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Aregu MB, Kanno GG, Ashuro Z, Alembo A, Alemayehu A. Safe water supply challenges for hand hygiene in the prevention of COVID-19 in Southern Nations, Nationalities, and People's Region (SNNPR), Ethiopia. Heliyon 2021; 7:e08430. [PMID: 34841117 PMCID: PMC8603866 DOI: 10.1016/j.heliyon.2021.e08430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/16/2021] [Accepted: 11/16/2021] [Indexed: 12/15/2022] Open
Abstract
Background Proper hand hygiene practices are critical in disease prevention and control, including preventing the spread of the COVID-19 pandemic, but according to a recent global report, three billion people lack access to basic hand washing facilities (soap and water) at home. Therefore, this study aimed to determine the challenges related to safe and adequate water provision for hand hygiene in the prevention of COVID-19 in Gedeo Zone, SNNPR, Ethiopia. Methods An institutional-based cross-sectional study design was used to assess the challenges associated with safe water supply in the prevention of COVID-19 in Gedeo Zone. Simple random sampling was used. The water sector's challenges were assessed using in-depth interviews with key informants. Water samples were collected from hand washing stations using a sterile bottle and the standard tap water sampling procedure. Bacterial analysis was carried out using membrane filtration techniques. The Wagtech Palin test and the Delagua portable water testing kit procedure was used to analyze World Health Organization (WHO) critical physicochemical parameters. Result The physicochemical analysis of the sample water from the hand washing facilities reveals that the pH (6.5-8) is within the WHO guideline in all samples except Gedeb town (11.1%). The residual chlorine in the samples was less than 0.2 mg/l, which is below the standard in all towns, but 15.8% of the samples in Wonago town were between 0.2-0.5mg/l. Faecal coliforms were not found in 27.5%, 21.0%, 16.6%, and 40.7% of the samples collected in Dilla, Wonago, Yirgachefe, and Gedeb town, respectively. The remaining samples were all positive for faecal coliforms. Unbalanced demand versus supply, inaccessibility, supply interruptions, financial constraints, a scarcity of competent human resources, a lack of regular water quality assessments, and a lack of stakeholder support were all identified as major challenges by all water sectors of the study towns. The majority of hand washing water samples from all of the study towns were bacteriologically unsafe. The water sector must work hard to ensure that the community has safe drinking water. All responsible bodies and potential stakeholders must support the water sectors in the Gedeo zone.
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Affiliation(s)
- Mekonnen Birhanie Aregu
- Department of Environmental Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Girum Gebremeskel Kanno
- Department of Environmental Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Zemachu Ashuro
- Department of Environmental Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Awash Alembo
- Department of Environmental Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Addisu Alemayehu
- Department of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Verbyla ME, Pitol AK, Navab-Daneshmand T, Marks SJ, Julian TR. Safely Managed Hygiene: A Risk-Based Assessment of Handwashing Water Quality. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2019; 53:2852-2861. [PMID: 30689351 DOI: 10.1021/acs.est.8b06156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sustainable Development Goal (SDG) Indicator 6.2.1 requires household handwashing facilities to have soap and water, but there are no guidelines for handwashing water quality. In contrast, drinking water quality guidelines are defined: water must be "free from contamination" to be defined as "safely managed" (SDG Indicator 6.1.1). We modeled the hypothesized mechanism of infection due to contaminated handwashing water to inform risk-based guidelines for microbial quality of handwashing water. We defined two scenarios that should not occur: (1) if handwashing caused fecal contamination, indicated using Escherichia coli, on a person's hands to increase rather than decrease and (2) if hand-to-mouth contacts following handwashing caused an infection risk greater than an acceptable threshold. We found water containing <1000 E. coli colony-forming units (CFU) per 100 mL removes E. coli from hands with>99.9% probability. However, for the annual probability of infection to be <1:1000, handwashing water must contain <2 × 10-6 focus-forming units of rotavirus, <1 × 10-4 CFU of Vibrio cholerae, and <9 × 10-6 Cryptosporidium oocysts per 100 mL. Our model suggests that handwashing with nonpotable water will generally reduce fecal contamination on hands but may be unable to lower the annual probability of infection risks from hand-to-mouth contacts below 1:1000.
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Affiliation(s)
- Matthew E Verbyla
- Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC) , École Polytechnique Fédérale de Lausanne (EPFL) , CH-1015 Lausanne , Switzerland
| | - Ana K Pitol
- Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC) , École Polytechnique Fédérale de Lausanne (EPFL) , CH-1015 Lausanne , Switzerland
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , CH-8600 Dübendorf , Switzerland
| | - Tala Navab-Daneshmand
- School of Chemical, Biological, and Environmental Engineering , Oregon State University , Corvallis , Oregon 97331 , United States
| | - Sara J Marks
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , CH-8600 Dübendorf , Switzerland
| | - Timothy R Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , CH-8600 Dübendorf , Switzerland
- Swiss Tropical and Public Health Institute , P.O. Box, CH-4002 Basel , Switzerland
- University of Basel , P.O. Box, CH-4003 Basel , Switzerland
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Abrar Ul Haq K, Gul NA, Hammad HM, Bibi Y, Bibi A, Mohsan J. Prevalence of Giardia intestinalis and Hymenolepis nana in Afghan refugee population of Mianwali district, Pakistan. Afr Health Sci 2015; 15:394-400. [PMID: 26124784 PMCID: PMC4480483 DOI: 10.4314/ahs.v15i2.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Present study aimed to investigate prevalence of Giardia intestinalis and Hymenolepis nana in Afghan refugees visiting Central Health Unit (CHU), Kot Chandana (Mianwali, Northern Punjab) during two years period (February 2007 to December 2009). METHODS A total of 687 stool samples were collected from different age groups of both genders. Samples were processed under sterile conditions after gross examination. Microscopic examination was done on same day along with eggs (H. nana), cyst and trophozoites (G. intestinalis) detection after staining. RESULTS The prevalence of G. intestinalis was significantly higher (x2=59.54, p<0.001) than that of H. nana. Females were found more likely to be infected as compared to males (OR: 1.40, 95% CI=1.03-1.92). Prevalence of both parasites decreased with age and highest prevalence was observed in young individuals belonging to 1-15 years of age group (41.8% and 48.7% respectively for H. nana and G. intestinalis, p<0.001). Abdominal distress (OR: 1.13, 95%CI=0.83-1.53), vomiting (OR: 1.13, 95%CI=1.13-1.81) and rectal prolapse (OR: 4.26, 95%CI=1.38-13.16) were the gastro-intestinal clinical symptoms observed in G. intestinalis. Whereas, bloody diarrhea (OR: 1.56, 95%CI=1.00-2.43) and rectal prolapse (OR: 5.79, 95%CI=1.87-17.91) were associated with H. nana infections. CONCLUSIONS Intestinal parasitic infections are common among Afghan refugees and serious preventive measures should be implemented to promote the safety and healthy lifestyle of these people.
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Affiliation(s)
- Khan Abrar Ul Haq
- Institute of Microbiology, University of Agriculture Faisalabad, Pakistan
| | - Naz Asma Gul
- Department of Zoology, Bahauddin Zakariya University, Multan, Pakistan
| | - Hussain Muhammad Hammad
- Veterinary Research Center,Ministry of Agriculture & Fisheries,Sultanate of Oman
- Department of Clinical Medicine & Surgery, University of Agriculture, Faisalabad
| | - Yasmeen Bibi
- Department of Zoology, Bahauddin Zakariya University, Multan, Pakistan
| | - Asma Bibi
- Department of Zoology, Bahauddin Zakariya University, Multan, Pakistan
| | - Javed Mohsan
- Department of Livestock & Dairy Development, Lahore, Punjab, Pakistan
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Alexander KA, Blackburn JK. Overcoming barriers in evaluating outbreaks of diarrheal disease in resource poor settings: assessment of recurrent outbreaks in Chobe District, Botswana. BMC Public Health 2013; 13:775. [PMID: 23971427 PMCID: PMC3765974 DOI: 10.1186/1471-2458-13-775] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 08/16/2013] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Diarrheal illness remains a leading cause of global morbidity and mortality, with the majority of deaths occurring in children <5 years of age. Lack of resources often prohibits the evaluation of outbreak characteristics and limits progress in managing this important disease syndrome, particularly in Africa. Relying only on existing medical staff and hospital resources, we assess the use of a questionnaire survey tool to identify baseline outbreak characteristics during recurrent diarrheal outbreaks in Chobe, Botswana. METHODS Using historical surveillance data (2006-2009), the temporal pattern of recurrent diarrheal outbreaks was evaluated among patients <5 years of age presenting to health facilities in Chobe District. Using a questionnaire survey tool, medical staff from selected health facilities assessed patients (all ages) presenting with diarrheal disease during two diarrheal outbreaks (2011-2012). Cluster analysis and classification and regression trees (CART) were used to evaluate patient attributes by outbreak. RESULTS We identified a bimodal, annual pattern of acute diarrhea in children <5 years of age across years (Wilcox test, W = 456.5, p = 0.052). Historical outbreak periods appeared to coincide with major hydrological phenomena (rainfall/flood recession). Across health facilities, a significant percent of patients in the prospective study were in the ≥5 age class (44%, n = 515 and 35%, n = 333 in the dry and wet season outbreaks, respectively). Cluster analysis of questionnaire data identified two main branches associated with patient age (<5 and ≥5 years of age). Patients did not cluster by outbreak or village. CART examination identified sex and hospitalization as being most predictive of patients <5 years and household diarrhea in patients ≥5 years. Water shortages and water quality deficiencies were identified in both outbreaks. CONCLUSIONS Diarrhea is a persistent, seasonally occurring disease in Chobe District, Botswana. Lack of variation in outbreak variables suggests the possibility of environmental drivers influencing outbreak dynamics and the potential importance of human-environmental linkages in this region. Public health strategy should be directed at securing improved water service and correcting water quality deficiencies. Public health education should include increased emphasis on sanitation practices when providing care to household members with diarrhea. While global diarrheal disease surveillance is directed at the under-5 age group, this may not be appropriate in areas of high HIV prevalence such as that found in our study area where a large immune-compromised population may warrant increased surveillance across age groups. The approach used in this study provided the first detailed characterization of diarrheal disease outbreaks in the area, an important starting point for immediate intervention and development of working hypotheses for future disease investigations. While data derived from this approach are necessarily limited, they identify critical information on outbreak characteristics in resource poor settings where data gaps continue and disease incidence is high.
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Affiliation(s)
- KA Alexander
- Department of Fish and Wildlife Conservation, Virginia Tech, 132 Cheatham Hall, Blacksburg, Virginia 24061, USA
- CARACAL (Center for Conservation of African Resources: Animals, Communities and Land use), Kasane, Botswana
| | - JK Blackburn
- Department of Geography, Spatial Epidemiology & Ecology Research Laboratory, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
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Ram PK, Crump JA, Gupta SK, Miller MA, Mintz ED. Part II. Analysis of data gaps pertaining to Shigella infections in low and medium human development index countries, 1984-2005. Epidemiol Infect 2007; 136:577-603. [PMID: 17686195 PMCID: PMC2870860 DOI: 10.1017/s0950268807009351] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The global incidence of Shigella infection has been estimated at 80-165 million episodes annually, with 99% of episodes occurring in the developing world. To identify contemporary gaps in the understanding of the global epidemiology of shigellosis, we conducted a review of the English-language scientific literature from 1984 to 2005, restricting the search to low and medium human development countries. Our review yielded 11 population-based studies of Shigella burden from seven countries. No population-based studies have been conducted in sub-Saharan Africa or in low human development countries. In studies done in all age groups, Shigella incidence varied from 0.6 to 107 episodes/1000 person-years. S. flexneri was the most commonly detected subgroup in the majority of studies. Case-fatality rates ranged from 0% to 2.6% in population-based studies and from 0% to 21% in facility-based studies. This review highlights the large gaps in data on the burden of Shigella infections for low human development index countries and, more specifically, for sub-Saharan Africa.
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Affiliation(s)
- P K Ram
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA.
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Guerin PJ, Grais RF, Rottingen JA, Valleron AJ. Using European travellers as an early alert to detect emerging pathogens in countries with limited laboratory resources. BMC Public Health 2007; 7:8. [PMID: 17239228 PMCID: PMC1804266 DOI: 10.1186/1471-2458-7-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 01/19/2007] [Indexed: 12/03/2022] Open
Abstract
Background The volume, extent and speed of travel have dramatically increased in the past decades, providing the potential for an infectious disease to spread through the transportation network. By collecting information on the suspected place of infection, existing surveillance systems in industrialized countries may provide timely information for areas of the world without adequate surveillance currently in place. We present the results of a case study using reported cases of Shigella dysenteriae serotype 1 (Sd1) in European travellers to detect "events" of Sd1, related to either epidemic cases or endemic cases in developing countries. Methods We identified papers from a Medline search for reported events of Sd1 from 1940 to 2002. We requested data on shigella infections reported to the responsible surveillance entities in 17 European countries. Reports of Sd1 from the published literature were then compared with Sd1 notified cases among European travellers from 1990 to 2002. Results Prior to a large epidemic in 1999–2000, no cases of Sd1 had been identified in West Africa. However, if travellers had been used as an early warning, Sd1 could have been identified in this region as earlier as 1992. Conclusion This project demonstrates that tracking diseases in European travellers could be used to detect emerging disease in developing countries. This approach should be further tested with a view to the continuous improvement of national health surveillance systems and existing European networks, and may play a significant role in aiding the international public health community to improve infectious disease control.
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Affiliation(s)
- Philippe J Guerin
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
- Epicentre, Paris, France
| | - Rebecca Freeman Grais
- Epicentre, Paris, France
- Universite Pierre et Marie Curie, UMR S707, Paris, F75012, France
- AP-HP, Hôpital Saint Antoine, Unité de Santé Publique, Paris, 75012 France
- INSERM, U707, Paris, F-75012 France
| | - John Arne Rottingen
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
- Institute for Nutrition Research, University of Oslo, Norway
| | - Alain Jacques Valleron
- Universite Pierre et Marie Curie, UMR S707, Paris, F75012, France
- AP-HP, Hôpital Saint Antoine, Unité de Santé Publique, Paris, 75012 France
- INSERM, U707, Paris, F-75012 France
| | - the Shigella Study Group
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
- Epicentre, Paris, France
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