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Berendes D, Martinsen A, Lozier M, Rajasingham A, Medley A, Osborne T, Trinies V, Schweitzer R, Prentice-Mott G, Pratt C, Murphy J, Craig C, Lamorde M, Kesande M, Tusabe F, Mwaki A, Eleveld A, Odhiambo A, Ngere I, Kariuki Njenga M, Cordon-Rosales C, Contreras APG, Call D, Ramay BM, Ramm RES, Paulino CJT, Schnorr CD, Aubin MD, Dumas D, Murray KO, Bivens N, Ly A, Hawes E, Maliga A, Morazan GH, Manzanero R, Morey F, Maes P, Diallo Y, Ilboudo M, Richemond D, Hattab OE, Oger PY, Matsuhashi A, Nsambi G, Antoine J, Ayebare R, Nakubulwa T, Vosburgh W, Boore A, Herman-Roloff A, Zielinski-Gutierrez E, Handzel T. Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19. PLOS Water 2022; 1:e0000027. [PMID: 38410139 PMCID: PMC10896259 DOI: 10.1371/journal.pwat.0000027] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices-for example, hand hygiene-are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.
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Affiliation(s)
- David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea Martinsen
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matt Lozier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anu Rajasingham
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexandra Medley
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taylor Osborne
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Victoria Trinies
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CDC Foundation, Atlanta, Georgia, USA
| | - Ryan Schweitzer
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Graeme Prentice-Mott
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caroline Pratt
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention
| | - Jennifer Murphy
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina Craig
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Maureen Kesande
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Fred Tusabe
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Alex Mwaki
- Safe Water and AIDS Project, Kisumu, Kenya
| | | | | | | | | | | | | | - Douglas Call
- Washington State University, Pullman, Washington, USA
| | | | | | | | | | - Michael De Aubin
- Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Devan Dumas
- Brigham and Women's Hospital, Harvard University, Boston, MA, USA
| | - Kristy O Murray
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nicholas Bivens
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Anh Ly
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Ella Hawes
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Adrianna Maliga
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Gerhaldine H Morazan
- Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | | | - Francis Morey
- Belize Ministry of Health and Wellness, Belmopan, Belize
| | - Peter Maes
- UNICEF, Kinshasa, Democratic Republic of Congo
| | | | | | | | | | | | | | - Gertrude Nsambi
- Department of Hygiene and Public Health, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | | | | | - Waverly Vosburgh
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy Boore
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy Herman-Roloff
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Emily Zielinski-Gutierrez
- Division of Global Health Protection, Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Tom Handzel
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Donahue M, Sreenivasan N, Stover D, Rajasingham A, Watson J, Bealle A, Ritchison N, Safranek T, Waltenburg MA, Buss B, Reefhuis J. Notes from the Field: Characteristics of Meat Processing Facility Workers with Confirmed SARS-CoV-2 Infection - Nebraska, April-May 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1020-1022. [PMID: 32759920 PMCID: PMC7454896 DOI: 10.15585/mmwr.mm6931a3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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3
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Rajasingham A, Hardy C, Kamwaga S, Sebunya K, Massa K, Mulungu J, Martinsen A, Nyasani E, Hulland E, Russell S, Blanton C, Nygren B, Eidex R, Handzel T. Evaluation of an Emergency Bulk Chlorination Project Targeting Drinking Water Vendors in Cholera-Affected Wards of Dar es Salaam and Morogoro, Tanzania. Am J Trop Med Hyg 2020; 100:1335-1341. [PMID: 31017078 PMCID: PMC6553885 DOI: 10.4269/ajtmh.18-0734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In August 2015, an outbreak of cholera was reported in Tanzania. In cholera-affected areas of urban Dar es Salaam and Morogoro, many households obtained drinking water from vendors, who sold water from tanks ranging in volume from 1,000 to 20,000 L. Water supplied by vendors was not adequately chlorinated. The Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children and the U.N. Children’s Fund, Tanzania, collaborated to enroll and train vendors to treat their water with 8.68-g sodium dichloroisocyanurate tablets (Medentech, Ireland). The Centers for Disease Control and Prevention (CDC) provided monitoring and evaluation support. Vendors were provided a 3-month supply of chlorine tablets. A baseline assessment and routine monitoring were conducted by ward environmental health officers. Approximately 3 months after chlorine tablet distribution, an evaluation of the program was conducted. The evaluation included a full enumeration of all vendors, an in-depth survey with half of the vendors enumerated, and focus group discussions. In total, 797 (88.9%) vendors were included in the full enumeration and 392 in the in-depth survey. Free residual chlorine (FRC) was detected in 12.0% of tanks at baseline and 69.6% of tanks during the evaluation; however, only 17.4% of these tanks had FRC ≥ 0.5 mg/L. The results suggest high acceptability and use of the chlorine tablets by water vendors. However, given variation in the water source used and longer storage times, dosing could be increased in future programming. Bulk chlorination using chlorine tablets offers an efficient community-level approach to treating water closer to the point of use.
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Affiliation(s)
- Anu Rajasingham
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Colleen Hardy
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kiwe Sebunya
- United Nations Children's Fund Tanzania, Dar es Salaam, Tanzania
| | - Khalid Massa
- Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Jane Mulungu
- Global Immunizations Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Martinsen
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Evalyne Nyasani
- United Nations Children's Fund Tanzania, Dar es Salaam, Tanzania
| | - Erin Hulland
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Russell
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Curtis Blanton
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Nygren
- Global Immunizations Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel Eidex
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Thomas Handzel
- Emergency Response and Recovery Branch, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Schilling KA, Awuor AO, Rajasingham A, Moke F, Omore R, Amollo M, Farag TH, Nasrin D, Nataro JP, Kotloff KL, Levine MM, Ayers T, Laserson K, Blackstock A, Rothenberg R, Stauber CE, Mintz ED, Breiman RF, O'Reilly CE. Water, Sanitation, and Hygiene Characteristics among HIV-Positive Households Participating in the Global Enteric Multicenter Study in Rural Western Kenya, 2008-2012. Am J Trop Med Hyg 2019; 99:905-915. [PMID: 30084344 DOI: 10.4269/ajtmh.17-0774] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Diarrheal illness, a common occurrence among people living with human immunodeficiency virus (PLHIV), is largely preventable through access to safe drinking water quality, sanitation, and hygiene (WASH) facilities. We examined WASH characteristics among households with and without HIV-positive residents enrolled in the Global Enteric Multicenter Study (GEMS) in rural Western Kenya. Using univariable logistic regression, we examined differences between HIV-positive and HIV-negative households in regard to WASH practices. Among HIV-positive households, we explored the relationship between the length of time knowing their HIV status and GEMS enrollment. No statistically significant differences were apparent in the WASH characteristics among HIV-positive and HIV-negative households. However, we found differences in the WASH characteristics among HIV-positive households who were aware of their HIV status ≥ 30 days before enrollment compared with HIV-positive households who found out their status < 30 days before enrollment or thereafter. Significantly more households aware of their HIV-positive status before enrollment reported treating their drinking water (odds ratio [OR] confidence interval [CI]: 2.34 [1.12, 4.86]) and using effective water treatment methods (OR [CI]: 9.6 [3.09, 29.86]), and had better drinking water storage practices. This suggests that within this region of Kenya, HIV programs are effective in promoting the importance of practicing positive WASH-related behaviors among PLHIV.
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Affiliation(s)
- Kathrine A Schilling
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alex O Awuor
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya
| | - Anu Rajasingham
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fenny Moke
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya
| | - Richard Omore
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya
| | - Manase Amollo
- Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya
| | - Tamer H Farag
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Dilruba Nasrin
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - James P Nataro
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Karen L Kotloff
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Myron M Levine
- Center for Vaccine Development, School of Medicine, University of Maryland, Baltimore, Maryland.,Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Tracy Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kayla Laserson
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.,Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisumu, Kenya.,Centers for Disease Control and Prevention India, Delhi, India
| | - Anna Blackstock
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Eric D Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.,Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Ciara E O'Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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5
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Davis W, Odhiambo A, Oremo J, Otieno R, Mwaki A, Rajasingham A, Kim S, Quick R. Evaluation of a Water and Hygiene Project in Health-Care Facilities in Siaya County, Kenya, 2016. Am J Trop Med Hyg 2019; 101:576-579. [PMID: 31333162 DOI: 10.4269/ajtmh.18-0945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To address water and hygiene infrastructure deficiencies in health-care facilities (HCFs) in Siaya County, Kenya, portable water stations, soap, and water treatment products were provided to 109 HCFs in 2005. In 2011 and again in 2016, we interviewed staff in 26 randomly selected HCFs, observed water sources, water stations, and tested source and stored water for chlorine residual and Escherichia coli. Of 26 HCFs, 22 (85%) had improved water supplies, and 22 (85%) had functioning handwashing and drinking water stations, but < 50% provided soap or water treatment. Thirteen (50%) of 26 source water samples yielded E. coli; 24 (92%) of 26 stored water samples yielded no E. coli, including nine with residual chlorine and nine untreated samples from sources yielding no E. coli. Eleven years after implementation, 85% of HCFs continued to use water stations that protected water from recontamination. Sustainable provision of soap and water treatment products could optimize intervention use.
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Affiliation(s)
- William Davis
- Centers for Disease Control and Prevention, Waterborne Diseases Prevention Branch, Atlanta, Georgia
| | | | | | | | - Alex Mwaki
- Safe Water and AIDS Project, Kisumu, Kenya
| | - Anu Rajasingham
- Centers for Disease Control and Prevention, Emergency Recovery and Response Branch, Atlanta, Georgia
| | - Sunkyung Kim
- Centers for Disease Control and Prevention, Biostatistics and Information Management Office, Atlanta, Georgia
| | - Robert Quick
- Centers for Disease Control and Prevention, Waterborne Diseases Prevention Branch, Atlanta, Georgia
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Rajasingham A, Routh JA, Loharikar A, Chemey E, Ayers T, Gunda AW, Russo ET, Wood S, Quick R. Diffusion of Handwashing Knowledge and Water Treatment Practices From Mothers in an Antenatal Hygiene Promotion Program to Nonpregnant Friends and Relatives, Machinga District, Malawi. Int Q Community Health Educ 2018; 39:63-69. [PMID: 30185142 DOI: 10.1177/0272684x18797063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Access to safe drinking water and improved hygiene are essential for preventing diarrheal diseases in low- and middle-income countries. Integrating water treatment and hygiene products into antenatal clinic care can motivate water treatment and handwashing among pregnant women. Free water hygiene kits (water storage containers, sodium hypochlorite water treatment solution, and soap) and refills of water treatment solution and soap were integrated into antenatal care and delivery services in Machinga District, Malawi, resulting in improved water treatment and hygiene practices in the home and increased maternal health service use. To determine whether water treatment and hygiene practices diffused from maternal health program participants to friends and relatives households in the same communities, we assessed the practices of 106 nonpregnant friends and relatives of these new mothers at baseline and 1-year follow-up. At follow-up, friends and relatives were more likely than at baseline to have water treatment products observable in the home (33.3% vs. 1.2%, p < 0.00001) and detectable free chlorine residual in their water, confirming water treatment (35.7% vs. 1.4%; p < 0.00001). Qualitative data from in-depth interviews also suggested that program participants helped motivate adoption of water treatment and hygiene behaviors among their friends and relatives.
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Affiliation(s)
- Anu Rajasingham
- 1 Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,2 Atlanta Research Educational Fund, Atlanta, GA, USA
| | - Janell A Routh
- 3 Epidemic Intelligence Service, Scientific Education and Professional Development Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anagha Loharikar
- 3 Epidemic Intelligence Service, Scientific Education and Professional Development Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elly Chemey
- 4 Clinton Health Access Initiative, Machinga District Hospital, Liwonde, Malawi
| | - Tracy Ayers
- 1 Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrews W Gunda
- 4 Clinton Health Access Initiative, Machinga District Hospital, Liwonde, Malawi
| | - Elizabeth T Russo
- 3 Epidemic Intelligence Service, Scientific Education and Professional Development Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Robert Quick
- 1 Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,6 IHRC, Inc., Atlanta, GA, USA
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Rajasingham A, Leso M, Ombeki S, Ayers T, Quick R. Water treatment and handwashing practices in rural Kenyan health care facilities and households six years after the installation of portable water stations and hygiene training. J Water Health 2018; 16:263-274. [PMID: 29676762 DOI: 10.2166/wh.2018.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Many health care facilities (HCFs) and households in low-and-middle-income countries have inadequate access to water for hygiene and consumption. To address these problems, handwashing and drinking water stations were installed in 53 HCFs with prevention-of-mother-to-child-transmission of HIV programs in Kenya in 2005, and hygiene education was provided to health workers and clinic clients. To assess this program, we selected a random sample of 30 HCFs, observed the percentage of handwashing and drinking water stations that were functional and in use, and after that interviewed health providers and clients about hygiene and water treatment. Results indicated that, six years after implementation, 80.0% of HCFs had at least one functional handwashing station and 83.3% had at least one functional drinking water station. In addition, 60% of HCFs had soap at ≥ one handwashing stations, and 23.3% had ≥ one container with detectable free chlorine. Of 299 clients (mothers with ≥ one child under five), 57.2% demonstrated proper water treatment knowledge, 93.3% reported ever using water treatment products, 16.4% had detectable chlorine residual in stored water, and 89.0% demonstrated proper handwashing technique. Six years after program implementation, although most HCFs had water stations and most clients could demonstrate proper handwashing technique, water stored in most clinics and homes was not treated.
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Affiliation(s)
- Anu Rajasingham
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA E-mail:
| | | | | | - Tracy Ayers
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA E-mail:
| | - Robert Quick
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA E-mail:
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Narra R, Maeda JM, Temba H, Mghamba J, Nyanga A, Greiner AL, Bakari M, Beer KD, Chae SR, Curran KG, Eidex RB, Gibson JJ, Handzel T, Kiberiti SJ, Kishimba RS, Lukupulo H, Malibiche T, Massa K, Massay AE, McCrickard LS, Mchau GJ, Mmbaga V, Mohamed AA, Mwakapeje ER, Nestory E, Newton AE, Oyugi E, Rajasingham A, Roland ME, Rusibamayila N, Sembuche S, Urio LJ, Walker TA, Wang A, Quick RE. Notes from the Field: Ongoing Cholera Epidemic - Tanzania, 2015-2016. MMWR Morb Mortal Wkly Rep 2017; 66:177-178. [PMID: 28207686 PMCID: PMC5657858 DOI: 10.15585/mmwr.mm6606a5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rupa Narra
- These authors contributed equally to this report
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9
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Sivapalasingam S, Rajasingham A, Macy JT, Friedman CR, Hoekstra RM, Ayers T, Gold B, Quick RE. Recurrence of Helicobacter pylori infection in Bolivian children and adults after a population-based "screen and treat" strategy. Helicobacter 2014; 19:343-8. [PMID: 24830916 DOI: 10.1111/hel.12137] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Strategies to prevent gastric cancer by decreasing Helicobacter pylori infections in high-prevalence, low-income countries could include a population-based "screen and treat" eradication program. METHODS We tested residents of two rural villages for H. pylori infection using urea breath test (UBT), treated infected persons using directly observed therapy (DOT), retested for cure, and retested after 1 year later for H. pylori infection. FINDINGS We tested 1,065 (92%) of 1153 residents from two villages in rural Bolivia. Baseline H. pylori prevalence was 80% (95% confidence interval [CI]: 78-84). Age-specific cure rates were similar (≥92%) after DOT. Among those cured, 12% (95% CI: 8-15) had recurrent infection. Age-specific annual H. pylori recurrence rates for combined villages were 20% (95% CI: 10-29) in persons <5 years, 20% (95% CI: 10-29) in 5-9 years, 8% (95% CI: 1-15) in 10-14 years, and 8% (95% CI: 4-12) in persons ≥15 years. Compared with the referent population, those ≥15 years, recurrent infections were significantly more likely in children <5 years (odds ratios [OR] 2.7, 95% CI: 1.2-5.8) and 5-9 years (OR 2.7, 95% CI: 1.4-5.1). INTERPRETATION Children <10 years had high H. pylori recurrence rates following a population-based screen and treat program; this H. pylori eradication strategy may not be feasible in high-prevalence, low-income settings.
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Affiliation(s)
- Sumathi Sivapalasingam
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rajasingham A, Bowen A, O'Reilly C, Sholtes K, Schilling K, Hough C, Brunkard J, Domercant JW, Lerebours G, Cadet J, Quick R, Person B. Cholera prevention training materials for community health workers, Haiti, 2010–2011. Emerg Infect Dis 2012; 17:2162-5. [PMID: 22204034 PMCID: PMC3310581 DOI: 10.3201/eid1711.110806] [Citation(s) in RCA: 6] [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] [Indexed: 11/19/2022] Open
Abstract
Stopping the spread of the cholera epidemic in Haiti required engaging community health workers (CHWs) in prevention and treatment activities. The Centers for Disease Control and Prevention collaborated with the Haitian Ministry of Public Health and Population to develop CHW educational materials, train >1,100 CHWs, and evaluate training efforts.
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Affiliation(s)
- Anu Rajasingham
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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11
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Brunkard JM, Ailes E, Roberts VA, Hill V, Hilborn ED, Craun GF, Rajasingham A, Kahler A, Garrison L, Hicks L, Carpenter J, Wade TJ, Beach MJ, Yoder Msw JS. Surveillance for waterborne disease outbreaks associated with drinking water---United States, 2007--2008. MMWR Surveill Summ 2011; 60:38-68. [PMID: 21937977] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PROBLEM/CONDITION Since 1971, CDC, the Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists have collaborated on the Waterborne Disease and Outbreak Surveillance System (WBDOSS) for collecting and reporting data related to occurrences and causes of waterborne disease outbreaks associated with drinking water. This surveillance system is the primary source of data concerning the scope and health effects of waterborne disease outbreaks in the United States. REPORTING PERIOD Data presented summarize 48 outbreaks that occurred during January 2007--December 2008 and 70 previously unreported outbreaks. DESCRIPTION OF SYSTEM WBDOSS includes data on outbreaks associated with drinking water, recreational water, water not intended for drinking (WNID) (excluding recreational water), and water use of unknown intent (WUI). Public health agencies in the states, U.S. territories, localities, and Freely Associated States are primarily responsible for detecting and investigating outbreaks and reporting them voluntarily to CDC by a standard form. Only data on outbreaks associated with drinking water, WNID (excluding recreational water), and WUI are summarized in this report. Outbreaks associated with recreational water are reported separately. RESULTS A total of 24 states and Puerto Rico reported 48 outbreaks that occurred during 2007--2008. Of these 48 outbreaks, 36 were associated with drinking water, eight with WNID, and four with WUI. The 36 drinking water--associated outbreaks caused illness among at least 4,128 persons and were linked to three deaths. Etiologic agents were identified in 32 (88.9%) of the 36 drinking water--associated outbreaks; 21 (58.3%) outbreaks were associated with bacteria, five (13.9%) with viruses, three (8.3%) with parasites, one (2.8%) with a chemical, one (2.8%) with both bacteria and viruses, and one (2.8%) with both bacteria and parasites. Four outbreaks (11.1%) had unidentified etiologies. Of the 36 drinking water--associated outbreaks, 22 (61.1%) were outbreaks of acute gastrointestinal illness (AGI), 12 (33.3%) were outbreaks of acute respiratory illness (ARI), one (2.8%) was an outbreak associated with skin irritation, and one (2.8%) was an outbreak of hepatitis. All outbreaks of ARI were caused by Legionella spp. A total of 37 deficiencies were identified in the 36 outbreaks associated with drinking water. Of the 37 deficiencies, 22 (59.5%) involved contamination at or in the source water, treatment facility, or distribution system; 13 (35.1%) occurred at points not under the jurisdiction of a water utility; and two (5.4%) had unknown/insufficient deficiency information. Among the 21 outbreaks associated with source water, treatment, or distribution system deficiencies, 13 (61.9%) were associated with untreated ground water, six (28.6%) with treatment deficiencies, one (4.8%) with a distribution system deficiency, and one (4.8%) with both a treatment and a distribution system deficiency. No outbreaks were associated with untreated surface water. Of the 21 outbreaks, 16 (76.2%) occurred in public water systems (drinking water systems under the jurisdiction of EPA regulations and water utility management), and five (23.8%) outbreaks occurred in individual systems (all of which were associated with untreated ground water). Among the 13 outbreaks with deficiencies not under the jurisdiction of a water system, 12 (92.3%) were associated with the growth of Legionella spp. in the drinking water system, and one (7.7%) was associated with a plumbing deficiency. In the two outbreaks with unknown deficiencies, one was associated with a public water supply, and the other was associated with commercially bottled water. The 70 previously unreported outbreaks included 69 Legionella outbreaks during 1973--2000 that were not reportable previously to WBDOSS and one previously unreported outbreak from 2002. INTERPRETATION More than half of the drinking water--associated outbreaks reported during the 2007--2008 surveillance period were associated with untreated or inadequately treated ground water, indicating that contamination of ground water remains a public health problem. The majority of these outbreaks occurred in public water systems that are subject to EPA's new Ground Water Rule (GWR), which requires the majority of community water systems to complete initial sanitary surveys by 2012. The GWR focuses on identification of deficiencies, protection of wells and springs from contamination, and providing disinfection when necessary to protect against bacterial and viral agents. In addition, several drinking water--associated outbreaks that were related to contaminated ground water appeared to occur in systems that were potentially under the influence of surface water. Future efforts to collect data systematically on contributing factors associated with drinking water outbreaks and deficiencies, including identification of ground water under the direct influence of surface water and the criteria used for their classification, would be useful to better assess risks associated with ground water. During 2007--2008, Legionella was the most frequently reported etiology among drinking water--associated outbreaks, following the pattern observed since it was first included in WBDOSS in 2001. However, six (50%) of the 12 drinking water--associated Legionella outbreaks were reported from one state, highlighting the substantial variance in outbreak detection and reporting across states and territories. The addition of published and CDC-investigated legionellosis outbreaks to the WBDOSS database clarifies that Legionella is not a new public health issue. During 2009, Legionella was added to EPA's Contaminant Candidate List for the first time. PUBLIC HEALTH ACTIONS CDC and EPA use WBDOSS surveillance data to identify the types of etiologic agents, deficiencies, water systems, and sources associated with waterborne disease outbreaks and to evaluate the adequacy of current technologies and practices for providing safe drinking water. Surveillance data also are used to establish research priorities, which can lead to improved water quality regulation development. Approximately two thirds of the outbreaks associated with untreated ground water reported during the 2007--2008 surveillance period occurred in public water systems. When fully implemented, the GWR that was promulgated in 2006 is expected to result in decreases in ground water outbreaks, similar to the decreases observed in surface water outbreaks after enactment of the Surface Water Treatment Rule in 1974 and its subsequent amendments. One third of drinking water--associated outbreaks occurred in building premise plumbing systems outside the jurisdiction of water utility management and EPA regulations; Legionella spp. accounted for >90% of these outbreaks, indicating that greater attention is needed to reduce the risk for legionellosis in building plumbing systems. Finally, a large communitywide drinking water outbreak occurred in 2008 in a public water system associated with a distribution system deficiency, underscoring the importance of maintaining and upgrading drinking water distribution system infrastructure to provide safe water and protect public health.
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Affiliation(s)
- Joan M Brunkard
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA 30333, USA.
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