Community-level impacts of sanitation coverage on maternal and neonatal health: a retrospective cohort of survey data

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.

Digital Subtraction Angiography a Door Opener for Neurosurgical Residents who want to Perform Neurointerventional Procedures

Digital subtraction angiography (DSA) has been a fluoroscopic golden investigative tool to know the vascular angiography of the brain and spinal cord. The technique in performing this procedure exposes residents in accessing the major vessels, branches of the arch of aorta, selective angiography and diagnosing different vascular anomalies of brain and spine. They are also exposed to the knowledge of different diagnostic catheters, its manipulation, use of dye and radiation exposure and safety. We would like to share our experience in training and disseminating the knowledge of digital subtraction angiography to the residents.

Evaluation of a barley core collection for spot form net blotch reaction reveals distinct genotype-specific pathogen virulence and host susceptibility

Spot form net blotch (SFNB) caused by Pyrenophora teres f. maculata is a major foliar disease of barley (Hordeum vulgare) worldwide. SFNB epidemics have recently been observed in major barley producing countries, suggesting that the local barley cultivars are not resistant and that virulence of the local pathogen populations may have changed. Here we attempt to identify sources of resistance effective against four diverse isolates of P. teres f. maculata collected from around the world. A total of 2,062 world barley core collection accessions were phenotyped using isolates of the pathogen collected in the United States (FGO), Australia (SG1), New Zealand (NZKF2), and Denmark (DEN 2.6). Isolate-specific susceptibility was identified in several of the barley accessions tested, indicating variability in both pathogen virulence and host resistance/susceptibility. Collectively, only 15 barley accessions were resistant across all isolates tested. These resistant accessions will be used to generate mapping populations and for germplasm development. Future research will involve the characterization of host resistance, pathogen virulence, and the host-pathogen interaction associated with SFNB of barley.