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Aboul-Enein BH, Kelly PJ, Raddi S, Keller T, Almoayad F. Effectiveness of hand hygiene campaigns and interventions across the League of Arab States: a region-wide scoping review. J Hosp Infect 2024:S0195-6701(24)00081-1. [PMID: 38492646 DOI: 10.1016/j.jhin.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/18/2024]
Abstract
Hand hygiene is a standard public health practice for limiting the spread of infectious diseases, yet they are still not routine global health behaviours. This review aimed to examine the effectiveness of various hand hygiene interventions conducted across the League of Arab States, identify gaps in the existing literature, and propose areas for future research and intervention development. A scoping review was conducted across 16 databases for relevant publications published up to and including October 2023. Forty studies met the inclusion criteria; of these, 34 were hospital-based and six community-based. Of the reviewed studies, 24 provided adequate details that would enable replication of their intervention. Eighteen of the studies used some variation of the World Health Organization's Five Moments for intervention content or assessment. More than half (N = 25) reported healthcare worker or student hand hygiene behaviours as an outcome and 15 studies also included some form of patient-centred outcomes. Six studies specified the use of theory or framework for their evaluation design or intervention content, and four studies mentioned use of local government guidelines or recommendations. Future research should focus on bridging the literature gaps by emphasizing community-based studies and integrating cultural nuances into intervention designs. Additionally, applying theoretical frameworks to hand hygiene studies could enhance understanding and effectiveness, ensuring sustainable improvements in hygiene practices across diverse settings in the League of Arab States.
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Affiliation(s)
- B H Aboul-Enein
- London School of Hygiene & Tropical Medicine, Faculty of Public Health and Policy, London, UK.
| | - P J Kelly
- Thomas Jefferson University, College of Nursing, Philadelphia, PA, USA
| | - S Raddi
- University of Bisha, College of Applied Medical Sciences, Department of Nursing, Bisha, Saudi Arabia
| | - T Keller
- New Mexico State University, School of Nursing, Las Cruces, NM, USA
| | - F Almoayad
- Princess Nourah Bint Abdulrahman University, College of Health and Rehabilitation Sciences, Department of Health Sciences, Riyadh, Saudi Arabia
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Huang J, Li J, Meng W, Su G. A critical review on organophosphate esters in drinking water: Analysis, occurrence, sources, and human health risk assessment. Sci Total Environ 2024; 913:169663. [PMID: 38159759 DOI: 10.1016/j.scitotenv.2023.169663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
Organophosphate esters (OPEs) are ubiquitous in the environment. Copious studies assessed OPEs in various environmental media. However, there is limited summative information about OPEs in drinking water. This review provides comprehensive data for the analytical methods, occurrence, sources, and risk assessment of OPEs in drinking water. In general, liquid-liquid extraction and solid-phase extraction are the most common methods in the extraction of OPEs from drinking water, while gas chromatography and liquid chromatography are the most commonly used instrumental methods for detecting OPEs in drinking water. On the basis of these techniques, a variety of methods on OPEs pretreatment and determination have been developed to know the pollution situation of OPEs. Studies on the occurrence of OPEs in drinking water show that the total concentrations of OPEs vary seasonally and regionally, with tris(1-chloro-2-isopropyl) phosphate and tris(2-chloroethyl) phosphate dominant among different kinds of drinking water. Source identification studies show that there are three main sources of OPEs in drinking water: 1) source water contamination; 2) residual in drinking water treatment process; 3) leakage from device or pipeline. Besides, risk assessments indicate that individual and total OPEs pose no or negligible health risk to human, but this result may be significantly underestimated. Finally, the current knowledge gaps on the research of OPEs in drinking water are discussed and some suggestions are provided for future environmental research.
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Affiliation(s)
- Jianan Huang
- Key Laboratory of Environmental Remediation and Ecological Health, Ministry of Industry and Information Technology, School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Jianhua Li
- Key Laboratory of Environmental Remediation and Ecological Health, Ministry of Industry and Information Technology, School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Weikun Meng
- Key Laboratory of Environmental Remediation and Ecological Health, Ministry of Industry and Information Technology, School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing 210094, China
| | - Guanyong Su
- Key Laboratory of Environmental Remediation and Ecological Health, Ministry of Industry and Information Technology, School of Environmental and Biological Engineering, Nanjing University of Science and Technology, Nanjing 210094, China.
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McAlister MM, Namakula P, Annis J, Mihelcic JR, Zhang Q. Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling. Environ Sci Technol 2024; 58:400-409. [PMID: 38113387 DOI: 10.1021/acs.est.3c09101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Improved sanitation provides many benefits to human health and well-being and is integral to achieving Sustainable Development Goal Six. However, many nations, including most of sub-Saharan Africa, are not on track to meeting sanitation targets. Recognizing the inherent complexity of environmental health, we used systems thinking to study sanitation sustainability in Uganda. Our study participants, 37 sanitation actors in three rural districts, were engaged in interviews, group model building workshops, and a survey. The resulting model was parametrized and calibrated using publicly available data and data collected through the Uganda Sanitation for Health Activity. Our simulations revealed slippage from improved sanitation in all study districts, a behavior reflected in real interventions. This implies that systemic changes-changes to the rules and relationships in the system-may be required to improve sanitation outcomes in this context. Adding reinforcing feedback targeting households' perceived value of sanitation yielded promising simulation results. We conclude with the following general recommendations for those designing sanitation policies or interventions: (1) conceptualize sanitation systems in terms of reinforcing and balancing feedback, (2) consider using participatory and simulation modeling to build confidence in these conceptual models, and (3) design many experiments (e.g., simulation scenarios) to test and improve understanding.
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Affiliation(s)
- Martha M McAlister
- Department of Civil & Environmental Engineering, University of South Florida, 4202 E Fowler Avenue, Tampa, Florida 33620, United States
| | - Patricia Namakula
- Tetra Tech, USAID Uganda Sanitation for Health Activity, Plot 12A, Farady Road, Tetra Tech, Kampala, Uganda
| | - Jonathan Annis
- Tetra Tech, USAID Uganda Sanitation for Health Activity, Plot 12A, Farady Road, Tetra Tech, Kampala, Uganda
| | - James R Mihelcic
- Department of Civil & Environmental Engineering, University of South Florida, 4202 E Fowler Avenue, Tampa, Florida 33620, United States
| | - Qiong Zhang
- Department of Civil & Environmental Engineering, University of South Florida, 4202 E Fowler Avenue, Tampa, Florida 33620, United States
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Caruso BA, Snyder JS, Cumming O, Esteves Mills J, Gordon B, Rogers H, Freeman MC, Wolfe M. Synthesising the evidence for effective hand hygiene in community settings: an integrated protocol for multiple related systematic reviews. BMJ Open 2023; 13:e077677. [PMID: 37967997 PMCID: PMC10660659 DOI: 10.1136/bmjopen-2023-077677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/19/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Despite evidence for the efficacy and effectiveness of hand hygiene in reducing the transmission of infectious diseases, there are gaps in global normative guidance around hand hygiene in community settings. The goal of this review is to systematically retrieve and synthesise available evidence on hand hygiene in community settings across four areas: (1) effective hand hygiene; (2) minimum requirements; (3) behaviour change and (4) government measures. METHODS AND ANALYSIS This protocol entails a two-phased approach to identify relevant studies for multiple related systematic reviews. Phase 1 involves a broad search to capture all studies on hand hygiene in community settings. Databases, trial registries, expert consultations and hand searches of reference lists will be used to ensure an exhaustive search. A comprehensive, electronic search strategy will be used to identify studies indexed in PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary published in English from January 1980 to March 2023. The outcome of phase 1 will be a reduced sample of studies from which further screening, specific to research questions across the four key areas can be performed. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Quantitative and qualitative data will be extracted following best practices. We will assess all studies using the Mixed Method Appraisal Tool. All effect measures pertaining to review outcomes will be reported and a narrative synthesis of all studies will be presented including 'data-driven' descriptive themes and 'theory-driven' analytical themes as applicable. ETHICS AND DISSEMINATION This systematic review is exempt from ethics approval because the work is carried out on published documents. The findings of the reviews will be disseminated in related peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42023429145.
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Affiliation(s)
- Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jedidiah S Snyder
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- Water, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland
| | - Joanna Esteves Mills
- Water, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland
| | - Bruce Gordon
- Water, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland
| | - Hannah Rogers
- Woodruff Health Sciences Center, Emory University, Atlanta, Georgia, USA
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Marlene Wolfe
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Essuman MA, Storph RP, Ahinkorah BO, Budu E, Yaya S. Hygienic Disposal of Children's Stools Practices Among Women of Children With Diarrhoea in Sub-Saharan Africa. Environ Health Insights 2023; 17:11786302231204764. [PMID: 37899844 PMCID: PMC10605691 DOI: 10.1177/11786302231204764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 10/31/2023]
Abstract
Background Diarrhoea stools contain infectious agents and pose a public health threat to children and members of the entire family when exposed to them. Therefore, their hygienic disposal is essential. Empirical data are needed to stir the needed public health interventions to encourage or enforce proper disposal practices to curb associated clinical issues. This study assessed the prevalence and correlates of hygienic stool disposal practices by mothers of children with diarrhoea in sub-Saharan Africa (SSA). Methods The Demographic and Health Surveys (DHS) data of 16 sub-Saharan African countries from 2015 to 2021 involving 22 590 mother-child pairs were analysed. Multilevel binary logistic analysis was conducted to assess the individual- and household-level factors associated with the hygienic disposal of stool practices by mothers of children with diarrhoea. The results were presented using adjusted odds ratios (AOR) and 95% confidence intervals (CI) at a statistical significance of P < .05. Results The overall prevalence of hygienic disposal of children's stools among women of children with diarrhoea was 49.01% (95% CI: 48.40-49.62) and ranged from 15.70% in Liberia to 86.6% in Rwanda. The practice of hygienic disposal of stools of children with diarrhoea was likely to increase among mothers who are working (AOR: 1.19; 95% CI: 1.09-1.30), those with partners with primary level of education (AOR: 1.18; 95% CI: 1.06-1.31), Muslims (AOR: 1.69; 95% CI: 1.49-1.91) and widowed/divorced (AOR: 8.94, 95% CI: 3.55-22.53). Again, mothers in the richer (AOR: 1.23; 95% CI: 1.08-1.39) wealth index had increased odds of disposing of stools hygienically compared to those in the poorest wealth index. Women who were 20 years and above, to who belonged to Traditional Religions (AOR: 0.57; 95% CI: 0.43-0.74), and those with unimproved sources of water (AOR: 0.89; 95% CI: 0.82-0.98) and toilet facilities (AOR: 0.63; 95% CI: 0.58-0.69) were less likely to dispose of child's diarrhoea stool hygienically than their counterparts. Conclusion The study reveals that the unhygienic disposal of the stool of children with diarrhoea is prevalent in SSA and requires a concerted effort to curb it. Sanitation practices such as educating mothers about hygienic disposal of children's stool and improving water and sanitation facilities are crucial in lowering the high prevalence of unhygienic disposal of the diarrhoeic stool of children. Additional country-level research is needed to assess children's defecation behaviours and the disposal of diarrhoeic stools using different methodologies.
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Affiliation(s)
- Mainprice Akuoko Essuman
- Department of Medical Laboratory Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Central, Ghana
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Eugene Budu
- Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Pessoa Colombo V, Chenal J, Koné B, Koffi JD, Utzinger J. Spatial Distributions of Diarrheal Cases in Relation to Housing Conditions in Informal Settlements: A Cross-Sectional Study in Abidjan, Côte d'Ivoire. J Urban Health 2023; 100:1074-1086. [PMID: 37801186 PMCID: PMC10618124 DOI: 10.1007/s11524-023-00786-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
In addition to individual practices and access to water, sanitation, and hygiene (WASH) facilities, housing conditions may also be associated with the risk of diarrhea. Our study embraced a broad approach to health determinants by looking at housing deprivation characteristics as exposures of interest and confronting the latter's spatial distribution to that of diarrheal cases. We tested the hypothesis that the risk of diarrhea in informal settlements is not only associated with WASH services, but also with inadequate dwelling characteristics, and that their spatial distributions follow similar patterns. We designed a cross-sectional study and collected primary data through georeferenced household surveys in two informal settlements in Abidjan, Côte d'Ivoire. We used local join count statistics to assess the spatial distribution of events and multiple logistic regressions to calculate adjusted odds ratios between diarrhea and exposures. A total of 567 households were enrolled. We found that constant access to basic WASH services, non-durable building materials, cooking outdoors, and water service discontinuity were associated with higher risks of diarrhea in the general population. The spatial distribution of diarrheal cases coincided with that of dwelling deprivation characteristics. We observed significant heterogeneity within the study sites regarding the spatial distribution of diarrheal cases and deprived dwellings. Along with WASH infrastructure, communities also need dignified housing to effectively prevent diarrhea. We recommend that decision-makers acknowledge a "spectrum" of deprivation within the heterogeneous universe of informal settlements, adopting a site-specific approach based on high-resolution data to address diarrhea and improve people's well-being.
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Affiliation(s)
| | - Jérôme Chenal
- École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Université Mohammed VI Polytechnique, Ben Guerir, Morocco
| | - Brama Koné
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
- Université Péléforo Gon Coulibaly, Korhogo, Côte d'Ivoire
| | - Jeanne d'Arc Koffi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Lin J, Feng XL. Exploring the impact of water, sanitation and hygiene (WASH), early adequate feeding and access to health care on urban-rural disparities of child malnutrition in China. Matern Child Nutr 2023; 19:e13542. [PMID: 37376961 PMCID: PMC10483939 DOI: 10.1111/mcn.13542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
To explore the effects of UNICEF-suggested modifiable factors, that is, water, sanitation and hygiene (WASH), early adequate feeding and health care on child malnutrition, and to examine the extent to which each factor contributes to urban-rural disparities of child malnutrition in China. Pooling two waves of regionally representative survey data from Jilin, China, in 2013 and 2018, we report on urban-rural relative risks (RRs) in the prevalence of child stunting, wasting and overweight. We employ Poisson regression to examine the effects of urban-rural setting and the three modifiable factors on the prevalence of each malnutrition outcome, that is, stunting, wasting and overweight. We perform mediation analyses to estimate the extent to which each modifiable factor could explain the urban-rural disparities in each malnutrition outcome. The prevalence of stunting, wasting and overweight were 10.9%, 6.3% and 24.7% in urban, and 27.9%, 8.2% and 35.9% in rural Jilin, respectively. The rural to urban crude RR was 2.55 (95% confidence interval [CI]: 1.92-3.39) for stunting, while the corresponding RRs for wasting and overweight were 1.31 (95% CI: 0.84-2.03) and 1.45 (95% CI: 1.20-1.76), respectively. The rural to urban RR for stunting reduced to 2.01 (95% CI: 1.44-2.79) after adjusting for WASH. The mediation analyses show that WASH could mediate 23.96% (95% CI: 4.34-43.58%) of the urban-rural disparities for stunting, while early adequate feeding and health care had no effects. To close the persistent urban-rural gap in child malnutrition, the specific context of rural China suggests that a multi-sectoral approach is warranted that focuses on the sanitation environment and other wider social determinants of health.
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Affiliation(s)
- Junjie Lin
- Department of Health Policy and Management, School of Public HealthPeking UniversityBeijingChina
| | - Xing Lin Feng
- Department of Health Policy and Management, School of Public HealthPeking UniversityBeijingChina
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Gaffan N, Degbey C, Kpozehouen A, Ahanhanzo YG, Paraïso MN. Exploring the association between household access to water, sanitation and hygiene (WASH) services and common childhood diseases using data from the 2017-2018 Demographic and Health Survey in Benin: focus on diarrhoea and acute respiratory infection. BMJ Open 2023; 13:e074332. [PMID: 37730407 PMCID: PMC10510876 DOI: 10.1136/bmjopen-2023-074332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE The paper aimed to study the association between household access to water, sanitation and hygiene (WASH) services and the occurrence of diarrhoea and acute respiratory infection among children under 5 years in Benin. DESIGN We performed secondary analyses using Benin's Fifth Demographic and Health Survey datasets. The dependent variables were diarrhoea and acute respiratory infection (yes=1, no=0). Among the independent variables were the household access to individual WASH services, grouped as follows: 'basic', 'limited', 'unimproved' and 'no service'. Multivariate logistic regression was used to determine the association between household access to WASH services and the occurrence of diarrhoea and acute respiratory infection. Results from the multivariate logistic regression were presented using adjusted Odds Ratios (aORs) with 95% Confidence Intervals (95% CIs). SETTING Benin. PARTICIPANTS Children under 5 years successfully surveyed during Benin's Fifth Demographic and Health Survey. OUTCOME MEASURES Diarrhoea and acute respiratory infection. RESULTS In the current study, 12 034 children under 5 years met the selection criteria and were included in the analyses. The prevalence of diarrhoea and acute respiratory infection was 10.5% (95% CI=9.8% to 11.3%) and 2.9% (95% CI=2.5% to 3.4%), respectively. Children living in households without sanitation service, that is, practising open defecation (aOR=1.9, 95% CI=1.4 to 2.6), and with unimproved (aOR=1.9, 95% CI=1.3 to 2.7) and limited (aOR=1.5, 95% CI=1.1 to 2.2) services were more likely to have diarrhoea compared with children with basic sanitation services. Household access to WASH services was not associated with acute respiratory infection. CONCLUSION We suggest reinforcing household access to basic sanitation services to combat diarrhoea in children under 5 years. Further research is needed on the effects of WASH interventions on diarrhoea and acute respiratory infection in children under 5 years.
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Affiliation(s)
- Nicolas Gaffan
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Cotonou, Benin
| | - Cyriaque Degbey
- Department of Environmental Health, Regional Institute of Public Health, University of Abomey-Calavi, Cotonou, Benin
| | - Alphonse Kpozehouen
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Cotonou, Benin
| | - Yolaine Glele Ahanhanzo
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Cotonou, Benin
| | - Moussiliou Noël Paraïso
- Department of Health Promotion, Regional Institute of Public Health, University of Abomey-Calavi, Cotonou, Benin
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Adhikari S, Hunter E, Vossenberg JVD, Thomas J. A review of latrine front-end characteristics associated with microbial infection risk; reveals a lack of pathogen density data. Int J Hyg Environ Health 2023; 254:114261. [PMID: 37734133 DOI: 10.1016/j.ijheh.2023.114261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
Unsafe sanitation accounts for an estimated 898,000 global deaths annually. The faecal pathogen transmission pathway is complex with several possible routes. Latrine front-end characteristics and usage behaviours are one key transmission pathway for microbial pathogens, however, there has not yet been a synthesis of the available research. This review aims to compare the microbial infection risks with latrine front-end components including any quantified microbial densities within the household latrines. This review was conducted with no restriction on the geographical location of the research. Of 118 studies reviewed, only ten (8%) have quantified the microbial density inside the household latrines compared to 109 (92%) measuring the infection risks. The reported risks were most frequent for specific bacterial (n = 34), and helminths infections (n = 32) compared to diarrhoea (n = 23), combined (n = 15), protozoan (n = 4), and viral (n = 4) infections. The infections risk decreased for using latrines lying at a higher position on the sanitation ladder (for example flush latrines) compared to those lying lower (for example pit latrines). The trend was similar for using floor materials that were easier to clean and less favourable for pathogen survival inside the latrines (for example, concrete as opposed to earth). Faecal coliforms were reported highest on the surface of the squat pan (743 CFU/cm2) of pour-flush latrines and helminths on earth floors of pit latrines (1.5 eggs and larvae per gram of soil). Irrespective of latrine type and its position on the sanitation ladder, a dirty latrine, evidenced by a visible lack of cleanliness, significantly increased the risk for all infections. This study recommends that effective microbial infection risk reduction in latrines can be gained efficiently by ensuring washable surfaces and consistent cleaning practices. Future studies should include more rigorous measurements of microbial densities in various latrine types incorporating the different front-end components and usage behaviours.
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Affiliation(s)
- Sabita Adhikari
- School of Civil Engineering, The University of Sydney, Australia.
| | - Erin Hunter
- Department of Public Health Sciences, College of Behavioural, Social and Health Sciences, Clemson University, United States.
| | - Jack van de Vossenberg
- Water Supply, Sanitation and Environmental Engineering Department, IHE Delft Institute of Water Education, the Netherlands.
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Brahmanandam N, Bharambe MS. Transition in availability of improved sanitation facilities and its effect on diarrhoeal disease in India: evidence from longitudinal data. Int Health 2023; 15:526-536. [PMID: 36626725 PMCID: PMC10472887 DOI: 10.1093/inthealth/ihac082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/12/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Poor sanitation, such as open defecation, is a major public health concern in India, causing diarrhoea and other infectious diseases. So far, few studies have linked poor sanitation with diarrhoea using longitudinal data. In this context, this study assesses the transition in availability of household sanitation facilities and its effect on diarrhoeal morbidity. METHODS We used two waves of longitudinal data from the India Human Development Survey, conducted in 2004-2005 and 2011-2012, and based on 34 131 followed-up households using a two-stage stratified random sampling method. In the first stage, multinomial logistic regression was used to assess socio-economic factors contributing to the transition in the availability of household sanitation facilities. In the second stage, multivariate linear regression was performed to examine the effect of the change in the availability of household sanitation facilities on the prevalence of diarrhoeal morbidity. All the analysis in this study was carried out by using Stata version 13 software. RESULTS The findings reveal that the practice of open defecation was continued to be higher among lower socio-economic households than better-off socio-economic households in both 2004-2005 and 2011-2012. The proportion of household members who fell sick due to diarrhoea morbidity has decreased significantly (β=-0.06, p<0.04) among households that switched from open defecation in 2004-2005 to improved sanitation facilities in 2011-12, compared to households that continued to practice open defecation in both periods (2004-2005 and 2011-2012). The share of household members who fell sick due to diarrhoeal morbidity was significantly lower (β=-0.09, p<0.001) among the households who adopted improved toilet facilities in both periods (2004-2005 and 2011-2012) as compared with the households who continued to defecate openly in both periods, net of other covariates. CONCLUSIONS Our findings show that there is a need to strengthen existing policies focusing on lower socio-economic groups to improve sanitation and eliminate its related diseases. In particular, the ongoing 'Clean India Mission' should play a critical role in promoting sanitation for all.
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Affiliation(s)
- N Brahmanandam
- Doctoral student, Development Studies, Department of Development Studies, International Institute for Population Sciences, Deonar, Govandi Station Road, Mumbai 400088, Maharashtra, India
| | - Milind Sadashiv Bharambe
- Doctoral student, School of Development Studies, Tata Institute of Social Sciences, Deonar, Mumbai 400088, Maharashtra, India
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Aydamo AA, Gari SR, Mereta ST. Access to Drinking Water, Sanitation, and Hand Hygiene Facilities in the Peri-Urban and Informal Settlements of Hosanna Town, Southern Ethiopia. Environ Health Insights 2023; 17:11786302231193604. [PMID: 37655235 PMCID: PMC10467220 DOI: 10.1177/11786302231193604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023]
Abstract
Access to water, sanitation, and hygiene (WASH) facilities and practices have been extensively studied in urban and rural areas. However, there is a paucity of information on the coverage of water, sanitation, and hygiene facilities in the peri-urban and informal settlement areas, which could potentially exacerbate the spread of water, sanitation, and hygiene-related diseases. Therefore, this study was designed to examine access to drinking water, sanitation, and hand hygiene facilities and their determinant factors in the peri-urban and informal settlements of Hosanna town. A community-based cross-sectional study involving 292 households was conducted in 3 kebeles of Hosanna town. The primary data was collected using a pretested structured questionnaire and an observational checklist. Bivariate and multivariable logistic regressions were used to analyze the data. All the households (100%) had access to piped water on and off-premises, but the reliability of the water sources was a big challenge. Findings revealed that only 35.1% and 16.8% of the households had basic sanitation and basic handwashing facilities, respectively. Households with a middle income were identified as a determinant factor for the presence of piped water on premises (AOR = 2.23; 95% CI = 1.24-4.00), improved sanitation (AOR = 2.17; 95% CI = 1.17-4.03) and handwashing facilities (AOR = 4.36; 95% CI = 1.98-9.62). Piped water on premises was also another strong predictor of the availability of improved sanitation (AOR = 3.34; 95% CI = 1.99-5.62) and handwashing facilities (AOR = 8.18; 95% CI = 4.08-16.42). The majority of the studied households living in the selected peri-urban and informal settlements had access to unreliable drinking water sources. The study also revealed that households had poor access to basic sanitation and basic handwashing facilities. Hence, the findings call for solid government interventions to improve the reliability of the drinking water sources, basic sanitation coverage, and availability of basic handwashing facilities.
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Affiliation(s)
- Abiot Abera Aydamo
- Ethiopian Institute of Water Resources (EiWR), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Environmental Sciences, Wachemo University, Hosanna, Ethiopia
| | - Sirak Robele Gari
- Ethiopian Institute of Water Resources (EiWR), Addis Ababa University, Addis Ababa, Ethiopia
| | - Seid Tiku Mereta
- Department of Environmental Health and Technology, Jimma University, Jimma, Ethiopia
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Sentamu DN, Kungu J, Dione M, Thomas LF. Prevention of human exposure to livestock faecal waste in the household: a scoping study of interventions conducted in sub-Saharan Africa. BMC Public Health 2023; 23:1613. [PMID: 37612675 PMCID: PMC10463677 DOI: 10.1186/s12889-023-16567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/20/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Poorly managed animal faecal waste can result in detrimental environmental and public health implications. Limiting human exposure to animal waste through Animal inclusive Water Sanitation and Hygiene (A-WASH) strategies is imperative to improve public health in livestock keeping households but has received little attention to date. A small number of A-WASH interventions have previously been identified through a systematic review by another research team, and published in 2017. To inform intervention design with the most up-to-date information, a scoping study was conducted to map the existing evidence for A-WASH in sub-Saharan Africa (SSA) emerging since the previous review. METHODS This review followed PRISMA guidelines to identify interventions in SSA published between January 2016 to October 2022. Databases searched included PubMed, PMC Europe, CabDirect and Web of Science. Studies were eligible for inclusion if they were written in English and documented interventions limiting human contact with animal faecal material in the SSA context. Key data extracted included: the intervention itself, its target population, cost, measure of effectiveness, quantification of effect, assessment of success, acceptability and limitations. These data were synthesized into a narrative, structured around the intervention type. FINDINGS Eight eligible articles were identified. Interventions to reduce human exposure to animal faecal matter were conducted in combination with 'standard' human-centric WASH practices. Identified interventions included the management of human-animal co-habitation, educational programs and the creation of child-safe spaces. No novel A-WASH interventions were identified in this review, beyond those identified by the review in 2017. Randomised Controlled Trials (RCTs) were used to evaluate six of the eight identified interventions, but as effect was evaluated through various measures, the ability to formally compare efficacy of interventions is lacking. CONCLUSION This study indicates that the number of A-WASH studies in SSA is increasing and the use of RCTs suggests a strong desire to create high-quality evidence within this field. There is a need for standardisation of effect measures to enable meta-analyses to be conducted to better understand intervention effectiveness. Evaluation of scalability and sustainability of interventions is still lacking in A - WASH research.
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Affiliation(s)
- Derrick N Sentamu
- Animal and Human Health Program, International Livestock Research Institute, P.O Box 30709, Nairobi, 00100, Kenya
| | - Joseph Kungu
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Michel Dione
- International Livestock Research Institute, c/o AfricaRice, Rue 18 CitéMamelles, BP 24265, Dakar, Senegal
| | - Lian F Thomas
- Animal and Human Health Program, International Livestock Research Institute, P.O Box 30709, Nairobi, 00100, Kenya.
- Institute of Infection, Veterinary & Ecological Sciences, The University of Liverpool, Leahurst Campus, Neston, Liverpool, CH64 7TE, UK.
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Aragaw FM, Merid MW, Tebeje TM, Erkihun MG, Tesfaye AH. Unimproved source of drinking water and its associated factors: a spatial and multilevel analysis of Ethiopian demographic and health survey. BMC Public Health 2023; 23:1455. [PMID: 37525187 PMCID: PMC10388450 DOI: 10.1186/s12889-023-16354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Drinking water quality has been a major public health concern in lower and middle income countries where access to improved water supplies is limited. Ethiopia is thought to have one of the worst drinking water infrastructures in the world. This study aimed to assess the spatial variation and determinants of using unimproved sources of drinking water in Ethiopia using recent nationally representative data. METHODS A population-based cross-sectional study was employed with the recent EDHS data of 2019. A total of 8663 households were sampled using a stratified two-stage cluster sampling method. Kuldorff's SaTScan version 9.6 software was used to generate spatial scan statistics. ArcGIS version 10.7 software was used to visualize the spatial patterns of unimproved drinking water sources. A multilevel multivariable mixed-effect logistic regression was used to identify factors associated with the use of an unimproved drinking water source. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of using an unimproved source of drinking water. RESULT Around 31% (95% CI: 30%, 32%) of the population in Ethiopia uses unimproved sources of drinking water with significant spatial variation across the country. Households aged 41-60 [AOR = 0.69; 95%CI; 0.53, 0.89] as compared to the households aged 10-25, households having middle wealth index [AOR = 0.48; 95%CI; 0.40, 0.59], and households having a rich wealth index [AOR = 0.31; 95%CI; 0.25, 0.39] as compared to the poor households, living in high community literacy level [AOR = 0.36; 95%CI; 0.16, 0.80], living in high-level community poverty [AOR = 3.03; 95%CI; 1.32, 6.98], rural residence [AOR = 7.88; 95%CI; 2.74, 22.67] were significant predictors of use of unimproved source of drinking water. Hot spot areas of use of unimproved drinking water sources were observed in Amhara, Afar, and Somalia regions and some parts of SNNPR and Oromia regions in Ethiopia. The primary clusters were found in Ethiopia's Somalia and Oromia regions. CONCLUSION Around one third of the Ethiopian population utilizes unimproved source of drinking water and it was distributed non-randomly across regions of Ethiopia. The age of the household head, wealth status of the household, residence, community poverty level, and community literacy level were found to be significantly associated with utilizing unimproved drinking water source. State authorities, non-governmental organizations and local health administrators should work to improve the quality of drinking water particularly for high risk groups such as communities living in high poverty and low literacy, poor households, rural residents, and hot spot areas to decrease the adverse consequences of using unimproved drinking water source.
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Affiliation(s)
- Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsion Mulat Tebeje
- Department of Epidemiology and Biostatistics, School of public health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Muluken Gizachew Erkihun
- Department of Surgery, School of medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Dickson-Gomez J, Nyabigambo A, Rudd A, Ssentongo J, Kiconco A, Mayega RW. Water, Sanitation, and Hygiene Challenges in Informal Settlements in Kampala, Uganda: A Qualitative Study. Int J Environ Res Public Health 2023; 20:6181. [PMID: 37372767 DOI: 10.3390/ijerph20126181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Diarrhea causes 1.6 million deaths annually, including 525,000 children. Further, chronic diarrhea puts children at risk for mineral deficiencies, malnutrition, and stunting which, in turn, can result in cognitive deficits, poor performance in school, and decreased disease immunity in adulthood. Most diarrhea is caused by water contaminated by fecal matter. Interventions to improve clean water and sanitation can save lives; however, challenges persist in informal settlements. In this study, we explored the views of residents of informal settlements regarding water and sanitation in their communities. Focus group interviews were conducted with residents of 6 informal settlements in Kampala, Uganda (n = 165 people), and 6 key informant interviews were conducted with governmental and nongovernmental organizations that work to improve informal settlements or provide services to them. The results from this study demonstrate that, although these informal settlements had many infrastructure "upgrades" such as latrines and toilets, water taps, wells, and garbage collection and drainage systems, the water, sanitation, and hygiene (WASH) system and its components largely failed due to point-of-use charges of water taps and toilets and the difficulty of emptying cesspits. Our results suggest that WASH must be considered a system and that multiple upgrading efforts are needed for WASH systems to work, including road construction and better oversight of fecal sludge disposal.
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Affiliation(s)
- Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | | | - Abigail Rudd
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | | | - Arthur Kiconco
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Siddiqui SA, Fernando I, Nisa' K, Shah MA, Rahayu T, Rasool A, Aidoo OF. Effects of undesired substances and their bioaccumulation on the black soldier fly larvae, Hermetia illucens (Diptera: Stratiomyidae)-a literature review. Environ Monit Assess 2023; 195:823. [PMID: 37291225 DOI: 10.1007/s10661-023-11186-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/01/2023] [Indexed: 06/10/2023]
Abstract
Black soldier fly (BSF), Hermetia illucens (L.) (Diptera: Stratiomyidae), is predominantly reared on organic wastes and other unused complementary substrates. However, BSF may have a buildup of undesired substances in their body. The contamination of undesired substance, e.g., heavy metals, mycotoxins, and pesticides, in BSF mainly occurred during the feeding process in the larval stage. Yet, the pattern of accumulated contaminants in the bodies of BSF larvae (BSFL) is varied distinctively depending on the diets as well as the contaminant types and concentrations. Heavy metals, including cadmium, copper, arsenic, and lead, were reported to have accumulated in BSFL. In most cases, the cadmium, arsenic, and lead concentration in BSFL exceeded the recommended standard for heavy metals occurring in feed and food. Following the results concerning the accumulation of the undesired substance in BSFL's body, they did not affect the biological parameters of BSFL, unless the amounts of heavy metals in their diets are highly exceeding their thresholds. Meanwhile, a study on the fate of pesticides and mycotoxins in BSFL indicates that no bioaccumulation was detected for any of the target substances. In addition, dioxins, PCBs, PAHs, and pharmaceuticals did not accumulate in BSFL in the few existing studies. However, future studies are needed to assess the long-term effects of the aforementioned undesired substances on the demographic traits of BSF and to develop appropriate waste management technology. Since the end products of BSFL that are contaminated pose a threat to both human and animal health, their nutrition and production process must be well managed to create end products with a low contamination level to achieve a closed food cycle of BSF as animal feed.
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Affiliation(s)
- Shahida Anusha Siddiqui
- Technical University of Munich Campus Straubing for Biotechnology and Sustainability, Essigberg 3, 94315, Straubing, Germany.
- German Institute of Food Technologies (DIL e.V.), Prof.-von-Klitzing Str. 7, 49610, D-Quakenbrück, Germany.
| | - Ito Fernando
- Department of Plant Pests and Diseases, Faculty of Agriculture, Universitas Brawijaya, Jl. Veteran, Malang, East Java, 65145, Indonesia
| | - Khoirun Nisa'
- Department of Environmental Engineering, Sepuluh Nopember Institute of Technology, Sukolilo, Surabaya, East Java, 60111, Indonesia
| | - Mohd Asif Shah
- Woxsen University, Kamkole, Sadasivpet, Hyderabad, Telangana, 502345, India
- Division of Research and Development, Lovely Professional University, Phagwara, Punjab, India
| | - Teguh Rahayu
- CV HermetiaTech, Voza Premium Office 20th Floor, Jl. HR. Muhammad No. 31A, Putat Gede, Surabaya, 60189, Jawa Timur, Indonesia
| | - Adil Rasool
- Department of Management, Bakhtar University, Kabul, Afghanistan.
| | - Owusu Fordjour Aidoo
- Department of Biological Sciences, School of Natural and Environmental Sciences, University of Environment and Sustainable Development, PMB, 00233, Somanya, Ghana
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Ming BW, Yang Z, Yan ZL, Shi C, Xu XH, Li L, Ou CQ. Impact of urbanization on morbidity of hepatitis A: a national panel study in China during 2005-2018. Infect Dis Poverty 2023; 12:56. [PMID: 37231511 DOI: 10.1186/s40249-023-01104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The effect of urbanization on the morbidity of hepatitis A remains unclear. We aimed to estimate the association between various urbanization-related indices and hepatitis A morbidity in China. METHODS Data on the annual morbidity of hepatitis A, urbanization-related measures (i.e., gross domestic product per capita, the number of hospitalization beds per 1000 persons, illiteracy rate, tap water coverage, motor vehicles per 100 persons, population density, and the proportion of arable land), and meteorological factors in 31 provincial-level administrative divisions of Chinese mainland during 2005-2018 were collected from the National Population and Health Science Data Sharing Platform, China Statistical Yearbooks, and the China Meteorological Data Sharing Service System, respectively. Generalized linear mixed models were applied to quantify the impacts of different urbanization-related indices on the morbidity of hepatitis A in China after adjusting for covariates. RESULTS A total of 537,466 hepatitis A cases were reported in China during 2005-2018. The annual morbidity had a decline of 79.4% from 5.64 cases to 1.16 cases per 100,000 people. There were obvious spatial variations with higher morbidity in western China. Nationally, gross domestic product per capita and the number of hospitalization beds per 1000 persons increased from 14,040 to 64,644 CNY and from 2.45 to 6.03 during 2005-2018, respectively. The illiteracy rate decreased from 11.0 to 4.9%. Gross domestic product per capita [relative risk (RR) = 0.96, 95% confidence interval (CI): 0.92-0.99], and the number of hospitalization beds per 1000 persons (RR = 0.79, 95% CI: 0.75-0.83) were associated with the declined morbidity of hepatitis A. By contrast, the increased morbidity of hepatitis A was linked to the illiteracy rate (RR = 1.04, 95% CI: 1.02-1.06). Similar influential factors were detected for children and adults, with greater effects witnessed for children. CONCLUSIONS People in the western region suffered the heaviest burden of hepatitis A in Chinese mainland. Nationally, there was a sharp decline in the morbidity of hepatitis A. The urbanization process was associated with the reduction of hepatitis A morbidity in China during 2005-2018.
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Affiliation(s)
- Bo-Wen Ming
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhou Yang
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Ze-Lin Yan
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chen Shi
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xiao-Han Xu
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Li Li
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Jensen PKM, Hossain ZZ, Sultana R, Ferdous J, Almeida S, Begum A. Introduction of the Personal Domain in Water Sanitation and Hygiene (WASH), a New Approach to Identify Missing Health Impacts. Trop Med Infect Dis 2023; 8:tropicalmed8050252. [PMID: 37235300 DOI: 10.3390/tropicalmed8050252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
The water sanitation and hygiene (WASH) sector has provided beneficiaries in low and middle-income countries with latrines and clean water for decades. However, we still need good evidence documenting the expected health impact. This paper investigates why we lack this evidence and ways to move forward. Using mTEC agar, we monitored E. coli contamination on selected "hotspot" surfaces within the kitchen environments of 32 low-income households in Dhaka, Bangladesh, every six weeks for two years. Despite being washed, the highest average contamination was found on food plates, at 253 cfu/10 cm2, followed by cutting knives, with 240 cfu/10 cm2. The drinking vessel surfaces and the latrine doorknobs had the lowest contaminations, with E. coli means of 167 and 73 cfu/10 cm2, respectively. These findings imply a need to measure an individual's pathogen exposure as close to the mouth as possible to estimate the true pathogen exposure. The paper proposes introducing the new "personal domain"-the point of consumption-as the physical sphere in which WASH interventions should be assessed. With this approach, we can observe and quantify the different pathogen exposure routes and, with this, further improve WASH interventions.
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Affiliation(s)
- Peter Kjær Mackie Jensen
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 22, 1014 Copenhagen, Denmark
| | - Zenat Zebin Hossain
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 22, 1014 Copenhagen, Denmark
- Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh
- Department of Public Health, School of Pharmacy and Public Health, Independent University, Dhaka 1229, Bangladesh
| | - Rebeca Sultana
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 22, 1014 Copenhagen, Denmark
- icddr,b, Dhaka 1212, Bangladesh
- Institute of Health Economics, University of Dhaka, Dhaka 1000, Bangladesh
| | - Jannatul Ferdous
- Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Sara Almeida
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 22, 1014 Copenhagen, Denmark
| | - Anowara Begum
- Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh
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Deichsel EL, Powell H, Troeger C, Hossain MJ, Sow SO, Omore R, Jasseh M, Onwuchekwa U, Obor D, Sanogo D, Jones JCM, Nasrin D, Tapia MD, Kotloff KL. Drivers of Decline in Diarrhea Mortality Between GEMS and VIDA Studies. Clin Infect Dis 2023; 76:S58-S65. [PMID: 37074431 PMCID: PMC10116520 DOI: 10.1093/cid/ciad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Statistical modeling suggests that decreasing diarrhea-associated mortality rates in recent decades are largely attributed to improved case management, rotavirus vaccine, and economic development. METHODS We examined data collected in 2 multisite population-based diarrhea case-control studies, both conducted in The Gambia, Kenya, and Mali: the Global Enteric Multicenter Study (GEMS; 2008-2011) and Vaccine Impact on Diarrhea in Africa (VIDA; 2015-2018). Population-level diarrhea mortality and risk factor prevalence, estimated using these study data, were used to calculate the attribution of risk factors and interventions for diarrhea mortality using a counterfactual framework. We performed a decomposition of the effects of the changes in exposure to each risk factor between GEMS and VIDA on diarrhea mortality for each site. RESULTS Diarrhea mortality among children under 5 in our African sites decreased by 65.3% (95% confidence interval [CI]: -80.0%, -45.0%) from GEMS to VIDA. Kenya and Mali had large relative declines in diarrhea mortality between the 2 periods with 85.9% (95% CI: -95.1%, -71.5%) and 78.0% (95% CI: -96.0%, 36.3%) reductions, respectively. Among the risk factors considered, the largest declines in diarrhea mortality between the 2 study periods were attributed to reduction in childhood wasting (27.2%; 95% CI: -39.3%, -16.8%) and an increased rotavirus vaccine coverage (23.1%; 95% CI: -28.4%, -19.4%), zinc for diarrhea treatment (12.1%; 95% CI: -16.0%, -8.9%), and oral rehydration salts (ORS) for diarrhea treatment (10.2%). CONCLUSIONS The VIDA study sites demonstrated exceptional reduction in diarrhea mortality over the last decade. Site-specific differences highlight an opportunity for implementation science in collaboration with policymakers to improve the equitable coverage of these interventions globally.
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Affiliation(s)
- Emily L Deichsel
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Helen Powell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Momodou Jasseh
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - David Obor
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Joquina Chiquita M Jones
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Pessoa Colombo V, Chenal J, Orina F, Meme H, Koffi JDA, Koné B, Utzinger J. Environmental determinants of access to shared sanitation in informal settlements: a cross-sectional study in Abidjan and Nairobi. Infect Dis Poverty 2023; 12:34. [PMID: 37038238 PMCID: PMC10084626 DOI: 10.1186/s40249-023-01078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/10/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Universal access to basic sanitation remains a global challenge, particularly in low- and middle-income countries. Efforts are underway to improve access to sanitation in informal settlements, often through shared facilities. However, access to these facilities and their potential health gains-notably, the prevention of diarrheal diseases-may be hampered by contextual aspects related to the physical environment. This study explored associations between the built environment and perceived safety to access toilets, and associations between the latter and diarrheal infections. METHODS A cross-sectional study was carried out between July 2021 and February 2022, including 1714 households in two informal settlements in Abidjan (Côte d'Ivoire) and two in Nairobi (Kenya). We employed adjusted odds ratios (aORs) obtained from multiple logistic regressions (MLRs) to test whether the location of the most frequently used toilet was associated with a perceived lack of safety to use the facility at any time, and whether this perceived insecurity was associated with a higher risk of diarrhea. The MLRs included several exposure and control variables, being stratified by city and age groups. We employed bivariate logistic regressions to test whether the perceived insecurity was associated with settlement morphology indicators derived from the built environment. RESULTS Using a toilet outside the premises was associated with a perceived insecurity both in Abidjan [aOR = 3.14, 95% confidence interval (CI): 1.13-8.70] and in Nairobi (aOR = 57.97, 95% CI: 35.93-93.53). Perceived insecurity to access toilets was associated with diarrheal infections in the general population (aOR = 1.90, 95% CI: 1.29-2.79 in Abidjan, aOR = 1.69, 95% CI: 1.22-2.34 in Nairobi), but not in children below the age of 5 years. Several settlement morphology features were associated with perceived insecurity, namely, buildings' compactness, the proportion of occupied land, and angular deviation between neighboring structures. CONCLUSIONS Toilet location was a critical determinant of perceived security, and hence, must be adequately addressed when building new facilities. The sole availability of facilities may be insufficient to prevent diarrheal infections. People must also be safe to use them. Further attention should be directed toward how the built environment affects safety.
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Affiliation(s)
| | - Jérôme Chenal
- École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Université Mohammed VI Polytechnique, Ben Guerir, Morocco
| | - Fred Orina
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Hellen Meme
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Brama Koné
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
- Université Péléforo Gon Coulibaly, Korhogo, Côte d'Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Lubeck-Schricker M, Patil-Deshmukh A, Murthy SL, Chaubey MD, Boomkar B, Shaikh N, Shitole T, Eliasziw M, Subbaraman R. Divided infrastructure: legal exclusion and water inequality in an urban slum in Mumbai, India. Environ Urban 2023; 35:178-198. [PMID: 37275771 PMCID: PMC10237587 DOI: 10.1177/09562478221121737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Inadequate water access is central to the experience of urban inequality across low- and middle-income countries and leads to adverse health and social outcomes. Previous literature on water inequality in Mumbai, India's second largest city, offers diverse explanations for water disparities between and within slums.(1) This study provides new insights on water disparities in Mumbai's slums by evaluating the influence of legal status on water access. We analyzed data from 593 households in Mandala, a slum with legally recognized (notified) and unrecognized (non-notified) neighborhoods. Relative to households in a notified neighborhood, households in a non-notified neighborhood suffered disadvantages in water infrastructure, accessibility, reliability, and spending. Non-notified households used significantly fewer liters per capita per day of water, even after controlling for religion and socioeconomic status. Our findings suggest that legal exclusion may be a central driver of water inequality. Extending legal recognition to excluded slum settlements, neighborhoods, and households could be a powerful intervention for reducing urban water inequality.
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Affiliation(s)
- Maya Lubeck-Schricker
- Department of Public Health and Community Medicine at the Tufts University School of Medicine, Boston, USA
| | | | | | | | | | | | | | - Misha Eliasziw
- Department of Public Health and Community Medicine at the Tufts University School of Medicine
| | - Ramnath Subbaraman
- Department of Public Health and Community Medicine and Associate Director of the Tufts Center for Global Public Health at the Tufts University School of Medicine. He is also an Attending Physician in the Division of Geographic Medicine and Infectious Diseases at Tufts Medical Center, Boston, USA. He is also a research advisor for PUKAR
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21
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Mertens A, Arnold BF, Benjamin-Chung J, Boehm AB, Brown J, Capone D, Clasen T, Fuhrmeister E, Grembi JA, Holcomb D, Knee J, Kwong LH, Lin A, Luby SP, Nala R, Nelson K, Njenga SM, Null C, Pickering AJ, Rahman M, Reese HE, Steinbaum L, Stewart J, Thilakaratne R, Cumming O, Colford JM, Ercumen A. Effects of water, sanitation, and hygiene interventions on detection of enteropathogens and host-specific faecal markers in the environment: a systematic review and individual participant data meta-analysis. Lancet Planet Health 2023; 7:e197-e208. [PMID: 36889861 PMCID: PMC10009758 DOI: 10.1016/s2542-5196(23)00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Water, sanitation, and hygiene (WASH) improvements are promoted to reduce diarrhoea in low-income countries. However, trials from the past 5 years have found mixed effects of household-level and community-level WASH interventions on child health. Measuring pathogens and host-specific faecal markers in the environment can help investigate causal pathways between WASH and health by quantifying whether and by how much interventions reduce environmental exposure to enteric pathogens and faecal contamination from human and different animal sources. We aimed to assess the effects of WASH interventions on enteropathogens and microbial source tracking (MST) markers in environmental samples. METHODS We did a systematic review and individual participant data meta-analysis, which included searches from Jan 1, 2000, to Jan 5, 2023, from PubMed, Embase, CAB Direct Global Health, Agricultural and Environmental Science Database, Web of Science, and Scopus, of prospective studies with water, sanitation, or hygiene interventions and concurrent control group that measured pathogens or MST markers in environmental samples and measured child anthropometry, diarrhoea, or pathogen-specific infections. We used covariate-adjusted regression models with robust standard errors to estimate study-specific intervention effects and pooled effect estimates across studies using random-effects models. FINDINGS Few trials have measured the effect of sanitation interventions on pathogens and MST markers in the environment and they mostly focused on onsite sanitation. We extracted individual participant data on nine environmental assessments from five eligible trials. Environmental sampling included drinking water, hand rinses, soil, and flies. Interventions were consistently associated with reduced pathogen detection in the environment but effect estimates in most individual studies could not be distinguished from chance. Pooled across studies, we found a small reduction in the prevalence of any pathogen in any sample type (pooled prevalence ratio [PR] 0·94 [95% CI 0·90-0·99]). Interventions had no effect on the prevalence of MST markers from humans (pooled PR 1·00 [95% CI 0·88-1·13]) or animals (pooled PR 1·00 [95% CI 0·97-1·03]). INTERPRETATION The small effect of these sanitation interventions on pathogen detection and absence of effects on human or animal faecal markers are consistent with the small or null health effects previously reported in these trials. Our findings suggest that the basic sanitation interventions implemented in these studies did not contain human waste and did not adequately reduce exposure to enteropathogens in the environment. FUNDING Bill and Melinda Gates Foundation and the UK Foreign and Commonwealth Development Office.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA.
| | - Benjamin F Arnold
- Francis I Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Alexandria B Boehm
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Joe Brown
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, Michael Hooker Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Drew Capone
- Department of Environmental and Occupational Health, Indiana University Bloomington, Bloomington, IN, USA
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, NE, Atlanta, GA, USA
| | - Erica Fuhrmeister
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | | | - David Holcomb
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, Michael Hooker Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jackie Knee
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - Laura H Kwong
- Division of Environmental Health Sciences, University of California, Berkeley, CA, USA
| | - Audrie Lin
- Department of Biobehavioral Health, Pennsylvania State University, PA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Rassul Nala
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Kara Nelson
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | | | | | - Amy J Pickering
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, Dhaka, Bangladesh
| | - Heather E Reese
- Department of Environmental Health, Rollins School of Public Health, Emory University, NE, Atlanta, GA, USA
| | - Lauren Steinbaum
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Jill Stewart
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, Michael Hooker Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ruwan Thilakaratne
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
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Woldesenbet B, Tolcha A, Tsegaye B. Water, hygiene and sanitation practices are associated with stunting among children of age 24-59 months in Lemo district, South Ethiopia, in 2021: community based cross sectional study. BMC Nutr 2023; 9:17. [PMID: 36691099 PMCID: PMC9869534 DOI: 10.1186/s40795-023-00677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Stunting among children of ages 24-59 months is a major public health challenge in developing countries. It has been linked with poor water quality, water accessibility, a lack of environmental sanitation, and personal hygiene (WASH) practices, particularly in food-insecure areas. Stunting occurs during certain seasons in food-insecure settings. Therefore, a complete understanding of risk factors is the first step in the development of a preventive strategy. However, information is scarce about the prevalence and factors associated with stunting among children of ages 24-59 months in these settings. OBJECTIVE This study aimed to assess the prevalence of and factors associated with stunting among children aged 24-59 months in Lemo district, south Ethiopia, in 2021. METHODS A community based cross-sectional study was conducted from January 1-30/2021. Data were collected from a total of 415 randomly selected children and mother /guardian/. Logistic regression analysis was done to identify factors associated with childhood stunting. In binary logistic regression analysis, independent variables with p-value < 0.25 were fitted into multivariable logistic regression analysis to explore final predictors of stunting/ thinness/. Independent variables with AOR and 95% CI and P-value < 0.05 was computed and reported as predictors of stunting among children in this study. RESULTS From a total of 450 children, only 415 were included in the final analysis, making a response rate of 92.2%. The prevalence of stunting among children was 33.5% (95% CI: 30.4 and 36.6%) in this study. Children ages 48-59 months (AOR = 2.8, 95% CI: 2.1, 12.1), children ages 36-47 months (AOR = 1.6, 95% CI: 1.1, 7.1), children of uneducated women (AOR = 1.8, 95% CI: 1.5, 4.2), children who lived near unimproved toilets (AOR = 1.7, 95% CI: 1.2, 2.6), children whose feces was disposed of unsafely (AOR = 2.8, 95% CI: 1.57, 5.31), and children whose mothers did not wash their hands before feeding their children (AOR = 6.2, 95% CI: 2.0, 19.1) were factors positively associated with stunting among children aged 24 months to 59 months. CONCLUSION The prevalence of stunting is high compared with the national prevalence of stunting in food insecure areas. Policy makers, local leaders, and community health extension workers should enhance environmental sanitation and create awareness about personal hygiene. Furthermore, improved toilet construction and appropriate utilization should be encouraged. Furthermore, the local government should work to improve the socio-economic status of poor households.
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Affiliation(s)
- Biruk Woldesenbet
- grid.192268.60000 0000 8953 2273Department of Environmental Health Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Alemu Tolcha
- grid.192268.60000 0000 8953 2273Department of Environmental Health Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Berhan Tsegaye
- grid.192268.60000 0000 8953 2273Department of Midwifery, College of Medicine and Health science, Hawassa University, Hawassa, Ethiopia
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Saad-Hussein A, Helmy MA, Ellaithy LS, Wheida A, El Nazer M, Alfaro SC, Siour G, Borbon A, Abdel Wahab MM, Mostafa AN. Temporal trend of diarrhea morbidity rate with climate change: Egypt as a case study. Environ Sci Pollut Res Int 2023; 30:5059-5075. [PMID: 35976593 PMCID: PMC9892124 DOI: 10.1007/s11356-022-22431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Many studies have detected a relationship between diarrhea morbidity rates with the changes in precipitation, temperature, floods, droughts, water shortage, etc. But, most of the authors were cautious in their studies, because of the lack of empirical climate-health data and there were large uncertainties in the future projections. The study aimed to refine the link between the morbidity rates of diarrhea in some Egyptian governorates representative of the three Egyptian geographical divisions with the meteorological changes that occurred in the 2006-2016 period for which the medical data are available, as a case study. Medical raw data was collected from the Information Centre Department of the Egyptian Ministry of Health and Population. The meteorological data of temperature and precipitation extremes were defined as data outside the 10th-90th percentile range of values of the period of study, and their analysis was done using a methodology similar to the one recommended by the WMO and integrated in the CLIMDEX software. Relationships between the morbidity rates of diarrhea in seven Egyptian governorates and the meteorological changes that occurred in the period 2006 to 2016 were analyzed using multiple linear regression analysis to identify the most effective meteorological factor that affects the trend of morbidity rate of diarrhea in each governorate. Statistical analysis revealed that some meteorological parameters can be used as predictors for morbidity rates of diarrhea in Cairo, Alexandria, and Gharbia, but not in Aswan, Behaira, and Dakahlia where the temporal evolution cannot be related with meteorology. In Red Sea, there was no temporal trend and no significant relationships between the diarrhea morbidity rate and meteorological parameters. The predictor meteorological parameters for morbidity rates of diarrhea were found to be depending on the geographic locations and infrastructures in these governorates. It was concluded that the meteorological data that can be used as predictors for the morbidity rate of diarrhea is depending on the geographical location and infrastructures of the target location. The socioeconomic levels as well as the infrastructures in the governorate must be considered confounders in future studies.
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Affiliation(s)
- Amal Saad-Hussein
- Environmental & Occupational Medicine Department, Environment & Climate Change Research Institute, National Research Centre, El-Buhouth Street, Dokki, Cairo Egypt
| | - Mona Adel Helmy
- Environmental & Occupational Medicine Department, Environment & Climate Change Research Institute, National Research Centre, El-Buhouth Street, Dokki, Cairo Egypt
| | - Lamia Samir Ellaithy
- Environmental & Occupational Medicine Department, Environment & Climate Change Research Institute, National Research Centre, El-Buhouth Street, Dokki, Cairo Egypt
| | - Ali Wheida
- Theoretical Physics Department, Physical Research Institute, National Research Centre, El-Buhouth Street, Dokki, Cairo Egypt
| | - Mostafa El Nazer
- Theoretical Physics Department, Physical Research Institute, National Research Centre, El-Buhouth Street, Dokki, Cairo Egypt
| | - Stephane C. Alfaro
- Laboratoire Inter-Universitaire Des Systèmes Atmosphériques, CNRS/Université de Paris-Est Créteil/Université de Paris-Diderot/IPSL, Créteil, France
| | - Guillaume Siour
- Laboratoire Inter-Universitaire Des Systèmes Atmosphériques, CNRS/Université de Paris-Est Créteil/Université de Paris-Diderot/IPSL, Créteil, France
| | - Agnes Borbon
- Laboratoire de Météorologie Physique, Université Clermont Auvergne, Aubière, France
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Abstract
BACKGROUND Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. METHODS We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. FINDINGS From an estimated 13·7 million (95% UI 10·9-17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7-10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2-18·1) of all global deaths and 56·2% (52·1-60·1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54·9% (52·9-56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4-71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. INTERPRETATION The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund.
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White S, Jain A, Bangura A, Farrington M, Mekonen M, Nhial BC, Hoque E, Moniruzzaman M, Namegabe P, Walassa J, Majorin F. Facilitating hand hygiene in displacement camps during the COVID-19 pandemic: a qualitative assessment of a novel handwashing stand and hygiene promotion package. Confl Health 2022; 16:65. [PMID: 36527055 PMCID: PMC9756724 DOI: 10.1186/s13031-022-00492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Handwashing with soap is critical for the prevention of diarrhoeal diseases and outbreak related diseases, including interrupting the transmission of COVID-19. People living in large displacement settings are particularly vulnerable to such outbreaks, however, practicing handwashing is typically challenging in these contexts. METHODS We conducted a qualitative assessment of the implementation of a combined intervention to facilitate handwashing behaviour in displacement camps and in surrounding communities in Bangladesh, Ethiopia and the Democratic Republic of Congo during the COVID-19 pandemic. The intervention comprised a 'hardware' infrastructural component (provision of the Oxfam Handwashing Station) and a 'software' hygiene promotion package (Mum's Magic Hands). We used programmatic logbooks, interviews with implementation staff and focus group discussions with crisis-affected populations to assess the use, feasibility and acceptability of the intervention. RESULTS Both components of the intervention were viewed as novel and appealing by implementing staff and crisis-affected populations across the study sites. The acceptability of the handwashing station could be improved by redesigning the tap and legs, exploring local supply chain options, and by providing a greater number of facilities. The implementation of the hygiene promotion package varied substantially by country making it challenging to evaluate and compare. A greater focus on community engagement could address misconceptions, barriers related to the intuitiveness of the handwashing station design, and willingness to participate in the hygiene promotion component. CONCLUSIONS The combination of a 'hardware' and 'software' intervention in these settings appeared to facilitate both access and use of handwashing facilities. The acceptability of the combined intervention was partially because a great deal of effort had been put into their design. However, even when delivering well-designed interventions, there are many contextual aspects that need to be considered, as well as unintended consequences which can affect the acceptability of an intervention.
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Affiliation(s)
- Sian White
- grid.8991.90000 0004 0425 469XDepartment of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - Abie Bangura
- grid.437028.a0000 0004 0450 9859Oxfam, John Smith Drive, Oxford, UK
| | | | | | - Bang Chuol Nhial
- Department of Public Health, Gambella University, Gambella Town, Gambella, Ethiopia
| | - Enamul Hoque
- Oxfam in Bangladesh, RAOWA Complex, VIP Road, Dhaka, 1206 Bangladesh
| | - Md. Moniruzzaman
- Oxfam in Bangladesh, RAOWA Complex, VIP Road, Dhaka, 1206 Bangladesh
| | | | - John Walassa
- Oxfam in DRC, Goma, Democratic Republic of Congo
| | - Fiona Majorin
- grid.8991.90000 0004 0425 469XDepartment of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Chen B, Jin F, Zhu Y. The impact of access to sanitary toilets on rural adult residents' health: Evidence from the China family panel survey. Front Public Health 2022; 10:1026714. [PMID: 36568759 PMCID: PMC9780489 DOI: 10.3389/fpubh.2022.1026714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
Toilet sanitation is related to public health and environmental protection. In the context of the toilet revolution in rural China, an ordered probit regression analysis was conducted to evaluate the impact of access to sanitary toilets on rural residents' health. Using data from the China Family Panel Study (CFPS) in 2014, we found that access to sanitary toilets in rural households significantly improved residents' health, and this finding remained robust across a series of checks. Meanwhile, results of the mechanism analysis showed that preventing feces from contaminating water sources was an important mechanism behind the positive effects of sanitary toilet use on health. We also found that the impact of access to sanitary toilets was more pronounced among female, middle-aged, and low-income people. Toilet revolution plays an important role in ensuring residents' health and protecting water sources, thereby underscoring the need for governments in developing countries to invest in sanitary toilets. In addition, the existing policies and sanitation programs in China need to be improved to promote public health.
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Sarmiento-Senior D, Matiz MI, Vargas-Cruz S, Jaramillo JF, Olano VA, Lenhart A, Stenström TA, Alexander N, Overgaard HJ. Improving knowledge, attitudes, and practices on dengue and diarrhea in rural primary school students, their parents, and teachers in Colombia: A cluster-randomized controlled trial. PLoS Negl Trop Dis 2022; 16:e0010985. [PMID: 36574453 PMCID: PMC9829171 DOI: 10.1371/journal.pntd.0010985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 01/09/2023] [Accepted: 11/26/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Improved education on water-related diseases in schools could help to reduce disease burden. This paper presents specific results on knowledge, attitudes and practices (KAP) of a cluster-randomized controlled trial to reduce diarrheal disease and dengue entomological risk factors in rural primary schools in Colombia. The aim was to investigate whether enhanced educational interventions on dengue and diarrheal disease in schools could improve KAP scores related to these diseases in students and teachers in rural primary schools, as well as the students' parents. METHODOLOGY/PRINCIPAL FINDINGS A factorial cluster-randomized controlled trial was carried out in 35 rural primary schools in two municipalities in Cundinamarca, central Colombia. Schools were randomized into four arms: interventions related to diarrheal disease (DIA), dengue (DEN), both (DIADEN), or no interventions (control, CON). Both educational and physical interventions to reduce risk factors of dengue and diarrhea were implemented. Comprehensive teachers' manuals were developed and deployed to guide the learning activities. The intervention was carried out over two school years. The knowledge scores of students receiving dengue interventions (DEN, DIADEN) increased by 1.16 point score (0.75-1.56, p<0.001) and those receiving diarrhea interventions (DIA, DIADEN) increased by 1.15 point score (0.67-1.63, p<0.001). The attitude and practice scores of students receiving the diarrhea interventions increased (Attitudes: 0.41 [0.11-0.71, p = 0.01]; Practices: 0.33 [0.01-0.65, p = 0.042]), but not for those receiving the dengue interventions (p = 0.31 and p = 0.08, respectively). CONCLUSIONS/SIGNIFICANCE There were increases in knowledge scores among students, their teachers and their parents for both diseases. However, the attitudes and practices components were not affected to the same extent. The hypothesis that the students would disseminate knowledge acquired from the educational interventions to their parents was confirmed for dengue, but not for diarrhea. TRIAL REGISTRATION ISRCTN40195031 The trial is registered in the Current Controlled Trials under Infections and Infestations category.
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Affiliation(s)
- Diana Sarmiento-Senior
- Instituto de Salud y Ambiente, Universidad El Bosque, Bogotá, Colombia
- * E-mail: (DSS); (NA); (HJO)
| | - Maria Ines Matiz
- Instituto de Salud y Ambiente, Universidad El Bosque, Bogotá, Colombia
| | | | | | | | - Audrey Lenhart
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Thor Axel Stenström
- Institute for Water and Waste Water Technology, Durban University of Technology, Durban, South Africa
| | - Neal Alexander
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail: (DSS); (NA); (HJO)
| | - Hans J. Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
- Department of Microbiology & Tropical Disease Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- * E-mail: (DSS); (NA); (HJO)
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Quagliariello A, Modi A, Innocenti G, Zaro V, Conati Barbaro C, Ronchitelli A, Boschin F, Cavazzuti C, Dellù E, Radina F, Sperduti A, Bondioli L, Ricci S, Lognoli M, Belcastro MG, Mariotti V, Caramelli D, Mariotti Lippi M, Cristiani E, Martino ME, Muntoni IM, Lari M. Ancient oral microbiomes support gradual Neolithic dietary shifts towards agriculture. Nat Commun 2022; 13:6927. [PMID: 36414613 DOI: 10.1038/s41467-022-34416-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
The human microbiome has recently become a valuable source of information about host life and health. To date little is known about how it may have evolved during key phases along our history, such as the Neolithic transition towards agriculture. Here, we shed light on the evolution experienced by the oral microbiome during this transition, comparing Palaeolithic hunter-gatherers with Neolithic and Copper Age farmers that populated a same restricted area in Italy. We integrate the analysis of 76 dental calculus oral microbiomes with the dietary information derived from the identification of embedded plant remains. We detect a stronger deviation from the hunter-gatherer microbiome composition in the last part of the Neolithic, while to a lesser extent in the early phases of the transition. Our findings demonstrate that the introduction of agriculture affected host microbiome, supporting the hypothesis of a gradual transition within the investigated populations.
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Olowoyo JO, Chiliza U, Selala C, Macheka L. Health Risk Assessment of Trace Metals in Bottled Water Purchased from Various Retail Stores in Pretoria, South Africa. Int J Environ Res Public Health 2022; 19:15131. [PMID: 36429849 PMCID: PMC9691128 DOI: 10.3390/ijerph192215131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
Bottled water is one of the fastest growing commercial products in both developing and developed countries owing to the believe that it is safe and pure. In South Africa, over the years, there has been an increase in the sale of bottled water due to the perceived notion that water supplied by the government may not be safe for human consumption. This study investigated the concentrations of trace metals and the physicochemical properties of bottled water purchased from various supermarkets (registered and unregistered) in Pretoria with a view to determining the health risk that may be associated with the levels of trace metals resulting from the consumption of the bottled water. Twelve commonly available different brands of bottled water were purchased and analysed for trace-metal content using inductively coupled plasma mass spectrometry (ICP-MS). The water samples were also analysed for various physicochemical parameters. The health risk was assessed using the target hazard quotient (THQ). For all the bottled water, the highest concentration of all the elements was recorded for Fe. The values reported for Cr, Ni and Pb were above the limit recommended by World Health Organization. The pH values ranged from 4.67 to 7.26. Three of the samples had pH values in the acidic region below the permissible standard of 6.8-8.0 set by the International Bottled Water Association (IBWA). The target hazard quotient calculated for the water samples showed a minimum risk for Pb, Cr and Ni. The study showed the need to adhere to a strict compliance standard considering the fact that South Africa has rich natural mineral elements, which may have played a role in the high levels of trace metals reported from some of the water samples.
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Affiliation(s)
- Joshua Oluwole Olowoyo
- Department of Health Sciences, Marieb College of Health and Human Services, Florida Gulf Coast University, Fort Myers, FL 33965, USA
- Department of Biology and Environmental Sciences, Sefako Makgatho Health Sciences University, Pretoria P.O. Box 139, South Africa
| | - Unathi Chiliza
- Department of Biology and Environmental Sciences, Sefako Makgatho Health Sciences University, Pretoria P.O. Box 139, South Africa
| | - Callies Selala
- Department of Biology and Environmental Sciences, Sefako Makgatho Health Sciences University, Pretoria P.O. Box 139, South Africa
| | - Linda Macheka
- Department of Biology and Environmental Sciences, Sefako Makgatho Health Sciences University, Pretoria P.O. Box 139, South Africa
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Yu CP, Lin IJ, Wang BL, Tsao CH, Huang SH, Huang YC, Sun CA, Chung CH, Hu JM, Chien WC. Intestinal infectious diseases increase the risk of psychiatric disorders: A nationwide population-based cohort study. Medicine (Baltimore) 2022; 101:e30959. [PMID: 36221435 PMCID: PMC9543017 DOI: 10.1097/md.0000000000030959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intestinal infectious diseases (IIDs) are among the most common diseases and are prevalent worldwide. IIDs are also one of the major disease groups with the highest incidence worldwide, especially among children and older adults. We observed a higher probability of IIDs in patients from the psychiatric department of Tri-Service General Hospital. Therefore, our objective was to investigate if there is an association between IIDs and the risk of developing psychiatric disorders. This nationwide population-based study used the database of the National Health Insurance (NHI) program in Taiwan. The study included 150,995 patients from 2000 to 2015, comprising 30,199 patients with IIDs as the study group and 120,796 patients without IIDs as the control group. Cox proportional hazards regression analysis was performed to calculate the hazard ratio of psychiatric disorders during the 16-year follow-up. Of the patients with IIDs, 4022 (13.32%) developed psychiatric disorders compared to 8119 (6.72%) who did not (P < .001). The adjusted hazard ratio (aHR) for overall psychiatric disorders in the study group was 2.724 (95% confidence interval [CI]: 2.482-2.976; P < .001). More specifically, the study group had a higher risk of developing a psychiatric disorder, including sleep disorders, depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD)/acute stress disorder (ASD), schizophrenia, mental retardation (MR), substance abuse, and other psychiatric disorders. Furthermore, refractory IIDs (seeking medical attention for IIDs 3 or more times) increased the risk (aHR: 3.918; 95% CI: 3.569-4.280; P < .001) of developing psychiatric disorders. There was an association between IIDs and the increased risk of developing psychiatric disorders. The novel role of etiological factors in the development of psychiatric disorders deserves more attention, and the control of pathogens that cause IIDs is of urgent public health importance.
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Affiliation(s)
- Chia-Peng Yu
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Iau-Jin Lin
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Bing-Long Wang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Shi-Hao Huang
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Yao-Ching Huang
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Je-Ming Hu
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- *Correspondence: Wu-Chien Chien, Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan and Je-Ming Hu, Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan (e-mail: (W-CC) and (J-MH))
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- *Correspondence: Wu-Chien Chien, Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan and Je-Ming Hu, Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan (e-mail: (W-CC) and (J-MH))
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Sesay BP, Hakizimana JL, Elduma AH, Gebru GN. Assessment of Water, Sanitation and Hygiene Practices Among Households, 2019 - Sierra Leone: A Community-based Cluster Survey. Environ Health Insights 2022; 16:11786302221125042. [PMID: 36185496 PMCID: PMC9520160 DOI: 10.1177/11786302221125042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION In Sierra Leone, diseases related to water, sanitation, and hygiene remain among the leading cause of morbidity and account for 20% of all death. This study assessed the water, sanitation, and hygiene services and practices at household level in Sierra Leone. METHODS A cluster survey was conducted among 1002 households in 4 districts of Sierra Leone. Data was collected on water, sanitation, and hygiene indicators, occurrence of diarrhoeal diseases at household level within 14-day prior to the survey. Chi-square test at 95% significant level was computed to compare the difference in accessing improved water sources, sanitation, and hygiene in urban and rural areas. RESULT Of the 1002 households surveyed, 650 (65%) had access to improved drinking water sources. In the urban areas, 432 (88%) out of 486 households had improved drinking water source, which is higher as compared to rural areas. Only 218 (42%) out of 516 households had improved drinking water (P < .001). Of the total households surveyed, 167 (17%) had improved sanitation with 45 (5%) having a handwashing facility. There were 173 households reporting diarrhoeal disease within 2 weeks prior to the survey, with prevalence of 17%. CONCLUSION Majority of households in rural areas do not have access to improved water sources, sanitation, and handwashing facilities. This study found a high prevalence of diarrhoeal disease at the household level. It is recommended that The Ministry of Health and Sanitation work with relevant sectors to increase access to improved drinking water, sanitation, and handwashing facilities in rural areas.
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Affiliation(s)
| | - Jean Leonard Hakizimana
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
- African Field Epidemiology Network, Freetown, Sierra Leone
| | - Adel Hussein Elduma
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
- African Field Epidemiology Network, Freetown, Sierra Leone
| | - Gebrekrstos Negash Gebru
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
- African Field Epidemiology Network, Freetown, Sierra Leone
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Jubayer A, Hafizul Islam M, Nowar A, Islam S. Exploring Household Water, Sanitation, and Hygiene and Acute Diarrhea among Children in St. Martin's Island, Bangladesh: A Cross-Sectional Study. Am J Trop Med Hyg 2022; 107:441-448. [PMID: 35895417 PMCID: PMC9393463 DOI: 10.4269/ajtmh.22-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/20/2022] [Indexed: 08/03/2023] Open
Abstract
Basic sanitation, safe drinking water, and proper hygiene practice may lessen the burden of waterborne illnesses and neglected tropical diseases. The current study sought, for the first time, to evaluate household water, sanitation, and hygiene (WASH) practices and acute diarrhea among children under 5 years of age and their associated factors on St. Martin's Island. Two hundred one households with at least one child aged under 5 years were interviewed using a pretested semi-structured questionnaire designed according to UNICEF/WHO Joint Monitoring Program for Water Supply, Sanitation, and Hygiene 2019 and on-the-spot observations. Multiple logistic regression analyses investigated the association between potential sociodemographic characteristics, WASH components, and acute diarrhea. Almost all sampled households (99.5%) had improved drinking water facilities. More than one-third (36.5%) did not have an improved sanitation facility, and open defecation was reported by 12.4% of study subjects. Only one-third of respondents reported washing their hands with soap or detergent after defecation, and approximately 29% of respondents reported sharing their toilet with other family members. A handwashing station with soap and water was observed in only 14.4% of cases, whereas more than 22% had none. More than one-quarter (26.4%) of children aged under 5 years were reported to experience acute diarrhea. Access to WASH facilities and the occurrence of acute diarrhea were found to be associated with a set of demographic and socioeconomic characteristics. Sanitation facilities are limited and inappropriate WASH practices are prevalent in the studied population with linkage to diarrhea in children; therefore, urgent attention is needed to improve WASH facilities and encourage health-promoting WASH behavior in St. Martin's Island population.
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Affiliation(s)
- Ahmed Jubayer
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
- Bangladesh Institute of Social Research Trust, Dhaka, Bangladesh
| | - Md. Hafizul Islam
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
| | - Abira Nowar
- National Heart Foundation and Research Institute, Dhaka, Bangladesh
| | - Saiful Islam
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh
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Chaúque BJM, Benetti AD, Brittes Rott M. Epidemiological and Immunological Gains from Solar Water Disinfection (SODIS): Fact or Wishful Thinking? Trop Med Int Health 2022; 27:873-880. [PMID: 35922391 DOI: 10.1111/tmi.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is still no consensus on the impact of using solar disinfection (SODIS) to reduce the prevalence of waterborne gastrointestinal diseases. The reported reduction in diarrhea prevalence among SODIS users has been attributed to the consumption of water free of viable pathogens. However, it has also been suggested that ingestion of SODIS-inactivated pathogens may induce protective immunological changes that may also contribute to a reduction in the frequency of diarrhea. The present study aimed to critically review the epidemiological and immunological gains of using SODIS. METHODS We critically reviewed 22 articles published in English, selected from 2,118 records systematically retrieved from the databases. RESULTS All trials (except one) reported a significant reduction in diarrhea prevalence among children using SODIS, but some of the data from trials report contrary findings. All in vitro and in vivo assays indicate that SODIS-inactivated pathogenic bacteria have the potential to induce immunological alterations that may result in protective immunological effects. Studies with a low risk of bias are still awaited to confirm the ability of using SODIS to reduce the prevalence of diarrhea. CONCLUSION Reducing the prevalence of diarrhea depends on the success of SODIS delivery strategies in inducing behavioral changes in communities that result in the production of SODIS-compliant outcomes. The results of trials reporting a reduction in the prevalence of diarrhea due to the use of SODIS seem to support the hypothesis of the contribution of the protective immunological effect against diarrhea in SODIS users.
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Affiliation(s)
- Beni Jequicene Mussengue Chaúque
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Brazil.,Department of Science, Technology, Engineering and Mathematics, Universidade Rovuma, Niassa Branch, Mozambique
| | | | - Marilise Brittes Rott
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Brazil
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Heller L. WASH services and health: syntheses and contexts. Lancet 2022; 400:5-7. [PMID: 35780793 DOI: 10.1016/s0140-6736(22)01108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Léo Heller
- Fundacao Oswaldo Cruz, Instituto Rene Rachou, Belo Horizonte 30.190-009, Brazil.
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Wolf J, Hubbard S, Brauer M, Ambelu A, Arnold BF, Bain R, Bauza V, Brown J, Caruso BA, Clasen T, Colford JM, Freeman MC, Gordon B, Johnston RB, Mertens A, Prüss-Ustün A, Ross I, Stanaway J, Zhao JT, Cumming O, Boisson S. Effectiveness of interventions to improve drinking water, sanitation, and handwashing with soap on risk of diarrhoeal disease in children in low-income and middle-income settings: a systematic review and meta-analysis. Lancet 2022; 400:48-59. [PMID: 35780792 PMCID: PMC9251635 DOI: 10.1016/s0140-6736(22)00937-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/26/2022] [Accepted: 05/17/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Estimates of the effectiveness of water, sanitation, and hygiene (WASH) interventions that provide high levels of service on childhood diarrhoea are scarce. We aimed to provide up-to-date estimates on the burden of disease attributable to WASH and on the effects of different types of WASH interventions on childhood diarrhoea in low-income and middle-income countries (LMICs). METHODS In this systematic review and meta-analysis, we updated previous reviews following their search strategy by searching MEDLINE, Embase, Scopus, Cochrane Library, and BIOSIS Citation Index for studies of basic WASH interventions and of WASH interventions providing a high level of service, published between Jan 1, 2016, and May 25, 2021. We included randomised and non-randomised controlled trials conducted at household or community level that matched exposure categories of the so-called service ladder approach of the Sustainable Development Goal (SDG) for WASH. Two reviewers independently extracted study-level data and assessed risk of bias using a modified Newcastle-Ottawa Scale and certainty of evidence using a modified Grading of Recommendations, Assessment, Development, and Evaluation approach. We analysed extracted relative risks (RRs) and 95% CIs using random-effects meta-analyses and meta-regression models. This study is registered with PROSPERO, CRD42016043164. FINDINGS 19 837 records were identified from the search, of which 124 studies were included, providing 83 water (62 616 children), 20 sanitation (40 799 children), and 41 hygiene (98 416 children) comparisons. Compared with untreated water from an unimproved source, risk of diarrhoea was reduced by up to 50% with water treated at point of use (POU): filtration (n=23 studies; RR 0·50 [95% CI 0·41-0·60]), solar treatment (n=13; 0·63 [0·50-0·80]), and chlorination (n=25; 0·66 [0·56-0·77]). Compared with an unimproved source, provision of an improved drinking water supply on premises with higher water quality reduced diarrhoea risk by 52% (n=2; 0·48 [0·26-0·87]). Overall, sanitation interventions reduced diarrhoea risk by 24% (0·76 [0·61-0·94]). Compared with unimproved sanitation, providing sewer connection reduced diarrhoea risk by 47% (n=5; 0·53 [0·30-0·93]). Promotion of handwashing with soap reduced diarrhoea risk by 30% (0·70 [0·64-0·76]). INTERPRETATION WASH interventions reduced risk of diarrhoea in children in LMICs. Interventions supplying either water filtered at POU, higher water quality from an improved source on premises, or basic sanitation services with sewer connection were associated with increased reductions. Our results support higher service levels called for under SDG 6. Notably, no studies evaluated interventions that delivered access to safely managed WASH services, the level of service to which universal coverage by 2030 is committed under the SDG. FUNDING WHO, Foreign, Commonwealth & Development Office, and National Institute of Environmental Health Sciences.
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Affiliation(s)
- Jennyfer Wolf
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland.
| | - Sydney Hubbard
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Argaw Ambelu
- Department of Environmental Health Sciences and Technology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Benjamin F Arnold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Robert Bain
- UNICEF Middle East and North Africa, Amman, Jordan
| | - Valerie Bauza
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Bethany A Caruso
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bruce Gordon
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland
| | - Richard B Johnston
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Annette Prüss-Ustün
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland
| | - Ian Ross
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeffrey Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jeff T Zhao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Sophie Boisson
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland
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Pessoa Colombo V, Chenal J, Koné B, Bosch M, Utzinger J. Using Open-Access Data to Explore Relations between Urban Landscapes and Diarrhoeal Diseases in Côte d’Ivoire. IJERPH 2022; 19:ijerph19137677. [PMID: 35805337 PMCID: PMC9265306 DOI: 10.3390/ijerph19137677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 02/01/2023]
Abstract
Unlike water and sanitation infrastructures or socio-economic indicators, landscape features are seldomly considered as predictors of diarrhoea. In contexts of rapid urbanisation and changes in the physical environment, urban planners and public health managers could benefit from a deeper understanding of the relationship between landscape patterns and health outcomes. We conducted an ecological analysis based on a large ensemble of open-access data to identify specific landscape features associated with diarrhoea. Designed as a proof-of-concept study, our research focused on Côte d’Ivoire. This analysis aimed to (i) build a framework strictly based on open-access data and open-source software to investigate diarrhoea risk factors originating from the physical environment and (ii) understand whether different types and forms of urban settlements are associated with different prevalence rates of diarrhoea. We advanced landscape patterns as variables of exposure and tested their association with the prevalence of diarrhoea among children under the age of five years through multiple regression models. A specific urban landscape pattern was significantly associated with diarrhoea. We conclude that, while the improvement of water, sanitation, and hygiene infrastructures is crucial to prevent diarrhoeal diseases, the health benefits of such improvements may be hampered if the overall physical environment remains precarious.
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Affiliation(s)
- Vitor Pessoa Colombo
- School of Architecture, Civil and Environmental Engineering, École Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland; (J.C.); (M.B.)
- Correspondence:
| | - Jérôme Chenal
- School of Architecture, Civil and Environmental Engineering, École Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland; (J.C.); (M.B.)
| | - Brama Koné
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan 01 BP 1303, Côte d’Ivoire;
| | - Martí Bosch
- School of Architecture, Civil and Environmental Engineering, École Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland; (J.C.); (M.B.)
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland;
- University of Basel, 4001 Basel, Switzerland
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Achore M, Bisung E. Experiences of inequalities in access to safe water and psycho-emotional distress in Ghana. Soc Sci Med 2022; 301:114970. [PMID: 35430464 DOI: 10.1016/j.socscimed.2022.114970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/21/2022]
Abstract
Research suggests that experiences of water insecurity may negatively impact the psycho-emotional wellbeing of water-insecure households. This paper examines how perceived inequalities in water access mediate the relationship between water insecurity and psycho-emotional distress. Data were collected among 1192 men and women in Ghana who are active water collectors within their households. We employed a binary logistics regression to identify the determinants of psycho-emotional distress. Sobel test was used to test the indirect effect of water insecurity and psycho-emotional distress through perceived inequalities. The results show that wealth (OR = 6.6, CI = 2.784-14.076), number of people in a household (OR = 1.07, CI = 1.002-1.145) and perceived inequalities (OR = 4.6, CI = 2.737-7.907) are significant predictors of psycho-emotional distress. Sobel test indicated that the point estimate (PE) of the indirect effect between water insecurity and psycho-emotional distress through perceived inequality is -0.136 (p = 0.000), meaning households were less likely to experience psycho-emotional distress if they felt that safe water facilities were equally distributed. The findings suggest that the distribution of water resources in cities with water challenges, no matter how scarce those resources are, has a profound effect on psycho-emotional distress. In resources constrained cities, there is a need for holistic water-related interventions that make inclusivity and fairness their primary focus.
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Venis RA, Taylor V, Sumayani P, Laizer M, Anderson T, Basu OD. Towards a participatory framework for improving water & health outcomes: A case study with Maasai women in rural Tanzania. Soc Sci Med 2022; 301:114966. [PMID: 35429839 DOI: 10.1016/j.socscimed.2022.114966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 02/07/2023]
Abstract
Rural communities in sub-Saharan Africa (SSA) are disproportionately burdened by a pervasive lack of access to safe drinking water. Widespread programmatic failure in the water, sanitation, and hygiene (WaSH) sector has resulted in particularly slow progress in alleviating these challenges in the region. Drawing from decolonial and participatory methodological scholarship, this research demonstrates how geographically and demographically specific, locally controlled, and long-term educational programming can improve health and wellness outcomes when associated with a technological intervention. Specifically, consultations between January 2015 and August 2018 were followed by an iterative and community-driven program development process between January and July 2019. Fifty Maasai women were subsequently recruited to participate and were provided with a point-of-use water treatment technology in August 2019. These women engaged in a series of three 14-week WaSH education programs over an 18-month evaluation period. Results showed that 38% of participants reported regular diarrhea at baseline, decreasing to 8%, 0%, and 3% immediately after each of the three WaSH education programs were provided at 3, 12, and 18 months. Interim measurements taken between WaSH programs showed 35% of participants (at 6 months) and 5% of participants (at 15 months) reporting regular diarrhea. A trend of improvement was thus observed over the study period, though the increase in reported diarrhea at 6 months demonstrates the need for long-term commitment on the part of WASH practitioners when engaging with end users to achieve sustained change. Further, this research highlights the importance of participatory program development and pedagogical approaches in WaSH interventions, where local control of study objective determination and implementation, combined with consistent and long-term engagement, can facilitate sustained technology use and associated reductions in diarrhea.
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Affiliation(s)
- Robbie A Venis
- Department of Civil and Environmental Engineering, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
| | - Virginia Taylor
- Sprott School of Business, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada; Tanzania Education and Micro Business Opportunity (TEMBO) Trust, P.O. Box 95, Longido, Longido District, Arusha Region, Tanzania
| | - Paulina Sumayani
- Tanzania Education and Micro Business Opportunity (TEMBO) Trust, P.O. Box 95, Longido, Longido District, Arusha Region, Tanzania
| | - Marie Laizer
- Tanzania Education and Micro Business Opportunity (TEMBO) Trust, P.O. Box 95, Longido, Longido District, Arusha Region, Tanzania
| | - Troy Anderson
- Sprott School of Business, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Onita D Basu
- Department of Civil and Environmental Engineering, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
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Meki CD, Ncube EJ, Voyi K. Community-level interventions for mitigating the risk of waterborne diarrheal diseases: a systematic review. Syst Rev 2022; 11:73. [PMID: 35436979 PMCID: PMC9016942 DOI: 10.1186/s13643-022-01947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Waterborne diarrhea diseases are among the leading causes of morbidity and mortality globally. These diseases can be mitigated by implementing various interventions. We reviewed the literature to identify available interventions to mitigate the risk of waterborne diarrheal diseases. METHODS We conducted a systematic database review of CINAHL (Cumulative Index to Nursing and Allied Health Literature), PubMed, Web of Science Core Collection, Cochrane library, Scopus, African Index Medicus (AIM), and LILACS (Latin American and Caribbean Health Sciences Literature). Our search was limited to articles published between 2009 and 2020. We conducted the review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement checklist. The identified studies were qualitatively synthesized. RESULTS Our initial search returned 28 773 articles of which 56 studies met the inclusion criteria. The included studies reported interventions, including vaccines for rotavirus disease (monovalent, pentavalent, and Lanzhou lamb vaccine); enhanced water filtration for preventing cryptosporidiosis, Vi polysaccharide for typhoid; cholera 2-dose vaccines, water supply, water treatment and safe storage, household disinfection, and hygiene promotion for controlling cholera outbreaks. CONCLUSION We retrieved few studies on interventions against waterborne diarrheal diseases in low-income countries. Interventions must be specific to each type of waterborne diarrheal disease to be effective. Stakeholders must ensure collaboration in providing and implementing multiple interventions for the best outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020190411 .
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Affiliation(s)
- Chisala D Meki
- University of Zambia, School of Public Health, University of Zambia, P O. BOX 50110, Lusaka, Zambia. .,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
| | - Esper J Ncube
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.,Rand Water, Johannesburg, South Africa
| | - Kuku Voyi
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Asare EO, Warren JL, Pitzer VE. Spatiotemporal patterns of diarrhea incidence in Ghana and the impact of meteorological and socio-demographic factors. Front Epidemiol 2022; 2:871232. [PMID: 35822109 PMCID: PMC9272077 DOI: 10.3389/fepid.2022.871232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Diarrhea remains a significant public health problem and poses a considerable financial burden on Ghana's health insurance scheme. In order to prioritize district-level hotspots of diarrhea incidence for effective targeted interventions, it is important to understand the potential drivers of spatiotemporal patterns of diarrhea. We aimed to identify the spatiotemporal heterogeneity of diarrhea incidence in Ghana and explore how meteorological and socio-demographic factors influence the patterns. METHODS We used monthly district-level clinically diagnosed diarrhea data between 2012 and 2018 obtained from the Centre for Health Information and Management of the Ghana Health Services. We utilized a hierarchical Bayesian spatiotemporal modeling framework to evaluate potential associations between district-level monthly diarrhea incidence and meteorological variables (mean temperature, diurnal temperature range, surface water presence) and socio-demographic factors (population density, Gini index, District League Table score) in Ghana. In addition, we investigated whether these associations were consistent across the four agro-ecological zones. RESULTS There was considerable spatial heterogeneity in diarrhea patterns across the districts, with clusters of high diarrhea risk areas mostly found in the transition and savannah zones. The average monthly temporal patterns of diarrhea revealed a weak biannual seasonality with major and minor peaks in June and October, respectively, coinciding with the major and minor rainy seasons. We found a significant association between both meteorological and socio-demographic factors and diarrhea risk, but the strength and direction of associations differed across the four agro-ecological zones. Surface water presence demonstrated consistently positive, while diurnal temperature range and population density demonstrated consistently negative associations with diarrhea both overall and across the agro-ecological zones. CONCLUSIONS Although overall diarrhea incidence is declining in Ghana, our results revealed high-risk districts that could benefit from district-specific tailored intervention strategies to improve control efforts. Ghana health sector policy-makers can use these results to assess the effectiveness of ongoing interventions at the district level and prioritize resource allocation for diarrhea control.
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Affiliation(s)
- Ernest O. Asare
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT USA
| | - Joshua L. Warren
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT USA
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT USA
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT USA
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Kann S, Concha G, Hartmann M, Köller T, Alker J, Schotte U, Kreienbrock L, Frickmann H, Warnke P. Only Low Effects of Water Filters on the Enteric Carriage of Gastrointestinal Pathogen DNA in Colombian Indigenous People. Microorganisms 2022; 10:microorganisms10030658. [PMID: 35336233 PMCID: PMC8955181 DOI: 10.3390/microorganisms10030658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/28/2022] [Accepted: 03/17/2022] [Indexed: 12/18/2022] Open
Abstract
Water filtration is a common strategy of water sanitation in resource-poor tropical settings. Here, we assessed the intermediate term effect of this preventive procedure including specific filter-related as well as general hygiene training on the molecular detection of enteric pathogens in stool samples from Colombian Indigenous people. From a total of 89 individuals from an Indigenous tribe called Wiwa, stool samples were assessed by real-time PCR for enteropathogenic microorganisms prior to the implementation of water filtration-based infection prevention. Three years after the onset of the preventive strategy, a follow-up assessment was performed. A significantly beneficial effect of water filtration could be shown for Ascaris spp. only (p = 0.035) and a tendency (p = 0.059) for Hymenolepis nana. No hints for effects on the gastrointestinal shedding of Giardia duodenalis, Entamoeba histolytica, Cryptosporidium spp., Campylobacter spp., Shigella spp./enteroinvasive Escherichia coli, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, and Taenia spp. were seen. In conclusion, the study indicates that water filtration can only be an element of a multi-modal hygiene concept to reduce enteric pathogen carriage in inhabitants of resource-poor tropical settings in spite of tendencies of beneficial effects.
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Affiliation(s)
- Simone Kann
- Medical Mission Institute, 97074 Würzburg, Germany
- Correspondence: (S.K.); (P.W.)
| | - Gustavo Concha
- Organization Wiwa Yugumaiun Bunkauanarrua Tayrona (OWYBT), Department Health Advocacy, Valledupar 2000001, Colombia;
| | - Maria Hartmann
- Institute for Biometry, Epidemiology and Information Processing, Veterinary Medical University Hannover, 30559 Hannover, Germany; (M.H.); (L.K.)
| | - Thomas Köller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (T.K.); (H.F.)
| | - Juliane Alker
- Department A-Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, 24119 Kronshagen, Germany; (J.A.); (U.S.)
| | - Ulrich Schotte
- Department A-Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, 24119 Kronshagen, Germany; (J.A.); (U.S.)
| | - Lothar Kreienbrock
- Institute for Biometry, Epidemiology and Information Processing, Veterinary Medical University Hannover, 30559 Hannover, Germany; (M.H.); (L.K.)
| | - Hagen Frickmann
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (T.K.); (H.F.)
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
| | - Philipp Warnke
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
- Correspondence: (S.K.); (P.W.)
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Gao Y, Sheng J, Mi X, Zhou M, Zou S, Zhou H. Household Water Access, Dietary Diversity and Nutritional Status among Preschoolers in Poor, Rural Areas of Central and Western China. Nutrients 2022; 14:nu14030458. [PMID: 35276816 PMCID: PMC8840283 DOI: 10.3390/nu14030458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/28/2022] Open
Abstract
Poor child feeding and childhood malnutrition are major public health problems in rural central and western China, with little evidence about their environmental determinants. This study aimed to investigate whether household water access is associated with dietary diversity and nutritional outcomes. We analyzed the cross-sectional data of 3727 children aged 6 to 59 months in rural central and western China, applying multivariate linear and logistic models to estimate the effect of water access on children’s anthropometric indices, hemoglobin, and dietary diversity. We found that unimproved water access was linked to a lower likelihood of achieving dietary diversity (OR = 0.65, 95% CI 0.44 to 0.98, p = 0.039); lower height-for-age z-score (β = −0.34, 95% CI −0.49 to −0.19, p < 0.001) and hemoglobin concentration (β = −2.78, 95% CI −5.16 to −0.41, p = 0.022); higher odds of stunting (OR = 1.50, 95% CI 1.01 to 2.25, p = 0.047) and anemia (OR = 1.34, 95% CI 1.02 to 1.77, p = 0.037). The associations between water access and nutritional outcomes were not explained by dietary diversity and were stronger in children who did not receive iron supplementation. These findings provide evidence for designing water-based nutritional interventions in China.
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Affiliation(s)
- Yaqing Gao
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Jie Sheng
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Peking University, Beijing 100191, China;
| | - Xiaoyi Mi
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Mo Zhou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Siyu Zou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
| | - Hong Zhou
- Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.G.); (X.M.); (M.Z.); (S.Z.)
- Correspondence: ; Tel.: +86-10-8280-1222
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Anderson DM, Birken SA, Bartram JK, Freeman MC. Adaptation of Water, Sanitation, and Hygiene Interventions: A Model and Scoping Review of Key Concepts and Tools. Front Health Serv 2022; 2:896234. [PMID: 36925880 PMCID: PMC10012759 DOI: 10.3389/frhs.2022.896234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022]
Abstract
Background Safe water, sanitation, and hygiene (WaSH) is important for health, livelihoods, and economic development, but WaSH programs have often underdelivered on expected health benefits. Underperformance has been attributed partly to poor ability to retain effectiveness following adaptation to facilitate WaSH programs' implementation in diverse contexts. Adaptation of WaSH interventions is common but often not done systematically, leading to poor outcomes. Models and frameworks from the adaptation literature have potential to improve WaSH adaptation to facilitate implementation and retain effectiveness. However, these models and frameworks were designed in a healthcare context, and WaSH interventions are typically implemented outside traditional health system channels. The purpose of our work was to develop an adaptation model tailored specifically to the context of WaSH interventions. Methods We conducted a scoping review to identify key adaptation steps and identify tools to support systematic adaptation. To identify relevant literature, we conducted a citation search based on three recently published reviews on adaptation. We also conducted a systematic database search for examples of WaSH adaptation. We developed a preliminary model based on steps commonly identified across models in adaptation literature, and then tailored the model to the WaSH context using studies yielded by our systematic search. We compiled a list of tools to support systematic data collection and decision-making throughout adaptation from all included studies. Results and Conclusions Our model presents adaptation steps in five phases: intervention selection, assessment, preparation, implementation, and sustainment. Phases for assessment through sustainment are depicted as iterative, reflecting that once an intervention is selected, adaptation is a continual process. Our model reflects the specific context of WaSH by including steps to engage non-health and lay implementers and to build consensus among diverse stakeholders with potentially competing priorities. We build on prior adaptation literature by compiling tools to support systematic data collection and decision-making, and we describe how they can be used throughout adaptation steps. Our model is intended to improve program outcomes by systematizing adaptation processes and provides an example of how systematic adaptation can occur for interventions with health goals but that are implemented outside conventional health system channels.
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Affiliation(s)
- Darcy M Anderson
- Public Health and Environment, The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, United States
| | - Jamie K Bartram
- Public Health and Environment, The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,School of Civil Engineering, University of Leeds, Leeds, United Kingdom
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Saaka M, Saapiire FN, Dogoli RN. Independent and joint contribution of inappropriate complementary feeding and poor water, sanitation and hygiene (WASH) practices to stunted child growth. J Nutr Sci 2021; 10:e109. [PMID: 35059190 PMCID: PMC8727702 DOI: 10.1017/jns.2021.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 11/14/2021] [Accepted: 11/28/2021] [Indexed: 11/07/2022] Open
Abstract
The causes of undernutrition are often linked to inappropriate complementary feeding practices and poor households' access to water, sanitation and hygiene (WASH), but limited evidence exists on the combined effect of poor WASH and inappropriate complementary feeding practices on stunted child growth. We assessed the independent and joint contribution of inappropriate complementary feeding and poor WASH practices to stunted growth among children aged 6-23 months in the Jirapa Municipality of Ghana. A community-based cross-sectional analytical study design was used with a sample of 301 mothers/caregivers having children aged 6-23 months. The results indicate that in a multivariable logistic regression model that adjusted for confounders, children receiving both unimproved water and inappropriate complementary feeding had a higher and significant odd of becoming stunted (adjusted odds ratio = 33. 92; 95 % confidence interval 3⋅04, 37⋅17; P = 0⋅004) compared to households having both improved water sources and appropriate complementary feeding practices. Except for unimproved drinking water sources, poor sanitation and hygiene, which comprised the use of unimproved household toilet facilities, washing hands without soap and improper disposal of child faeces were not associated with the risks of stunting among children aged 6-23 months. The combined effect of unimproved water and inappropriate complementary feeding on stunting was greater than either unimproved water only or inappropriate complementary feeding only.
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Affiliation(s)
- Mahama Saaka
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, P. O. Box 1883, Tamale, Ghana
| | - Ferguson N Saapiire
- St. Joseph Nursing Training College, Ministry of Health, P. O. BOX 24, Jirapa, Wa, Ghana
| | - Richard N Dogoli
- Jhpiego Ghana, 14 Ollenu Street, East Legon, PMB 18, Legon Accra, Ghana
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Benameur T, Benameur N, Saidi N, Tartag S, Sayad H, Agouni A. Predicting factors of public awareness and perception about the quality, safety of drinking water, and pollution incidents. Environ Monit Assess 2021; 194:22. [PMID: 34904198 DOI: 10.1007/s10661-021-09557-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Abstract
Public perception of drinking water quality and safety results from the interaction of multiple factors, including the public engagement, which requires sufficient knowledge and awareness. This issue has yet to be addressed in Algeria. This study investigated the residents' perception and awareness about the drinking water quality, safety, and water pollution events. A survey-based cross-sectional study was conducted amongst citizens living in the province of Biskra. Multinomial regression analysis was used to identify the predicted public perception factors about drinking water-related issues. Regardless of the degree of public trust in the drinking water sources, the main drinking water source reported by the participants was tank water (43.3%) followed by tap water (32%). Water quality standards are a measure of the condition of water relative to the contaminants. Water consumption profiles gave priority attention to taste (48.7%), odour (35%), appearance (34.7%), and colour (32%), reflecting a low level of knowledge about the water quality standards. Most of the residents (55.7%) reported a deficient communication about the preventive measures to protect public health. The higher level of education showed a statistically significant impact in discriminating between those who felt very satisfied and dissatisfied participants with the drinking water quality and those who felt between satisfied and dissatisfied (P = 0.023, P = 0.034, respectively). Additionally, education level had a statistically significant role in differentiating trust levels in drinking water quality between two groups, those belonging to either confident or relatively confident and the group of extremely worried respondents, with P = 0.000 and P = 0.000, respectively. Interviewed respondents with certain education levels showed higher trust in the safety of drinking water when compared to those with lower education levels. Gender had a significant role in differentiating the group of respondents who were relatively confident from those who were extremely worried (P = 0.016). The public knowledge about the standards of water quality, safety, and the pollution-related issues remains relatively low. This study is of interest to policy makers and public health authorities who implement actions for water contamination prevention and public health protection. These findings could have national implications and are also applicable, in general context, particularly in low and middle-income countries.
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Affiliation(s)
- Tarek Benameur
- College of Medicine, King Faisal University, P.O. Box 380, Al Ahsa, Kingdom of Saudi Arabia.
| | - Nassima Benameur
- Faculty of Exact Sciences and Sciences of Nature and Life, Research Laboratory of Civil Engineering, Hydraulics, Sustainable Development and Environment (LARGHYDE), Mohamed Khider University, Biskra, Algeria
| | - Neji Saidi
- College of Sciences, King Faisal University, P.O. Box 380, Al Ahsa, Kingdom of Saudi Arabia
| | - Sakina Tartag
- Faculty of Exact Sciences and Sciences of Nature and Life, Research Laboratory of Civil Engineering, Hydraulics, Sustainable Development and Environment (LARGHYDE), Mohamed Khider University, Biskra, Algeria
| | - Hadjer Sayad
- Faculty of Exact Sciences and Sciences of Nature and Life, Research Laboratory of Civil Engineering, Hydraulics, Sustainable Development and Environment (LARGHYDE), Mohamed Khider University, Biskra, Algeria
| | - Abdelali Agouni
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
- Biomedical and Pharmaceutical Research Unit (BPRU), QU Health, Qatar University, Doha, Qatar
- Office of Vice President for Research and Graduate Studies, Qatar University, Doha, Qatar
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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 Syst Rev 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chan EYY, Tong KHY, Dubois C, Mc Donnell K, Kim JH, Hung KKC, Kwok KO. Narrative Review of Primary Preventive Interventions against Water-Borne Diseases: Scientific Evidence of Health-EDRM in Contexts with Inadequate Safe Drinking Water. Int J Environ Res Public Health 2021; 18:ijerph182312268. [PMID: 34885995 PMCID: PMC8656607 DOI: 10.3390/ijerph182312268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/22/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Waterborne diseases account for 1.5 million deaths a year globally, particularly affecting children in low-income households in subtropical areas. It is one of the most enduring and economically devastating biological hazards in our society today. The World Health Organization Health Emergency and Disaster Risk Management (health-EDRM) Framework highlights the importance of primary prevention against biological hazards across all levels of society. The framework encourages multi-sectoral coordination and lessons sharing for community risk resilience. A narrative review, conducted in March 2021, identified 88 English-language articles published between January 2000 and March 2021 examining water, sanitation, and hygiene primary prevention interventions against waterborne diseases in resource-poor settings. The literature identified eight main interventions implemented at personal, household and community levels. The strength of evidence, the enabling factors, barriers, co-benefits, and alternative measures were reviewed for each intervention. There is an array of evidence available across each intervention, with strong evidence supporting the effectiveness of water treatment and safe household water storage. Studies show that at personal and household levels, interventions are effective when applied together. Furthermore, water and waste management will have a compounding impact on vector-borne diseases. Mitigation against waterborne diseases require coordinated, multi-sectoral governance, such as building sanitation infrastructure and streamlined waste management. The review showed research gaps relating to evidence-based alternative interventions for resource-poor settings and showed discrepancies in definitions of various interventions amongst research institutions, creating challenges in the direct comparison of results across studies.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, Hong Kong, China;
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-2252-8850
| | - Kimberley Hor Yee Tong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
| | - Caroline Dubois
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
| | | | - Jean H. Kim
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, Hong Kong, China;
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Kin On Kwok
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong, China
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48
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Girma M, Hussein A, Norris T, Genye T, Tessema M, Bossuyt A, Hadis M, van Zyl C, Goyol K, Samuel A. Progress in Water, Sanitation and Hygiene (WASH) coverage and potential contribution to the decline in diarrhea and stunting in Ethiopia. Matern Child Nutr 2021:e13280. [PMID: 34738323 DOI: 10.1111/mcn.13280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/23/2021] [Accepted: 09/16/2021] [Indexed: 12/20/2022]
Abstract
Inadequate safe water supply and poor sanitation and hygiene continue to be important risk factors for diarrhoea and stunting globally. We used data from the four rounds of the Ethiopian Demographic and Health Survey and applied the new World Health Organization (WHO)/UNICEF Joint Monitoring Program (JMP) service standards to assess progress in water, sanitation and hygiene (WASH) coverage between 2000 and 2016. We also performed an age-disaggregated pooled linear probability regression analysis followed by a decomposition analysis to determine whether changes in WASH practices have contributed to the changing prevalence of diarrhoea and stunting in children under 5 years of age. We observed a significant increase in the coverage of safe drinking water and adequate sanitation facilities over the period. At the national level, the use of a basic water source increased from 18% in 2000 to 50% in 2016. Open defecation declined from 82% to 32% over the same period. However, in 2016, only 6% of households had access to a basic sanitation facility, and 40% of households had no handwashing facilities. The reduction in surface water use between 2000 and 2016 explained 6% of the decline in diarrhoea observed among children aged 0-5 months. In children aged 6-59 months, between 7% and 9% of the reduction in stunting were attributable to the reduction in open defecation over this period. Despite progress, improvements are still needed to increase basic WASH coverage in Ethiopia. Our findings showed that improvements in water and sanitation only modestly explained reductions in diarrhoea and stunting.
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Affiliation(s)
- Meron Girma
- National Information Platforms for Nutrition (NIPN), Ethiopian Public Health Institute, Arbegnoch Street, Addis Ababa, 1242, Ethiopia
| | - Alemayehu Hussein
- National Information Platforms for Nutrition (NIPN), Ethiopian Public Health Institute, Arbegnoch Street, Addis Ababa, 1242, Ethiopia
| | - Tom Norris
- National Information Platforms for Nutrition (NIPN) Collaborator, International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Tirsit Genye
- National Information Platforms for Nutrition (NIPN), International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Masresha Tessema
- National Information Platforms for Nutrition (NIPN), Ethiopian Public Health Institute, Arbegnoch Street, Addis Ababa, 1242, Ethiopia
| | - Anne Bossuyt
- National Information Platforms for Nutrition (NIPN), International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Mamuye Hadis
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Cornelia van Zyl
- National Information Platforms for Nutrition (NIPN), International Food Policy Research Institute, Addis Ababa, Ethiopia
| | - Kitka Goyol
- Water, Sanitation and Hygiene (WASH), UNICEF, Addis Ababa, Ethiopia
| | - Aregash Samuel
- National Information Platforms for Nutrition (NIPN), Ethiopian Public Health Institute, Arbegnoch Street, Addis Ababa, 1242, Ethiopia
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49
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Kmush BL, Walia B, Neupane A, Frances C, Mohamed IA, Iqbal M, Larsen DA. Community-level impacts of sanitation coverage on maternal and neonatal health: a retrospective cohort of survey data. BMJ Glob Health 2021; 6:bmjgh-2021-005674. [PMID: 34625456 PMCID: PMC8504178 DOI: 10.1136/bmjgh-2021-005674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Access to sanitation facilities (toilets or latrines) greatly improves human health. Low community sanitation coverage may lead to increased exposure to pathogens for households both with and without a sanitation facility. Methods We created a retrospective cohort using Demographic and Health Surveys from 1990 through 2018. Using regression with matched women as a random intercept, we assessed the association between community-level sanitation coverage and neonatal mortality (Poisson model, n=1 254 862 live births, 187 datasets), small birth size (logit model, n=1 058 843 live births, 187 datasets) and anaemia (logit model, n=1 304 626 women, 75 datasets). Results Among women with household sanitation, the incidence of neonatal death (incidence rate ratio: 0.85, 95% CI 0.77 to 0.93), the odds of small birth size (OR: 0.81, 95% CI 0.76 to 0.87) and anaemia (OR: 0.82, 95% CI 0.79 to 0.85) were lower for women in communities with 100% sanitation coverage compared with 1%–30% (p≤0.001 for all). There was no difference in neonatal deaths between women in communities with 31%–99% sanitation coverage compared with 1%–30% (p≥0.05). Among women without household sanitation, there were no differences in neonatal mortality by community sanitation (p≥0.05). The odds of small birth size were decreased (OR: 0.91, 95% CI 0.87 to 0.97, p=0.003) for women in communities with 61%–99% sanitation coverage compared with 1%–30%; there was no association with the other community sanitation categories (p≥0.05). The odds of anaemia were increased (OR: 1.08, 95% CI 1.06 to 1.11, p<0.001) for women living in communities with 0% sanitation coverage compared with 1%–30%, but no association with the other community sanitation categories (p≥0.05). Conclusion Community sanitation coverage is associated with improved maternal and neonatal outcomes, particularly among women with household sanitation. This suggests that the impact of sanitation coverage on maternal and neonatal health is underestimated unless the community-level effects are considered.
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Affiliation(s)
- Brittany L Kmush
- Department of Public Health, Syracuse University, Syracuse, New York, USA
| | - Bhavneet Walia
- Department of Public Health, Syracuse University, Syracuse, New York, USA
| | - Anushruta Neupane
- Department of Public Health, Syracuse University, Syracuse, New York, USA
| | - Carolina Frances
- Department of Public Health, Syracuse University, Syracuse, New York, USA
| | | | - Mahwish Iqbal
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - David A Larsen
- Department of Public Health, Syracuse University, Syracuse, New York, USA
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50
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Bolatova Z, Tussupova K, Toleubekov B, Sukhanberdiyev K, Sharapatova K, Stafström M. Challenges of Access to WASH in Schools in Low- and Middle-Income Countries: Case Study from Rural Central Kazakhstan. Int J Environ Res Public Health 2021; 18:ijerph18189652. [PMID: 34574575 PMCID: PMC8472705 DOI: 10.3390/ijerph18189652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
Safe water and sanitation, which give rise to appropriate hygiene, are fundamental determinants of individual and social health and well-being. Thereby, assessing and widening access to sustainable, durable water and sanitation infrastructure remains a global health issue. Rural areas are already at a disadvantage. Poor access to water, sanitation, and hygiene (WASH) can have a major negative effect on students in rural schools. Thus, the paper aims to assess the current condition and the challenge to access WASH in rural Kazakh schools. The study was conducted in three rural schools in Central Kazakhstan. Data were gathered through a survey among pupils, observations of the WASH infrastructure and maintenance, and a face-to-face interview with school administrators. The mean survey response rate was 65% across schools. Results indicated there was no alternative drinking-water source in schools, and 15% of students said they had access to water only occasionally. Half of the students reported that the water was unsafe to drink because of a poor odor, taste, or color. The toilet in school 3 was locked with a key, and a quarter of the students reported there was no access to a key. Moreover, not having gender-separated toilet facilities was a challenge because of the traditional gender norms. Despite the effective regulations and measures of handwashing taken during COVID-19, 27.7% of the students answered that soap was not offered daily in classrooms. Additionally, warm water was only provided in school 2. About 75% of students did not have access to drying materials continuously. The study shows that having the schools’ infrastructure is not enough when characteristics, such as availability, accessibility, maintenance, operation, quality of services, education, and practices, are ignored. Cooperation between local education authorities, school administration, and parents should be encouraged to the achievement of the sustainable development goals (SDGs) by 2030.
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Affiliation(s)
- Zhanerke Bolatova
- School of Public Health, Biomedicine and Pharmacy, Karaganda Medical University, Karaganda 100008, Kazakhstan; (Z.B.); (B.T.)
| | - Kamshat Tussupova
- Division of Water Resources Engineering, Lund University, SE-22100 Lund, Sweden
- Kazakh National Agrarian University, Almaty 050010, Kazakhstan
- Correspondence:
| | - Berik Toleubekov
- School of Public Health, Biomedicine and Pharmacy, Karaganda Medical University, Karaganda 100008, Kazakhstan; (Z.B.); (B.T.)
- Department of Clinical Sciences, Lund University, SE-22100 Lund, Sweden;
| | | | - Kulyash Sharapatova
- Department of Surgery and Gynecology and Pediatry, Pavlodar Branch, Semey State Medical University, Pavlodar 140000, Kazakhstan;
| | - Martin Stafström
- Department of Clinical Sciences, Lund University, SE-22100 Lund, Sweden;
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