aged from 1 to 15 years. In all identified studies, solar disinfection reduced the risk of diarrhoea in children, and the effect was statistically significant in eight of the studies. The estimated pooled risk ratio of childhood diarrhoea among participants that used the solar disinfection water treatment method was 0.62 (95% CI 0.53 to 0.72). The overall pooled results indicated that the intervention of solar disinfection water treatment had reduced the risk of childhood diarrhoea by 38%. CONCLUSIONS The intervention of solar disinfection water treatment significantly reduced the risk of childhood diarrhoea. However, the risk of bias and marked heterogeneity of the included studies precluded definitive conclusions. Further high-quality studies are needed to determine whether solar disinfection water treatment is an important method to reduce childhood diarrhoea. PROSPERO REGISTRATION NUMBER CRD42020159243.
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Affiliation(s)
- Negasa Eshete Soboksa
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sirak Robele Gari
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Beyene Hailu
- College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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Cohen A, Pillarisetti A, Luo Q, Zhang Q, Li H, Zhong G, Zhu G, Colford JM, Smith KR, Ray I, Tao Y. Boiled or Bottled: Regional and Seasonal Exposures to Drinking Water Contamination and Household Air Pollution in Rural China. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:127002. [PMID: 33275452 PMCID: PMC7717838 DOI: 10.1289/ehp7124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Inadequate access to safe drinking water remains a global health problem, particularly in rural areas. Boiling is the most commonly used form of point-of-use household water treatment (HWT) globally, although the use of bottled water in low- and middle-income countries (LMICs) is increasing rapidly. OBJECTIVES We assessed the regional and seasonal prevalence of HWT practices (including bottled water use) in low-income rural areas in two Chinese provinces, evaluated the microbiological safety of drinking water and associated health outcomes, and estimated the air pollution burden associated with the use of solid fuels for boiling. METHODS We conducted cross-sectional surveys and collected drinking water samples from 1,033 rural households in Guangxi and Henan provinces. Temperature sensors affixed to pots and electric kettles were used to corroborate self-reported boiling frequencies and durations, which were used to model household air pollution (HAP) in terms of estimated particulate matter ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 ) concentrations. RESULTS Based on summer data collection in both provinces, after controlling for covariates, boiling with electric kettles was associated with the largest log reduction in thermotolerant coliforms (TTCs) (- 0.66 log 10 TTC most probable number/ 100 mL ), followed by boiling with pots (- 0.58 ), and bottled water use (- 0.39 ); all were statistically significant (p < 0.001 ). Boiling with electric kettles was associated with a reduced risk of TTC contamination [risk ratio ( RR ) = 0.25 , p < 0.001 ] and reported diarrhea (RR = 0.80 , p = 0.672 ). TTCs were detected in 51% (n = 136 ) of bottled water samples. For households boiling with biomass, modeled PM 2.5 concentrations averaged 79 μ g / m 3 (standard deviation = 21 ). DISCUSSION Our findings suggest that where boiling is already common and electricity access is widespread, the promotion of electricity-based boiling may represent a pragmatic stop-gap means of expanding safe water access until centralized, or decentralized, treated drinking water is available; displacing biomass use for water boiling could also reduce HAP concentrations and exposures. Our results also highlight the risks of increasing bottled water use in rural areas, and its potential to displace other sources of safe drinking water, which could in turn hamper efforts in China and other LMICs toward universal and affordable safe water access. https://doi.org/10.1289/EHP7124.
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Affiliation(s)
- Alasdair Cohen
- Public Health Program, Department of Population Health Sciences, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, Virginia, USA
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Qing Luo
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Qi Zhang
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Hongxing Li
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
| | - Gemei Zhong
- Guangxi CDC, Nanning, Guangxi Autonomous Region, China
| | - Gang Zhu
- Henan CDC, Zhengzhou, Henan Province, China
| | - John M. Colford
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Kirk R. Smith
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley, Berkeley, California, USA
- Berkeley Water Center, University of California, Berkeley, Berkeley, California, USA
| | - Yong Tao
- National Center for Rural Water Supply Technical Guidance, Chinese Center for Disease Control and Prevention (CDC), Beijing, China
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Franer K, Meijerink H, Hyllestad S. Compliance with a boil water advisory after the contamination of a municipal drinking water supply system in Norway. JOURNAL OF WATER AND HEALTH 2020; 18:1084-1090. [PMID: 33328377 DOI: 10.2166/wh.2020.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Boil-water advisories (BWAs) are one of the several methods to prevent the spread of infectious diseases through contaminated water. However, for BWAs to be effective, consumers need to be aware of, understand and comply with the advisories. Although BWAs are a widely used preventive public health measure, compliance with BWAs is rarely examined. In Norway, only one previous study on compliance with BWAs has been conducted. Therefore, we conducted a cross-sectional study to estimate consumers' perception of and compliance with a BWA following a contamination incident at an elevated reservoir in Konnerud (population 10,314), Norway. In total, 2,451 of the 9,312 (26.3%) invited residents responded to the questionnaire. Among the respondents, 97.6% remembered receiving the BWA, of whom 94.6% complied with the advice. Effective compliance with the BWA was thus 92.3%. Only 130 (5.4%) respondents did not comply with the BWA. The main reason for non-compliance was perceived low or no risk of getting sick from the water (34.2%). Our study revealed high awareness of and compliance with the BWA, but the people who did not comply maintained several misconceptions about waterborne infections and transmission. The findings can be used by local health authorities to improve future BWAs.
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Affiliation(s)
- Kristian Franer
- Department of Prevention of Infectious Diseases and Preparedness, Norwegian Institute of Public Health, Oslo, Norway E-mail: ; European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Hinta Meijerink
- Department of Prevention of Infectious Diseases and Preparedness, Norwegian Institute of Public Health, Oslo, Norway E-mail:
| | - Susanne Hyllestad
- Department of Prevention of Infectious Diseases and Preparedness, Norwegian Institute of Public Health, Oslo, Norway E-mail:
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Dogan Ü, Kasap EN, Sucularlı F, Yildirim E, Tamer U, Cetin D, Suludere Z, Boyaci IH, Ertas N. Multiplex enumeration of Escherichia coli and Salmonella enteritidis in a passive capillary microfluidic chip. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:3788-3796. [PMID: 32760943 DOI: 10.1039/d0ay01030h] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Multiplex detection and quantification of bacteria in water by using portable devices are particularly essential in low and middle-income countries where access to clean drinking water is limited. Addressing this crucial problem, we report a highly sensitive immunoassay sensor system utilizing the fluorescence technique with magnetic nanoparticles (MNPs) to separate target bacteria and two different types of quantum dots (CdTe and Ni doped CdTe QDs) incorporated into a passive microfluidic chip to transport and to form sandwich complexes for the detection of two target bacteria, namely Escherichia coli (E. coli) and Salmonella enteritidis (S. enteritidis) in less than 60 min. The assay is carried out on a capillary driven microfluidic chip that can be operated by merely pipetting the samples and reagents, and fluorescence measurements are done by using a handheld fluorescence spectrophotometer, which renders the system portable. The linear range of the method was found to be 101 to 105 cfu mL-1 for both E. coli and S. enteritidis. The limit of detection (LOD) was calculated to be 5 and 3 cfu mL-1 for E. coli and S. enteritidis, respectively. The selectivity of the method was examined by testing Enterobacter dissolvens (E. dissolvens) and Staphylococcus aureus (S. aureus) samples, and no significant interference was observed. The method was also demonstrated to detect bacteria in tap water and lake water samples spiked with target bacteria.
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Affiliation(s)
- Üzeyir Dogan
- Department of Analytical Chemistry, Faculty of Pharmacy, Gazi University, Etiler, Ankara 06330, Turkey.
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Heitzinger K, Hawes SE, Rocha CA, Alvarez C, Evans CA. Assessment of the Feasibility and Acceptability of Using Water Pasteurization Indicators to Increase Access to Safe Drinking Water in the Peruvian Amazon. Am J Trop Med Hyg 2020; 103:455-464. [PMID: 32372750 PMCID: PMC7356428 DOI: 10.4269/ajtmh.18-0963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Approximately two billion people lack access to microbiologically safe drinking water globally. Boiling is the most popular household water treatment method and significantly reduces diarrheal disease, but is often practiced inconsistently or ineffectively. The use of low-cost technologies to improve boiling is one approach with potential for increasing access to safe drinking water. We conducted household trials to evaluate the feasibility and acceptability of water pasteurization indicators (WAPIs) in the Peruvian Amazon in 2015. A total of 28 randomly selected households were enrolled from a rural and a peri-urban community. All households trialed two WAPI designs, each for a 2-week period. Ninety-six percent of participants demonstrated the correct use of the WAPIs at the end of each trial, and 88% expressed satisfaction with both WAPI models. Ease of use, short treatment time, knowledge of the association between WAPI use and improved health, and the taste of treated water were among the key factors that influenced acceptability. Ease of use was the key factor that influenced design preference. Participants in both communities preferred a WAPI with a plastic box that floated on the water's surface compared with a WAPI with a wire that was dipped into the pot of drinking water while it was heating (77% versus 15%, P < 0.001); we selected the box design for a subsequent randomized trial of this intervention. The high feasibility and acceptability of the WAPIs in this study suggest that these interventions have potential to increase access to safe water in resource-limited settings.
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Affiliation(s)
- Kristen Heitzinger
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation for Health and Development, Department of Infectious Disease, Imperial College London, London, United Kingdom
- Address correspondence to Kristen Heitzinger, Asociación Benéfica Prisma, 251 Carlos Gonzales, Lima 15073 Peru. E-mail:
| | - Stephen E. Hawes
- Department of Epidemiology, University of Washington, Seattle, Washington
| | | | - Carlos Alvarez
- Regional Center for Disease Prevention and Control, Loreto Regional Ministry of Health, Iquitos, Peru
| | - Carlton A. Evans
- Innovacion Por la Salud Y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru
- IFHAD: Innovation for Health and Development, Department of Infectious Disease, Imperial College London, London, United Kingdom
- IFHAD: Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru
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Hartinger SM, Nuño N, Hattendorf J, Verastegui H, Karlen W, Ortiz M, Mäusezahl D. A factorial cluster-randomised controlled trial combining home-environmental and early child development interventions to improve child health and development: rationale, trial design and baseline findings. BMC Med Res Methodol 2020; 20:73. [PMID: 32241260 PMCID: PMC7115072 DOI: 10.1186/s12874-020-00950-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Exposure to unhealthy environments and inadequate child stimulation are main risk factors that affect children’s health and wellbeing in low- and middle-income countries. Interventions that simultaneously address several risk factors at the household level have great potential to reduce these negative effects. We present the design and baseline findings of a cluster-randomised controlled trial to evaluate the impact of an integrated home-environmental intervention package and an early child development programme to improve diarrhoea, acute respiratory infections and childhood developmental outcomes in children under 36 months of age living in resource-limited rural Andean Peru. Methods We collected baseline data on children’s developmental performance, health status and demography as well as microbial contamination in drinking water. In a sub-sample of households, we measured indoor kitchen 24-h air concentration levels of carbon monoxide (CO) and fine particulate matter (PM2.5) and CO for personal exposure. Results We recruited and randomised 317 children from 40 community-clusters to four study arms. At baseline, all arms had similar health and demographic characteristics, and the developmental status of children was comparable between arms. The analysis revealed that more than 25% of mothers completed primary education, a large proportion of children were stunted and diarrhoea prevalence was above 18%. Fifty-two percent of drinking water samples tested positive for thermo-tolerant coliforms and the occurrence of E.coli was evenly distributed between arms. The mean levels of kitchen PM2.5 and CO concentrations were 213 μg/m3 and 4.8 ppm, respectively. Conclusions The trial arms are balanced with respect to most baseline characteristics, such as household air and water pollution, and child development. These results ensure the possible estimation of the trial effectiveness. This trial will yield valuable information for assessing synergic, rational and cost-effective benefits of the combination of home-based interventions. Trial Registry ISRCTN-26548981.
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Affiliation(s)
- Stella M Hartinger
- Department of Epidemiology & Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Nestor Nuño
- Department of Epidemiology & Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jan Hattendorf
- Department of Epidemiology & Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hector Verastegui
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Walter Karlen
- Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | | | - Daniel Mäusezahl
- Department of Epidemiology & Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Chakrabarti S, Singh P, Bruckner T. Association of Poor Sanitation With Growth Measurements Among Children in India. JAMA Netw Open 2020; 3:e202791. [PMID: 32293682 PMCID: PMC7160693 DOI: 10.1001/jamanetworkopen.2020.2791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
Importance Much research on sanitation and linear growth in low- and middle-income countries focuses on children younger than 5 years. However, poor sanitation may be associated with growth faltering during middle and late childhood to a greater extent than previously recognized. Objective To characterize the association of poor sanitation with height-for-age z (HAZ) scores in children and adolescents in India aged 0 to 18 years. Design, Setting, and Participants This cross-sectional study examined 134 882 children and adolescents aged 0 to 18 years who were surveyed in the fourth round of India's District Level Household and Facilities Survey (survey conducted August 2012 to February 2014). Data were analyzed from June 1, 2019, to August 20, 2019. Exposures Proportion of households reporting open defecation at the village level (to account for its high negative externality) and household-level access to boiled or filtered drinking water. Main Outcomes and Measures Individual-level HAZ scores were measured in standard deviations. The association of exposures with outcomes was estimated using ordinary least-squares regression stratified by sex (boys and girls) and 4 age groups (≤1, >1 to ≤7, >7 to ≤12, >12 to ≤18 years). Models controlled for parental height and education, socioeconomic status, maternal age at birth, hemoglobin level, and indicators for state and birth year to adjust for regional (state) and temporal (birth year) fixed effects. Results The sample comprised 70 463 male (52.5%) and 64 419 female (47.8%) children and adolescents aged 0 to 18 years; 46 722 participants (34.6%) were aged older than 12 to 18 years. Open defecation was inversely associated with HAZ score among all age groups except boys aged 1 year and younger (>1 to ≤7 years: β, -0.22; 95% CI, -0.35 to -0.10; >7 to ≤12 years: β, -0.15; 95% CI, -0.24 to -0.06; >12 to ≤18 years: β, -0.10; 95% CI, -0.19 to -0.01) and among girls aged between 7 and 18 years (>7 to ≤12 years: β, -0.22; 95% CI, -0.33 to -0.12; >12 to ≤18 years: β, -0.16; 95% CI, -0.23 to -0.09). Boiled or filtered drinking water was positively associated with HAZ score among younger girls (≤1 year: β, 0.26; 95% CI, 0.07 to 0.45; >1 to ≤7 years: β, 0.07; 95% CI, 0.01 to 0.14) and across all age groups in boys (≤1 years: β, 0.19; 95% CI, 0.03 to 0.35; >1 to ≤7 years: β, 0.07; 95% CI, 0.00 to 0.14; >7 to ≤12 years: β, 0.08; 95% CI, 0.03 to 0.13; >12 to ≤18 years: β, 0.06; 95% CI, 0.01 to 0.11). Conclusions and Relevance In this study, open defecation and lack of boiled or filtered drinking water were inversely associated with height-for-age measures across all ages in children and adolescents in India. Improved sanitation may benefit growth among children and adolescents older than 5 years.
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Affiliation(s)
- Suman Chakrabarti
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle
| | - Parvati Singh
- Program in Public Health, Anteater Instruction and Research Offices, University of California, Irvine
| | - Tim Bruckner
- Program in Public Health, Anteater Instruction and Research Offices, University of California, Irvine
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Dinkel KA, Costa ME, Kraft TS, Stieglitz J, Cummings DK, Gurven M, Kaplan H, Trumble BC. Relationship of sanitation, water boiling, and mosquito nets to health biomarkers in a rural subsistence population. Am J Hum Biol 2020; 32:e23356. [PMID: 31821682 PMCID: PMC8018599 DOI: 10.1002/ajhb.23356] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Throughout human evolutionary history, parasites and pathogens were a major cause of mortality-modern urban life with public health infrastructure has changed disease exposure. We examine associations between boiling water, using latrines, mosquito net usage, and biomarkers among the Tsimane, a nonindustrial subsistence population with little public health infrastructure. METHODS We conducted cross sectional surveys on water, latrines, and bed nets among 507 heads of households (aged 18-92 years, median age 41 years). Regression models estimated associations between behaviors and health biomarkers (ie, white blood cell count [WBC], hemoglobin, eosinophil count, and erythrocyte sedimentation rate) adjusting for age, sex, body mass index, wealth, schooling, and distance to the nearby market town. RESULTS Latrine use is associated with 6.5% lower WBC count (β = -679.6, P = .031, SE = 314.1), 17.4% lower eosinophil counts (β = -244.7, P = .023, SE = 107.2), and reduced odds of eosinophilia (adjusted OR = 0.40, P < .019, 95% CI = 0.18-0.86). Boiling water and mosquito net use are not significantly associated with any biomarkers measured. CONCLUSIONS In a subsistence population currently undergoing epidemiological transition, we find that latrine use was associated with several objective measures of health. This suggests that relatively low cost and low maintenance public health interventions may wish to focus on latrine use, as there is unmet need and potential health benefits for those who use latrines. Additionally, while the cost is higher, public health organizations aimed at improving sanitation may be able to use minimally invasive field-collected biomarkers as a diagnostic to objectively test the efficacy of interventions with greater specificity than anthropometric measurements.
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Affiliation(s)
- Katelyn A. Dinkel
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona
| | - Megan E. Costa
- Sanford School of Family Dynamics, Arizona State University, Tempe, Arizona
| | - Thomas S. Kraft
- Department of Anthropology, University of California Santa Barbara, California, Santa Barbara
| | | | - Daniel K. Cummings
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California
| | - Michael Gurven
- Department of Anthropology, University of California Santa Barbara, California, Santa Barbara
| | - Hillard Kaplan
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California
| | - Benjamin C. Trumble
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona,Center for Evolution and Medicine, Arizona State University, Tempe, Arizona
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Souza VGC, Lopes DF, Machado FC, Fabri RL, Apolônio ACM. The Novel Coronavirus: An Alert for Pacifiers’ Disinfection. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lopes DF, Fernandes RT, Medeiros YDL, Apolonio ACM. Disinfection of Pacifier Focusing on Candida albicans. Clin Pediatr (Phila) 2019; 58:1540-1543. [PMID: 31522541 DOI: 10.1177/0009922819875541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Singh AK, Das S, Singh S, Pradhan N, Gajamer VR, Kumar S, Lepcha YD, Tiwari HK. Physicochemical Parameters and Alarming Coliform Count of the Potable Water of Eastern Himalayan State Sikkim: An Indication of Severe Fecal Contamination and Immediate Health Risk. Front Public Health 2019; 7:174. [PMID: 31355173 PMCID: PMC6636254 DOI: 10.3389/fpubh.2019.00174] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 06/10/2019] [Indexed: 02/05/2023] Open
Abstract
Continuous decline in potable water sources has raised serious concerns over human health. Developing countries are the most affected in this regard due to a lack of proper hygiene maintenance. Sikkim, an Eastern Himalayan state with mountains as the predominant topological features, harbors several perennial natural springs. Spring water is the primary source of potable water for the population in four districts of the state viz. East, West, North and South. Recent outbreaks of water-borne diseases and the relative lack of scientific studies on its potential correlation with the water quality of the area have educed this study. Physicochemical parameters of springs, community reservoirs, and household water were analyzed by ICP-MS and multi probe meter. Using the membrane filtration method, the microbial quality of the water samples during different seasons was assessed, primarily evaluating the presence of fecal indicators viz. Escherichia coli, total coliform and Enterococcus. The seasonal risk category of the water sources was also determined. Most of the physicochemical parameters of the spring water were within the permissible limits of WHO standards. However, water from four districts was recorded with traces of toxic heavy metals like mercury (0.001-0.007 mg/l), lead (0.001-0.007 mg/l), and selenium (0.526-0.644 mg/l), which are above the permissible limits of WHO. All the spring water samples were categorized as Mg-HCO 3 - type and can be predicted as shallow fresh ground water based on the piper analysis. Microbial confirmatory testing indicated severe fecal contamination of water sources with high counts of total coliform (TC), Escherichia coli (EC) and Enterococcus (EN). The highest level of TC was recorded from West Sikkim (37.26 cfu/100 ml) and the lowest in North Sikkim (22.13 cfu/100 ml). The highest level of contamination of E. coli and Enterococcus was found in East Sikkim (EC = 8.7 cfu/100 ml; EN = 2.08 cfu/100 ml) followed by South Sikkim (EC = 8.4 cfu/100 ml; EN = 2.05 cfu/100 ml). There was a significant positive correlation between the contamination levels of the spring water and the community reservoir tank. As far as the seasonal variation is concerned, the rainy season showed the most contamination with coliform correlating with a high incidence of different water-borne diseases (East = 86%; West = 100%; South = 100%; North = 80%).
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Affiliation(s)
- Ashish Kumar Singh
- Department of Microbiology, School of Life Sciences, Sikkim University, Gangtok, India
| | - Saurav Das
- Department of Microbiology, School of Life Sciences, Sikkim University, Gangtok, India
| | - Samer Singh
- Department of Microbial Biotechnology, Panjab University, Chandigarh, India
- Centre of Experimental Medicine & Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Nilu Pradhan
- Department of Microbiology, School of Life Sciences, Sikkim University, Gangtok, India
| | - Varsha Rani Gajamer
- Department of Microbiology, School of Life Sciences, Sikkim University, Gangtok, India
| | - Santosh Kumar
- Department of Microbiology, School of Life Sciences, Sikkim University, Gangtok, India
| | - Yangchen D. Lepcha
- State Institute of Rural Development, Government of Sikkim, Gangtok, India
| | - Hare K. Tiwari
- Department of Microbiology, School of Life Sciences, Sikkim University, Gangtok, India
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Du W, Cohen A, Shen G, Ru M, Shen H, Tao S. Fuel Use Trends for Boiling Water in Rural China (1992-2012) and Environmental Health Implications: A National Cross-Sectional Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:12886-12894. [PMID: 30290697 DOI: 10.1021/acs.est.8b02389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Survey data from a comprehensive national survey of ∼34 000 households were analyzed for the mix status and transition trajectory of energy for boiling water in rural Chinese households from 1992 to 2012. In 1992, ∼6% of households reported using electricity, biogas, or liquefied petroleum gas (LPG) to boil drinking water; in 2012, the proportion was ∼60%. Income per capita appeared most strongly associated with this transition toward electricity and other clean fuels. Median annual incomes for households using biomass fuels, electric kettles, and LPG were RMB 15 000, 28 000, and 30 000, respectively. Overall, the transition was most pronounced in eastern China, a region which experienced relatively higher rates of economic growth over the same 20-year period. Energy type preferences appear to be highly dependent on fuel accessibility such that coal and straw usage was higher in provinces with higher coal and grain production. These trends suggest that electric kettle use would likely increase from ∼29% (2012) to ∼60% by 2030, at which point <5% of rural households would be expected to boil with solid fuels. Recent evidence suggests that this transition could contribute to reductions in water-related gastrointestinal illness as well as reductions in air pollutant emissions in rural China.
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Affiliation(s)
- Wei Du
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences , Peking University , Beijing 100871 , China
| | - Alasdair Cohen
- Berkeley Water Center , University of California Berkeley , 410 O'Brien Hall , Berkeley , California 94720-1718 , United States
- Energy and Resources Group, College of Natural Resources , University of California Berkeley , 310 Barrows Hall , Berkeley , California 94720-3050 , United States
| | - Guofeng Shen
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences , Peking University , Beijing 100871 , China
| | - Muye Ru
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences , Peking University , Beijing 100871 , China
| | - Huizhong Shen
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences , Peking University , Beijing 100871 , China
| | - Shu Tao
- Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences , Peking University , Beijing 100871 , China
- Sino-French Institute for Earth System Science , Peking University , Beijing 100871 , China
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Human fascioliasis infection sources, their diversity, incidence factors, analytical methods and prevention measures. Parasitology 2018; 145:1665-1699. [PMID: 29991363 DOI: 10.1017/s0031182018000914] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Human fascioliasis infection sources are analysed for the first time in front of the new worldwide scenario of this disease. These infection sources include foods, water and combinations of both. Ingestion of freshwater wild plants is the main source, with watercress and secondarily other vegetables involved. The problem of vegetables sold in uncontrolled urban markets is discussed. Distinction between infection sources by freshwater cultivated plants, terrestrial wild plants, and terrestrial cultivated plants is made. The risks by traditional local dishes made from sylvatic plants and raw liver ingestion are considered. Drinking of contaminated water, beverages and juices, ingestion of dishes and soups and washing of vegetables, fruits, tubercles and kitchen utensils with contaminated water are increasingly involved. Three methods to assess infection sources are noted: detection of metacercariae attached to plants or floating in freshwater, anamnesis in individual patients, and questionnaire surveys in endemic areas. The infectivity of metacercariae is reviewed both under field conditions and experimentally under the effects of physicochemical agents. Individual and general preventive measures appear to be more complicated than those considered in the past. The high diversity of infection sources and their heterogeneity in different countries underlie the large epidemiological heterogeneity of human fascioliasis throughout.
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Xue C, Pan L, Zhu W, Wang Y, Fu H, Cui C, Lu L, Qiao S, Xu B. Molecular epidemiology of genogroup II norovirus infections in acute gastroenteritis patients during 2014-2016 in Pudong New Area, Shanghai, China. Gut Pathog 2018; 10:7. [PMID: 29483945 PMCID: PMC5824483 DOI: 10.1186/s13099-018-0233-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/19/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Norovirus (NoV), a member of the Caliciviridae, is now recognized as the leading cause of acute gastroenteritis (AGE) worldwide. Globally, the GII.4 Sydney_2012 variant has predominated in NoV-related AGE since 2012, although the novel variant GII.17 has also been reported as responsible for gastroenteritis outbreaks in East Asia since 2014. This study aimed to disclose the recent genotype patterns of NoV genogroup II (GII) presenting in AGE patients in Pudong New Area of Shanghai through a laboratory-based syndromic surveillance system. The study further aimed to delineate the predominant strains circulating in the population. METHODS Pudong New Area is located in eastern Shanghai and covers 20.89% of the Shanghai population. The laboratory-based syndromic surveillance system is composed of 12 sentinel hospitals among the 68 general hospitals in this area. AGE patients who sought medical care were sampled following an AGE surveillance protocol. Stool samples were collected from participating patients, and a standardized questionnaire was given to each patient by trained nurses to gain information on the disease profiles and demographics of the patients. Real-time reverse transcription polymerase chain reaction (qRT-PCR) was used to screen the GI nd GII NoV and RT-PCR was used to amplify NoV GII partial capsid protein open reading frame 2 (ORF2). NoV Genotyping Tool (version 1.0, RIVM, MA Bilthoven, Netherlands) was used for genotyping, and a phylogenetic analysis was conducted by MEGA 7.0. RESULTS During 2014-2016, among the 2069 virus-infected AGE cases, 65.88% were caused by NoV. NoV-AGE occurred most frequently in the periods from October to March. The patients with more severe diarrheal symptoms and vomiting were more likely to be infected by NoV. The main genotypes were GII.17 (44.69%) and GII.4 (39.26%), which dominated the NoV-AGE epidemics jointly or in turn, whereas a slight increase in GII.2 was observed beginning in May 2016. The GII.17 strains tended to cluster more with the Hu/JP/2014/GII.P17_GII.17/Kawasaki323 variants, representing novel prevalent strains. Among the GII.4 strains, the GII.4 Sydney_2012 variant was still the predominant strain. CONCLUSIONS NoV GII has become the main cause of virus-infected AGE in Pudong New Area, Shanghai. The predominant genotypes of NoV GII were GII.17 and GII.4. Comprehensive laboratory-based surveillance is important for clinical diagnosis and treatment. Identification of emerging new genotypes is also crucial for the prevention and control of NoV-infected AGE.
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Affiliation(s)
- Caoyi Xue
- School of Public Health, Fudan University, Shanghai, 200032 China
- Shanghai Pudong New Area Center for Disease Control and Prevention, 3039 Zhangyang Road, Shanghai, 200136 China
- Fudan University Pudong Institute of Preventive Medicine, Shanghai, 200136 China
| | - Lifeng Pan
- Shanghai Pudong New Area Center for Disease Control and Prevention, 3039 Zhangyang Road, Shanghai, 200136 China
- Fudan University Pudong Institute of Preventive Medicine, Shanghai, 200136 China
| | - Weiping Zhu
- Shanghai Pudong New Area Center for Disease Control and Prevention, 3039 Zhangyang Road, Shanghai, 200136 China
- Fudan University Pudong Institute of Preventive Medicine, Shanghai, 200136 China
| | - Yuanping Wang
- Shanghai Pudong New Area Center for Disease Control and Prevention, 3039 Zhangyang Road, Shanghai, 200136 China
- Fudan University Pudong Institute of Preventive Medicine, Shanghai, 200136 China
| | - Huiqin Fu
- Shanghai Pudong New Area Center for Disease Control and Prevention, 3039 Zhangyang Road, Shanghai, 200136 China
- Fudan University Pudong Institute of Preventive Medicine, Shanghai, 200136 China
| | - Chang Cui
- Shanghai Pudong New Area Center for Disease Control and Prevention, 3039 Zhangyang Road, Shanghai, 200136 China
- Fudan University Pudong Institute of Preventive Medicine, Shanghai, 200136 China
| | - Lan Lu
- Shanghai Pudong New Area Center for Disease Control and Prevention, 3039 Zhangyang Road, Shanghai, 200136 China
- Fudan University Pudong Institute of Preventive Medicine, Shanghai, 200136 China
| | - Sun Qiao
- Shanghai Pudong New Area Center for Disease Control and Prevention, 3039 Zhangyang Road, Shanghai, 200136 China
- Fudan University Pudong Institute of Preventive Medicine, Shanghai, 200136 China
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai, 200032 China
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