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Long KZ, Gunanti IR, Stride C, Sanchez J, Sur D, Manna B, Ramamurthy T, Kanungo S, Nataro JP, Powell H, Roose A, Nasrin D, Sommerfelt H, Levine M, Kotloff K. Identification of Enteric Pathogen Reservoirs and Transmission Pathways Associated with Short Childhood Stature in the Kolkata Indian Site of the Global Enteric Multicenter Study. Nutrients 2024; 16:2733. [PMID: 39203869 PMCID: PMC11357064 DOI: 10.3390/nu16162733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024] Open
Abstract
Age-stratified path analyses modeled associations between enteric pathogen reservoirs, transmission pathways and height-for-age z-scores (HAZ) to identify determinants of childhood growth in the Kolkata, India site of the Global Enteric Multicenter Study (GEMS). Models tested direct associations of potential pathogen reservoirs with HAZ at 60-day follow-up in separate moderate and severe diarrhea (MSD) case and control cohorts or indirectly when mediated by enteric infections. In the MSD cohort, rotavirus and typical EPEC (tEPEC) infections among children 0-11 months of age and ST-ETEC infections among children 12-23 months of age were associated with lower HAZ. Handwashing after defecating and before cooking reduced impaired growth through reductions in rotavirus and tEPEC infections. Water storage increased rotavirus and ST-ETEC infection risks, resulting in increased impaired growth, but was reduced with reported child feces disposal. The GII norovirus variant was inversely associated with HAZ among children 12-59 months of age in the control cohort. Reported handwashing before the handling of children reduced GII infections and impaired growth. Boiling water and the disposal of children's feces mediated by stored water were positively associated with HAZ. The targeting of pathogen-specific reservoirs and transmission pathways may more effectively improve childhood linear growth in South Asian urban communities.
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Affiliation(s)
- Kurt Z. Long
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Faculty of Medicine, University of Basel, Peterplatz 1, 4003 Basel, Switzerland
- The Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane 4101, Australia
| | - Inong R. Gunanti
- The Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane 4101, Australia
| | - Chris Stride
- The Institute of Work Psychology, University of Sheffield, Sheffield S10 2TN, UK;
| | - Johanna Sanchez
- The Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane 4101, Australia
| | - Dipika Sur
- ICMR—National Institute for Research in Bacterial Infections, Kolkata 700010, India
| | - Byomkesh Manna
- ICMR—National Institute for Research in Bacterial Infections, Kolkata 700010, India
| | | | - Suman Kanungo
- ICMR—National Institute for Research in Bacterial Infections, Kolkata 700010, India
| | - James P. Nataro
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Helen Powell
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Anna Roose
- Department of Medicine Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Dilruba Nasrin
- Department of Medicine Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Halvor Sommerfelt
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen and the Norwegian Institute of Public Health, NO-5020 Bergen, Norway
| | - Myron Levine
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Medicine Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Karen Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Medicine Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Aguzie IO, Obioha AM, Unachukwu CE, Okpasuo OJ, Anunobi TJ, Ugwu KO, Ubachukwu PO, Dibua UME. Hand contamination and hand hygiene knowledge and practices among commercial transport users after the SARS-CoV-2 virus (COVID-19) scare, Enugu State, Nigeria. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002627. [PMID: 38820394 PMCID: PMC11142581 DOI: 10.1371/journal.pgph.0002627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/06/2024] [Indexed: 06/02/2024]
Abstract
Contaminated hands are one of the most common modes of microorganism transmission that are responsible for many associated infections in healthcare, food industries, and public places such as transportation parks. Public health approaches during COVID-19 pandemic have shown that hand hygiene practices and associated knowledge are critical measure to control the spread of infectious agent. Hence, assessment of commercial transport users' knowledge, belief and practices on hand hygiene, and potential contamination with infectious agents which is the aim of the study, aligns with general health concern of quantifying contamination risk levels to predict disease outbreaks. This study utilized a randomized sampling approach to select 10 frequently used commercial parks within two districts in the State: Enugu and Nsukka. The parameters analysed include a cross-sectional questionnaire survey, hand swab and hand washed samples collected from dominant hand of participants. A total of 600 participants responded to the questionnaire survey, while 100 participants' hand swabs were examined for microbial contamination. This study recorded a high prevalence of fungal (90.0%) and bacterial (87.0%) species; 20 species of fungus were identified with prevalence range of 1% to 14%; 21 bacterial species were isolated with prevalence range of 1% to 16%. These species were identified as either opportunistic, non-invasive, or pathogenic, which may constitute a health concern amongst immunocompromised individuals within the population. Aspergillus spp. (14%), was the most common fungal species that was exclusively found amongst Nsukka commercial users, while E. coli was the most prevalent isolated bacterial species amongst Nsukka (12%) and Enugu (20%) commercial park users. Prevalence of fungal contamination in Nsukka (94.0%; 47/50) and Enugu (86.0%; 43/50) were both high. Prevalence of bacterial contamination was higher in Enugu than Nsukka but not significantly (47[94.0%] vs. 40[80.0%], p = 0.583). A greater number of participants (99.3%) were aware of the importance of hand hygiene, however with low compliance rate aside "after using the toilet" (80%) and "before eating" (90%), other relevant hand washing and sanitizing practices were considered less important. With these observations, we can emphatically say that despite the COVID-19 scare, commercial park users within the sampled population do not efficiently practice quality hand wash and hygiene measures, hence, risking the widespread of infectious agents in situation of disease outbreak or among immunocompromised individuals.
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Affiliation(s)
- Ifeanyi O. Aguzie
- Department of Zoology and Environmental Biology, University of Nigeria, Nsukka, Nigeria
| | - Ahaoma M. Obioha
- Department of Zoology and Environmental Biology, University of Nigeria, Nsukka, Nigeria
| | - Chisom E. Unachukwu
- Department of Zoology and Environmental Biology, University of Nigeria, Nsukka, Nigeria
| | - Onyekachi J. Okpasuo
- Department of Zoology and Environmental Biology, University of Nigeria, Nsukka, Nigeria
| | - Toochukwu J. Anunobi
- Department of Science Laboratory Technology, Federal Polytechnic, Idah, Kogi State, Nigeria
| | - Kenneth O. Ugwu
- Department of Microbiology, University of Nigeria, Nsukka, Nigeria
| | - Patience O. Ubachukwu
- Department of Zoology and Environmental Biology, University of Nigeria, Nsukka, Nigeria
| | - Uju M. E. Dibua
- Department of Microbiology, University of Nigeria, Nsukka, Nigeria
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Manisha M, Verma K, Ramesh N, Anirudha TP, Santrupt RM, Rao L. Water, sanitation, and hygiene implications of large-scale recycling of treated municipal wastewater in semi-arid regions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166631. [PMID: 37659564 DOI: 10.1016/j.scitotenv.2023.166631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
Access to water, sanitation, and hygiene (WaSH) is crucial for national development, as it improves human health and fulfills a fundamental need. This study examines the impact of a large-scale groundwater (GW) recharge scheme using secondary treated wastewater (STW) on WaSH characteristics and identifies the major determinants of improved WaSH charecteristics in drought-hit regions of Kolar district, southern India. The study quantifies improved WaSH practices by comparing WaSH characteristics between impacted areas (influenced by STW) and non-impacted areas (not influenced by STW) of Kolar, using household survey data. Pearson's chi-square and student's t-test are used to verify differences between WaSH characteristics. Furthermore, a composite WaSH score is formulated, and a hierarchical stepwise multiple linear regression model is constructed to identify major determinants of improved WaSH scores. The results show that impacted areas have better WaSH characteristics, including daily water supply by gram panchayat, enhanced toilet uses among all family members, bathing patterns, cloth washing practices, toilet cleaning patterns, and water consumption per capita per day. The maximum and minimum WaSH scores of impacted areas were 17.50 and 6.50, respectively, while those of non-impacted areas were 14 and 4.5. This study finds that improved water availability, quality, and security due to daily water supply at the household level are the major determinants of improved WaSH practices. These results can inform policymakers in designing sanitation and hygiene improvement policies that integrate water recycling projects in drought-hit areas.
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Affiliation(s)
- Manjari Manisha
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India.
| | - Kavita Verma
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
| | - N Ramesh
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
| | - T P Anirudha
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
| | - R M Santrupt
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
| | - Lakshminarayana Rao
- Centre for Sustainable Technologies, Indian Institute of Science, Bengaluru, India
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Som SV, Wieringa FT, Campos Ponce M, Polman K, Dakurah P, Duncan D, Blomberg J, Rasphone S, Hoeven MVD. Association of both Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF) practices with childhood malnutrition in Lao PDR: a cross-sectional study of the 2017 Lao Social Indicator Survey II. BMJ Open 2023; 13:e073974. [PMID: 37832981 PMCID: PMC10582958 DOI: 10.1136/bmjopen-2023-073974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE We assessed whether Water, Sanitation and Hygiene (WASH) and Infant and Young Child Feeding (IYCF), either alone or combined, were associated with malnutrition among Lao People's Democratic Republic (Lao PDR) children aged 6 to <24 months. DESIGN This is a secondary analysis of the 2017 Lao Social Indicator Survey II (LSIS II), which used multistage probability proportional to size sampling. Logistic regression analyses were conducted with OR and its corresponding 95% CI. SETTING The LSIS II was conducted a nationwide household-based survey covering all 18 provinces in Lao PDR. PARTICIPANTS We had a total of 3375 children (weighted sample 3345) and 357 households with data on drinking water. OUTCOME MEASURES The outcomes of this study were stunting and wasting. RESULTS The prevalence of stunting and wasting was 28.9% and 10.1%, respectively. Even though households with access to a basic or improved water source were high (82.5%), over 83% of drinking water was contaminated with Escherichia coli. Access to improved sanitation, basic hygiene and adequate IYCF gave a significant lower risk of becoming stunted. The combined effect of these practices on stunting was (adjusted OR (AOR)=0.54; 95% CI=0.41 to 0.73) greater than each practice alone (improved sanitation: AOR=0.75; 95% CI=0.61 to 0.93; basic hygiene: AOR=0.69; 95% CI=0.57 to 0.83; adequate IYCF: AOR=0.79; 95% CI=0.64 to 0.98). Access to improved sanitation and adequate IYCF was associated with a significant lower risk for being wasted, and again the combined effect of these practices was (AOR=0.64; 95% CI=0.44 to 0.92) greater than each practice alone (improved sanitation: AOR=0.68; 95% CI=0.49 to 0.93 and adequate IYCF: AOR=0.66; 95% CI=0.47 to 0.92). CONCLUSION Given the strong associations with both stunting and wasting, and the added benefits when combining WASH and IYCF, there is a need of multisectoral interventions to reduce early childhood malnutrition in Lao PDR.
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Affiliation(s)
- Somphos Vicheth Som
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank T Wieringa
- UMR QualiSud, French National Research Institute for Sustainable Development, Montpellier, France
| | - Maiza Campos Ponce
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Katja Polman
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Prosper Dakurah
- United Nations Children's Emergency Fund Lao PDR, Vientiane, Lao People's Democratic Republic
| | - David Duncan
- United Nations Children's Emergency Fund Lao PDR, Vientiane, Lao People's Democratic Republic
| | - Janneke Blomberg
- United Nations Children's Emergency Fund Lao PDR, Vientiane, Lao People's Democratic Republic
| | - Sitthorot Rasphone
- The Ministry of Planning and Investment's National Economic Research Institute, Vientiane, Lao People's Democratic Republic
| | - Marinka van der Hoeven
- Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Santos MCS, Heller L. [Schistosomiasis, soil-transmitted helminthiases and sanitation in Latin America and the Caribbean: a systematic reviewRelación entre la prevalencia de esquistosomiasis y geohelmintiasis y las condiciones sanitarias en América Latina y el Caribe: una revisión sistemática]. Rev Panam Salud Publica 2023; 47:e111. [PMID: 37609526 PMCID: PMC10441557 DOI: 10.26633/rpsp.2023.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/11/2023] [Indexed: 08/24/2023] Open
Abstract
Objective To investigate the relationship between the prevalence of schistosomiasis and soil-transmitted helminthiasis with variables related to access to water, sanitation and solid waste in Latin American and Caribbean (LAC) countries. Method A systematic review was performed in the LILACS, PubMed, Web of Science, and SciELO databases. Studies published between 1950 and August 2021, with an ecological design and a focus on population groups (states, municipalities and/or districts), having the prevalence of infection by Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides or Trichuris trichiura as primary variable and access to water, sewage and/or solid waste as explanatory variables were included. Open access articles with full text available in English, Spanish, or Portuguese were considered. The risk of bias and the quality of the studies were assessed according to the Joanna Briggs Institute manual. Results Of 2 714 articles, nine were eligible, published between 1994 and 2021 and covering 22 LAC countries and 14 350 municipalities. All articles had moderate methodological quality. Environmental variables indicated an association between water supply and solid waste collection with schistosomiasis; water supply with ascariasis, trichuriasis and hookworm; and sewage with ascariasis and hookworm. Except for one article, which had regional coverage for LAC, all the others were developed in Brazil. Conclusion There is a clear need to expand research on the association between household and collective health conditions and parasitic diseases for all endemic countries in LAC to support environmental strategies to control these diseases.
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Affiliation(s)
- Mariana Cristina Silva Santos
- Instituto René RachouFiocruz MinasBelo Horizonte (MG)BrasilInstituto René Rachou, Fiocruz Minas, Belo Horizonte (MG), Brasil.
| | - Léo Heller
- Instituto René RachouFiocruz MinasBelo Horizonte (MG)BrasilInstituto René Rachou, Fiocruz Minas, Belo Horizonte (MG), Brasil.
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Wolf J, Johnston RB, Ambelu A, Arnold BF, Bain R, Brauer M, Brown J, Caruso BA, Clasen T, Colford JM, Mills JE, Evans B, Freeman MC, Gordon B, Kang G, Lanata CF, Medlicott KO, Prüss-Ustün A, Troeger C, Boisson S, Cumming O. Burden of disease attributable to unsafe drinking water, sanitation, and hygiene in domestic settings: a global analysis for selected adverse health outcomes. Lancet 2023; 401:2060-2071. [PMID: 37290458 PMCID: PMC10290941 DOI: 10.1016/s0140-6736(23)00458-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Assessments of disease burden are important to inform national, regional, and global strategies and to guide investment. We aimed to estimate the drinking water, sanitation, and hygiene (WASH)-attributable burden of disease for diarrhoea, acute respiratory infections, undernutrition, and soil-transmitted helminthiasis, using the WASH service levels used to monitor the UN Sustainable Development Goals (SDGs) as counterfactual minimum risk-exposure levels. METHODS We assessed the WASH-attributable disease burden of the four health outcomes overall and disaggregated by region, age, and sex for the year 2019. We calculated WASH-attributable fractions of diarrhoea and acute respiratory infections by country using modelled WASH exposures and exposure-response relationships from two updated meta-analyses. We used the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene public database to estimate population exposure to different WASH service levels. WASH-attributable undernutrition was estimated by combining the population attributable fractions (PAF) of diarrhoea caused by unsafe WASH and the PAF of undernutrition caused by diarrhoea. Soil-transmitted helminthiasis was fully attributed to unsafe WASH. FINDINGS We estimate that 1·4 (95% CI 1·3-1·5) million deaths and 74 (68-80) million disability-adjusted life-years (DALYs) could have been prevented by safe WASH in 2019 across the four designated outcomes, representing 2·5% of global deaths and 2·9% of global DALYs from all causes. The proportion of diarrhoea that is attributable to unsafe WASH is 0·69 (0·65-0·72), 0·14 (0·13-0·17) for acute respiratory infections, and 0·10 (0·09-0·10) for undernutrition, and we assume that the entire disease burden from soil-transmitted helminthiasis was attributable to unsafe WASH. INTERPRETATION WASH-attributable burden of disease estimates based on the levels of service established under the SDG framework show that progress towards the internationally agreed goal of safely managed WASH services for all would yield major public-health returns. FUNDING WHO and Foreign, Commonwealth & Development Office.
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Affiliation(s)
- Jennyfer Wolf
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland.
| | - Richard B Johnston
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Argaw Ambelu
- Division of Water and Health, Ethiopian Institution of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Benjamin F Arnold
- FI Proctor Foundation, University of California, San Francisco, CA, USA
| | - Robert Bain
- UNICEF Middle East and North Africa, Amman, Jordan
| | - 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
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 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
- Gangarose 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
| | - Joanna Esteves Mills
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Barbara Evans
- School of Civil Engineering, University of Leeds, Leeds, UK
| | - Matthew C Freeman
- Gangarose Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bruce Gordon
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tami Nadu, India
| | - Claudio F Lanata
- Instituto de Investigación Nutricional, Lima, Peru; School of Medicine, Vanderbilt University, Nashville, TN, USA; Department of Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate O Medlicott
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Annette Prüss-Ustün
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Christopher Troeger
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Sophie Boisson
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
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Gaffan N, Kpozehouen A, Degbey C, Ahanhanzo YG, Paraïso MN. Effects of household access to water, sanitation, and hygiene services on under-five mortality in Sub-Saharan Africa. Front Public Health 2023; 11:1136299. [PMID: 37181724 PMCID: PMC10173862 DOI: 10.3389/fpubh.2023.1136299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/22/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Sub-Saharan Africa has the highest under-five mortality rate and is among the regions where people have the least access to adequate Water, Sanitation, and Hygiene (WASH) services. The work aimed to investigate the effects of WASH conditions faced by children on under-five mortality in Sub-Saharan Africa. Methods We carried out secondary analyses using the Demographic and Health Survey datasets of 30 countries in Sub-Saharan Africa. The study population consisted of children born within 5 years preceding the selected surveys. The dependent variable was the child's status (1 = deceased versus 0 = alive) on the survey day. The individual WASH conditions in which children live were assessed in their immediate environment, i.e., at the level of their households of residence. The other explanatory variables were related to the child, mother, household, and environment. Following a description of the study variables, we identified the predictors of under-five mortality using a mixed logistic regression. Results The analyses involved 303,985 children. Overall, 6.36% (95% CI = 6.24-6.49) of children died before their fifth birthday. The percentage of children living in households with access to individual basic WASH services was 58.15% (95% CI = 57.51-58.78), 28.18% (95% CI = 27.74-28.63), and 17.06% (95% CI = 16.71-17.41), respectively. Children living in households using unimproved water facilities (aOR = 1.10; 95% CI = 1.04-1.16) or surface water (aOR = 1.11; 95% CI = 1.03-1.20) were more likely to die before five than those coming from households with basic water facilities. The risk of under-five mortality was 11% higher for children living in households with limited sanitation facilities (aOR = 1.11; 95% CI = 1.04-1.18) than for those with basic sanitation services. We found no evidence to support a relationship between household access to hygiene services and under-five mortality. Conclusion Interventions to reduce under-five mortality should focus on strengthening access to basic water and sanitation services. Further studies are needed to investigate the contribution of access to basic hygiene services on under-five mortality.
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Affiliation(s)
- Nicolas Gaffan
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | - Alphonse Kpozehouen
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | - Cyriaque Degbey
- Department of Environmental Health, Regional Institute of Public Health, University of Abomey Calavi, Ouidah, Benin
- University Hospital Hygiene Clinic, National Hospital and University Centre Hubert Koutoukou Maga, Cotonou, Benin
| | - Yolaine Glele Ahanhanzo
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | - Moussiliou Noël Paraïso
- Department of Health Promotion, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
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Nambiar D, Mathew B, Dubey S, Moola S. Interventions addressing maternal and child health among the urban poor and homeless: an overview of systematic reviews. BMC Public Health 2023; 23:492. [PMID: 36918855 PMCID: PMC10015840 DOI: 10.1186/s12889-023-15410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Inequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs. METHODS We searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization's (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107). RESULTS In a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed. CONCLUSION The generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health, 308 Elegance Tower, Jasola District Centre, 110025, New Delhi, India.
| | | | - Shubhankar Dubey
- Indian Council of Medical Research- Regional Medical Research Center, Bhubaneswar, Odisha, India
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Um S, Vang D, Pin P, Chau D. Trends and determinants of acute respiratory infection symptoms among under-five children in Cambodia: Analysis of 2000 to 2014 Cambodia demographic and health surveys. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001440. [PMID: 37134089 PMCID: PMC10155954 DOI: 10.1371/journal.pgph.0001440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/31/2023] [Indexed: 05/04/2023]
Abstract
Acute Respiratory Infections (ARIs) are the leading cause of mortality and morbidity among children under 5 years old and about 1.3 million annually worldwide. Account for 33% of deaths among children under 5 years that occurred in developing countries. In Cambodia, ARIs prevalence in children under 5 years old was 20% in 2000, and 6% in 2014. Hence, the aimed to describe the trends of ARI symptoms among children aged 0-59 months over time using the 2000, 2005, 2010, and 2014 Cambodia Demographic and Health Survey (CDHS) and determined the relationships between socio-demographic, behavioral, and environmental factors with ARI symptoms. We analyzed existing children's data from 2000, 2005, 2010 and 2014 of Cambodia Demographic and Health Survey (CDHS) that used a two-stage stratified cluster sampling design. We limited our analysis to children born in the last five years prior to the surveys, alive and living in households during interview time. Data were pooled across the four survey years for 29,171 children aged 0-59 months. All statistics were carried out using STATA V16, and survey weights were taken into account for the survey design of the CDHS. We used multiple logistic regression to determine the main predictors of ARI symptoms among children under 5 years. ARI symptoms in the previous two weeks in children aged 0-59 months in Cambodia were 19.9% in 2000 to 8.6% in 2005 to 6.4% in 2010, and 5.5% in 2014. Factors independently associated with increased odds of ARI symptoms were children ages 6-11 months with adjusted odds ratio [AOR = 1.91; 95% CI: 1.53-2.38], 12-23 months [AOR = 1.79; 95% CI: 1.46-2.20], and 24-35 months [AOR = 1.41; 95% CI: 1.13-1.76], smoking mother [AOR = 1.61; 95% CI: 1.27-2.05], and using non-improved toilets in households [AOR = 1.20; 95% CI: 0.99-1.46]. However, the following factors were found to be associated with decreased odds of having ARI symptoms: Mothers with higher education [AOR = 0.45; 95% CI: 0.21-0.94], breastfeeding children [AOR = 0.87; 95% CI: 0.77-0.98], and children born into richest wealth quantile [AOR = 0.73; 95% CI: 0.56-0.95], respectively. Survey 2005 [AOR = 0.36; 95% CI: 0.31-0.42], 2010 [AOR = 0.27; 95% CI: 0.22-0.33], 2014 [AOR = 0.24; 95% CI: 0.19-0.30]. The trends of ARI symptoms among children under five in Cambodia significantly decreased from 2000-2014. Smoking mothers, young children ages (0-35 months), and using non-improved toilet in household are factors that independently increased the likelihood that children would develop ARI symptoms. Inversely, factors were found to be associated with decreased odds of having ARI symptoms: Mothers with higher education, breastfeeding children, and children born into the richest wealth quantile and Survey years. Therefore, government and child family programs must promote maternal education, particularly infant breastfeeding. The government ought to support maternal education and infant breastfeeding in the interest of early childhood care.
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Affiliation(s)
- Samnang Um
- National Institute of Public Health (NIPH), Phnom Penh, Cambodia
| | - Daraden Vang
- National Institute of Public Health (NIPH), Phnom Penh, Cambodia
| | - Punleak Pin
- Doctoral specialization in Pneumology, Faculty of Medicine at the University of Health Sciences (UHS) in Phnom Penh, Phnom Penh, Cambodia
| | - Darapheak Chau
- National Institute of Public Health (NIPH), Phnom Penh, Cambodia
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Fauziah N, Aviani JK, Agrianfanny YN, Fatimah SN. Intestinal Parasitic Infection and Nutritional Status in Children under Five Years Old: A Systematic Review. Trop Med Infect Dis 2022; 7:371. [PMID: 36422922 PMCID: PMC9697828 DOI: 10.3390/tropicalmed7110371] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 09/01/2023] Open
Abstract
Intestinal parasitic infections are common infectious diseases causing many health problems and impaired growth and physical development.. Children under five years old are the most vulnerable to infections, due to their immature immunity and feeding and exploratory behaviours. This systematic review aimed to assess the relationship between intestinal parasitic infections and undernutrition among children under 5 years old. Fifteen studies met the inclusion and exclusion criteria and were classified as high-quality studies. Twelve parasites were reported, including Ascaris lumbricoides, Cryptosporodium spp., Entamoeba histolytica, Enterobius vermicularis, Giardia lamblia, hookworm, Hymenolepis nana, Strongyloides sterocalis, Taenia spp. and Trichuris trichuria. Ascariasis is the most reported infection, with a prevalence ranging from 10.77% in Ethiopia to 57.14% in Malaysia, and is correlated with stunting (OR 2.17 (95% CI 1.14, 4.13), p = 0.02). Giardiasis is the second most reported infection, with a prevalence ranging from 4.43% in Ethiopia to 66.33% in the Central African Republic, and is related to an increased risk of stunting (OR 2.34 (95% CI 1.07, 5.10), p = 0.03)), wasting (OR 2.90 (95% CI 1.12, 7.49, p = 0.03)), and being underweight (OR 1.53 (95% CI 1.02, 2.29, p = 0.04)). The third and fourth most prevalent infections are T. trichiura and hookworm infections. Intestinal parasitic infections can occur very early in life and cause significant growth retardation. It is important to understand the prevalence and effects of infection based on the parasite species in order to implement therapeutic interventions and prevention controls.
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Affiliation(s)
- Nisa Fauziah
- Division of Parasitology, Department of Basic Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
- Laboratory of Parasitology, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Jenifer Kiem Aviani
- Department of Biotechnology, School of Life Science and Technology, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Yukan Niko Agrianfanny
- Laboratory of Parasitology, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
| | - Siti Nur Fatimah
- Division of Clinical Nutrition, Faculty of Medicine, Universitas Padjadjaran, Bandung 45363, Indonesia
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11
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Sangalang SO, Lemence ALG, Ottong ZJ, Valencia JC, Olaguera M, Canja RJF, Mariano SMF, Prado NO, Ocaña RMZ, Singson PAA, Cumagun ML, Liao J, Anglo MVJC, Borgemeister C, Kistemann T. School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines. BMC Public Health 2022; 22:2034. [PMID: 36344973 PMCID: PMC9641834 DOI: 10.1186/s12889-022-14398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/15/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The impacts of multicomponent school water, sanitation, and hygiene (WaSH) interventions on children's health are unclear. We conducted a cluster-randomized controlled trial to test the effects of a school WaSH intervention on children's malnutrition, dehydration, health literacy (HL), and handwashing (HW) in Metro Manila, Philippines. METHODS The trial lasted from June 2017 to March 2018 and included children, in grades 5, 6, 7, and 10, from 15 schools. At baseline 756 children were enrolled. Seventy-eight children in two clusters were purposively assigned to the control group (CG); 13 clusters were randomly assigned to one of three intervention groups: low-intensity health education (LIHE; two schools, n = 116 children), medium-intensity health education (MIHE; seven schools, n = 356 children), and high-intensity health education (HIHE; four schools, n = 206 children). The intervention consisted of health education (HE), WaSH policy workshops, provision of hygiene supplies, and WaSH facilities repairs. Outcomes were: height-for-age and body mass index-for-age Z scores (HAZ, BAZ); stunting, undernutrition, overnutrition, dehydration prevalence; HL and HW scores. We used anthropometry to measure children's physical growth, urine test strips to measure dehydration, questionnaires to measure HL, and observation to measure HW practice. The same measurements were used during baseline and endline. We used multilevel mixed-effects logistic and linear regression models to assess intervention effects. RESULTS None of the interventions reduced undernutrition prevalence or improved HAZ, BAZ, or overall HL scores. Low-intensity HE reduced stunting (adjusted odds ratio [aOR] 0.95; 95% CI 0.93 to 0.96), while low- (aOR 0.57; 95% CI 0.34 to 0.96) and high-intensity HE (aOR 0.63; 95% CI 0.42 to 0.93) reduced overnutrition. Medium- (adjusted incidence rate ratio [aIRR] 0.02; 95% CI 0.01 to 0.04) and high-intensity HE (aIRR 0.01; 95% CI 0.00 to 0.16) reduced severe dehydration. Medium- (aOR 3.18; 95% CI 1.34 to 7.55) and high-intensity HE (aOR 3.89; 95% CI 3.74 to 4.05) increased observed HW after using the toilet/urinal. CONCLUSION Increasing the intensity of HE reduced prevalence of stunting, overnutrition, and severe dehydration and increased prevalence of observed HW. Data may be relevant for school WaSH interventions in the Global South. Interventions may have been more effective if adherence was higher, exposure to interventions longer, parents/caregivers were more involved, or household WaSH was addressed. TRIAL REGISTRATION NUMBER DRKS00021623.
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Affiliation(s)
- Stephanie O Sangalang
- Center for Development Research, University of Bonn, Genscherallee 3, 53113, Bonn, Germany.
| | - Allen Lemuel G Lemence
- Department of Industrial Engineering, University of the Philippines Los Baños, Los Baños, Philippines
| | - Zheina J Ottong
- School of Earth Sciences and Environmental Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
- National Institute of Physics, College of Science, University of the Philippines Diliman, Quezon City, Philippines
| | | | - Mikaela Olaguera
- College of Mass Communication, University of the Philippines Diliman, Quezon City, Philippines
| | - Rovin James F Canja
- Philippines Department of Education, Meralco Avenue, Pasig City, Philippines
| | - Shyrill Mae F Mariano
- Marine Science Institute, University of the Philippines Diliman, Quezon City, Philippines
| | - Nelissa O Prado
- Department of Environment Systems, University of Tokyo, Kashiwa, Chiba, Japan
- National Institute of Geological Sciences, University of the Philippines Diliman, Quezon City, Philippines
| | - Roezel Mari Z Ocaña
- School of Medicine, Far Eastern University - Nicanor Reyes Medical Foundation, Quezon City, Philippines
| | | | - Ma Lourdes Cumagun
- Department of Science and Technology, Food and Nutrition Research Institute, Taguig, Philippines
| | - Janine Liao
- School of Diplomacy and Governance, De La Salle - College of Saint Benilde, Manila, Philippines
| | | | - Christian Borgemeister
- Center for Development Research, University of Bonn, Genscherallee 3, 53113, Bonn, Germany
| | - Thomas Kistemann
- Center for Development Research, University of Bonn, Genscherallee 3, 53113, Bonn, Germany
- Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
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Food Safety Practices and Stunting among School-Age Children—An Observational Study Finding from an Urban Slum of Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138044. [PMID: 35805701 PMCID: PMC9265275 DOI: 10.3390/ijerph19138044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
Background: Food safety incorporates the handling, preparation, and storage of food materials in ways that prevent foodborne illness. We aimed to investigate the typical food safety practices in a Bangladeshi slum context and to explore if stunting among school-age children was associated with various components of food safety. Method: We analysed the MAL-ED birth cohort data from the Bangladesh site. A total of 265 healthy children were enrolled in the study; we could follow up and collect food safety-related data from 187 participants. Results: The average age of the children was 6.5 years (standard deviation or SD 0.04) and 49% of them were female. About 26% of the children were stunted. In our bivariate analysis, caregivers’ handwashing practice after using the toilet, treatment of drinking water, presence of insects/pests in the cooking area, and child’s eating ready-made/street food more than three times per day were significantly associated with stunting. After adjusting for pertinent factors, treatment of drinking water (adjusted odds ratio or AOR = 2.50, 95% confidence interval or CI: 1.03, 6.05), and child’s eating ready-made/street food more than three times/day (AOR = 2.34, 95%CI: 1.06, 5.15) remained significantly associated with stunting. Conclusions: Diverse aspects of food safety practices have a substantial association with stunting among school-age children living in an unhygienic slum environment in Dhaka, Bangladesh.
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Influence of Environmental Pollution and Living Conditions on Parasite Transmission among Indigenous Ecuadorians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116901. [PMID: 35682484 PMCID: PMC9180715 DOI: 10.3390/ijerph19116901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to evaluate the influence of environmental pollution and the living conditions of indigenous Ecuadorians on the transmission of enteroparasites in an Andean agricultural area located at high altitude. Environmental pollution was recorded after observation in each community. The parasites were identified by microscopic sediment analysis using physiological saline solution from macerated arthropods, washed vegetables, and human stools, utilizing four coproparasitological techniques (direct examination, Kato–Katz, ether concentration, and Ziehl–Neelsen). The results show that the inadequate disposal of human and animal excreta that contaminate soil and water, incorrect food hygiene, inadequate sanitary infrastructure in houses, a lack of animal veterinary care, and rodent proliferation are important reservoirs of zoonotic parasites. The use of excrement as fertilizer increases the number of flies, which act as mechanical vectors, and vegetables grown in areas with disperse infective parasitic forms act as vehicles that are marketed at the local, regional, and international levels. These analyses verify contamination levels of 52.7% in mechanical vectors, 70.6% in vegetables, and 98.2% in human stools. The agricultural communities analyzed maintained poor hygienic–sanitary and environmental conditions, which had a significant influence on the transmission of enteroparasites that affect human health.
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Kibemo B, Mulugeta A, Hailu D, Gelaw B. The association of socio-demographic and environmental factors with stunting among under-five children in Hawassa City, Sidama National Regional State, Ethiopia. J Nutr Sci 2022; 11:e33. [PMID: 35620765 PMCID: PMC9108000 DOI: 10.1017/jns.2022.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
Undernutrition in children is a challenging problem in developing countries, including Ethiopia. Stunting is the most prevalent form of undernutrition. The majority of studies on childhood stunting and its associated factors focused on children, maternal and socioeconomic components. However, a few studies reported poor WaSH status and antibiotic exposure as environmental risk factors for child stunting, and the case of socio-demographic factors also lacks consistency. Concerning this, there is a lack of information in Ethiopia. Therefore, the present study assessed the association of socio-demographic, WaSH, and antibiotic exposure with stunting among under-five children. A cross-sectional study was conducted involving 340 mother-child pairs. Anthropometric data were collected using standard and calibrated height and weight scales. For factorial data, an interviewer-guided standard questionnaire was used. Logistic regression analyses were used to identify factors determining childhood stunting. In the present study, the prevalence of stunting, underweight and wasting was 14⋅7 % (95 % CI 10⋅9, 18⋅5), 4⋅4 % (95 % CI 2⋅4, 6⋅8) and 2⋅1 % (95 % CI 0⋅6, 3⋅5), respectively. Low dietary diversity, being born from a mother with an education level of secondary school, and belonging to a female-headed household were positively associated (P < 0⋅05) with stunting. The prevalence of overall undernutrition was lower (21⋅2 %) in the study area. Stunting was significantly associated with dietary diversity, maternal educational level and sex of households head. The government policy should focus on enhancing the dietary diversity of households, and encouraging women's education.
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Affiliation(s)
- Berhanu Kibemo
- School of Nutrition, Food Science and Technology, College of Agriculture, University of Hawassa, Hawassa, Ethiopia
| | - Afework Mulugeta
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Dejene Hailu
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Baye Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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15
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Zhao H, Jatana S, Bartoszko J, Loeb M. Nonpharmaceutical interventions to prevent viral respiratory infection in community settings: an umbrella review. ERJ Open Res 2022; 8:00650-2021. [PMID: 35651370 PMCID: PMC9149389 DOI: 10.1183/23120541.00650-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Background Respiratory viruses pose an important public health threat to most communities. Nonpharmaceutical interventions (NPIs) such as masks, hand hygiene or physical distancing, among others, are believed to play an important role in reducing transmission of respiratory viruses. In this umbrella review, we summarise the evidence of the effectiveness of NPIs for the prevention of respiratory virus transmission in the community setting. Observations A systematic search of PubMed, Embase, Medline and Cochrane reviews resulted in a total of 24 studies consisting of 11 systematic reviews and meta-analyses, 12 systematic reviews without meta-analyses and one standalone meta-analysis. The current evidence from these data suggests that hand hygiene is protective against respiratory viral infection. The use of hand hygiene and facemasks, facemasks alone and physical distancing were interventions with inconsistent evidence. Interventions such as school closures, oral hygiene or nasal saline rinses were shown to be effective in reducing the risk of influenza; however, the evidence is sparse and mostly of low and critically low quality. Conclusions Studies on the effectiveness of NPIs for the prevention of respiratory viral transmission in the community vary in study design, quality and reported effectiveness. Evidence for the use of hand hygiene or facemasks is the strongest; therefore, the most reasonable suggestion is to use hand hygiene and facemasks in the community setting.
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Affiliation(s)
- Hedi Zhao
- McGill University, Faculty of Medicine, Montreal, QC, Canada
- These authors contributed equally
| | - Sukhdeep Jatana
- McGill University, Faculty of Medicine, Montreal, QC, Canada
- These authors contributed equally
| | - Jessica Bartoszko
- Dept of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Mark Loeb
- Dept of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Patlán‐Hernández AR, Stobaugh HC, Cumming O, Angioletti A, Pantchova D, Lapègue J, Stern S, N'Diaye DS. Water, sanitation and hygiene interventions and the prevention and treatment of childhood acute malnutrition: A systematic review. MATERNAL & CHILD NUTRITION 2022; 18:e13257. [PMID: 34612592 PMCID: PMC8710129 DOI: 10.1111/mcn.13257] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/02/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
Undernutrition is more prevalent among children living in unsanitary environments with inadequate water, sanitation and hygiene (WASH). Despite good evidence for the effect of WASH on multiple infectious diseases, evidence for the effect of WASH interventions on childhood undernutrition is less well established, particularly for acute malnutrition. To assess the effectiveness of WASH interventions in preventing and treating acute childhood malnutrition, we performed electronic searches to identify relevant studies published between 1 January 2000 and 13 May 2019. We included studies assessing the effect of WASH on prevention and treatment of acute malnutrition in children under 5 years of age. Data were extracted by two independent reviewers. We included 26 articles of 599 identified references with a total of 43,083 participants. Twenty-five studies reported on the effect of WASH on prevention, and two studies reported its effect on treatment of acute malnutrition. Current evidence does not show consistent associations of WASH conditions and interventions with prevention of acute malnutrition or with the improvement of its treatment outcomes. Only two high-quality randomized controlled trials (RCTs) demonstrated that improved water quality during severe acute malnutrition treatment improved recovery outcomes but did not prevent relapse. Many of the interventions consisted of a package of WASH services, making impossible to attribute the effect to one specific component. This highlights the need for high-quality, rigorous intervention studies assessing the effects of WASH interventions specifically designed to prevent acute malnutrition or improve its treatment.
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Affiliation(s)
| | - Heather C. Stobaugh
- Action Against HungerNew YorkNew YorkUSA
- Tufts UniversityBostonMassachusettsUSA
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Danka Pantchova
- Action Contre la FaimParisFrance
- Global Nutrition ClusterUnited Nations Children's FundNew YorkNew YorkUSA
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Hamlet LC, Chakrabarti S, Kaminsky J. Reduced water collection time improves learning achievement among primary school children in India. WATER RESEARCH 2021; 203:117527. [PMID: 34399248 DOI: 10.1016/j.watres.2021.117527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 06/13/2023]
Abstract
In low-and-middle-income countries, the provisioning of safe drinking water is a challenge that will likely worsen with climate change. Securing water will require more work and time, burdening women and children the most. Currently, the consequences of this time burden to children's development remain understudied. To address this gap, we examine the tradeoff between children's household water collection responsibilities and learning achievement. Using nationally representative data from India, we measure the effect of daily fetching time on primary school children's learning achievement in a two-stage regression model, with rainfall as the instrument. Our analyses indicate that higher fetching times predict lower mathematics (-1.23 standard deviations, 95CI[-2.32, -0.14]), reading (-1.13 standard deviations, 95CI[-2.07, -0.19]), and writing (-1.21 standard deviations, 95CI[-1.89, -0.51]) test scores. These effects are heterogeneous across sex and infrastructure type. For example, we find girls' mathematical and reading skills profit more from reductions in fetching time than boys' (score less affected for boys by β amount: mathematics: β=0.26 points, 95CI[0.095, 0.42]; reading: β=0.27 points, 95CI[0.054, 0.49]). Children using hand pumps, open wells, or tube wells are hurt more academically in mathematics and writing by increases in fetching time than children with mostly off-premises piped access (e.g., writing scores more affected by β amount: hand pump: β=-0.18, 95CI[-0.29, -0.081]; open well: β=-0.18, 95CI[-0.33, -0.040]; tube well: β=-0.14, 95CI[-0.29, -0.00072]). Given these results, we recommend off-premises piped infrastructure in the absence of piped-to-premises water in water-insecure contexts and offer guidance for targeting infrastructure investments in India.
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Affiliation(s)
- Leigh C Hamlet
- Department of Civil & Environmental Engineering, University of Washington College of Engineering, 201 More Hall Box 252700, Seattle, WA, United States 98195.
| | - Suman Chakrabarti
- Department of Global Health, University of Washington Schools of Public Health and Medicine, Hans Rosling Center Box 351620, Seattle, WA, United States, 98195
| | - Jessica Kaminsky
- Department of Civil & Environmental Engineering, University of Washington College of Engineering, 201 More Hall Box 252700, Seattle, WA, United States 98195
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Ademas A, Adane M, Keleb A, Berihun G, Tesfaw G. Water, sanitation, and hygiene as a priority intervention for stunting in under-five children in northwest Ethiopia: a community-based cross-sectional study. Ital J Pediatr 2021; 47:174. [PMID: 34429146 PMCID: PMC8385795 DOI: 10.1186/s13052-021-01128-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Stunting was a significant public health problem for under-five in developing countries including Ethiopia. Globally, it was estimated 21.9% or 149 million (81.7 million in Asia and 58.8 million in Africa) under-five children stunted in 2018. In East Africa, 24 million are stunted which is the highest-burden from African regions. Hence, this study aimed to assess the prevalence of stunting and its association with Water Sanitation and Hygiene (WASH) in northwestern Ethiopia. Method A community-based cross-sectional study design was conducted among 630 participants from December to mid-January 2019. From five kebeles, two were selected by a simple random sampling technique for the study. To reach study participants a systematic sampling technique was used. Data were collected by using an observational checklist, pretested questionnaire, and anthropometric measurement. Anthropometric indicator, height-for-age was determined using the current World Health Organization (WHO) growth standards. Multivariable logistic regression analysis was computed to analyze the data. From the multivariable analysis the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) and P-value < 0.05 were used to declare statistical significance. Result The prevalence of stunting among under-five children was 35.6% (95%CI; 31.9–39.5%). The result from this study showed that having illiterate father and mother, give birth before marriage (single), large family size, short maternal height, unimproved drinking water source, unimproved sanitation, poor hygienic practice, having diarrhea in the previous 2 weeks before the data collection, method of child feeding, age at which complementary feeding started, frequency of feeding, not deworming and mothers who had antenatal care visit of fewer than three times were statistically associated with stunting. Conclusion In this study, stunting was an important public health problem among under-five children. It remains the same as the national average prevalence of Ethiopia. To alleviate this problem proper family planning utilization, good dietary intake, maternal and paternal education, and WASH interventions are critical.
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Affiliation(s)
- Ayechew Ademas
- Department of Environmental Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Awoke Keleb
- Department of Environmental Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Gete Berihun
- Department of Environmental Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Getu Tesfaw
- Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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von Salmuth V, Brennan E, Kerac M, McGrath M, Frison S, Lelijveld N. Maternal-focused interventions to improve infant growth and nutritional status in low-middle income countries: A systematic review of reviews. PLoS One 2021; 16:e0256188. [PMID: 34407128 PMCID: PMC8372927 DOI: 10.1371/journal.pone.0256188] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/01/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Small and nutritionally at-risk infants under 6 months (<6m) are a vulnerable group at increased risk of mortality, morbidity, poor growth and sub-optimal development. Current national and international (World Health Organization) management guidelines focus mainly on infants' needs, yet growing evidence suggests that maternal factors also influence infant outcomes. We aimed to inform future guidelines by exploring the impacts of maternal-focused interventions on infant feeding and growth. METHODS We conducted a systematic review of reviews published since 2008 (PROSPERO, register number CRD 42019141724). We explored five databases and a wide variety of maternal-focused interventions based in low- and middle-income countries. Infant outcomes of interest included anthropometric status, birthweight, infant mortality, breastfeeding and complementary feeding practices. Given heterogenous interventions, we present a narrative synthesis of the extracted data. RESULTS We included a total of 55 systematic reviews. Numerous maternal interventions were effective in improving infant growth or feeding outcomes. These included breastfeeding promotion, education, support and counselling interventions. Maternal mental health, while under-researched, showed potential to positively impact infant growth. There was also some evidence for a positive impact of: women's empowerment, m-health technologies, conditional cash transfers, water, sanitation and hygiene and agricultural interventions. Effectiveness was increased when implemented as part of a multi-sectoral program. Antenatal supplementation with macronutrient, multiple micronutrients, Vitamin D, zinc, iron folic acid and possibly calcium, iodine and B12 in deficient women, improved birth outcomes. In contrast, evidence for postnatal supplementation was limited as was evidence directly focusing on small and nutritionally at-risk infants; most reviews focused on the prevention of growth faltering. CONCLUSION Our findings suggest sufficient evidence to justify greater inclusion of mothers in more holistic packages of care for small and nutritionally at-risk infants aged <6m. Context specific approaches are likely needed to support mother-infant dyads and ensure infants survive and thrive.
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Affiliation(s)
- Victoria von Salmuth
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eilise Brennan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Emergency Nutrition Network, Kidlington, Oxford, United Kingdom
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marie McGrath
- Emergency Nutrition Network, Kidlington, Oxford, United Kingdom
| | - Severine Frison
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Effect of Sanitation Interventions on Health Outcomes: A Systematic Review of Cluster-Randomized Controlled Trials in Rural Communities of Low- and Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168313. [PMID: 34444063 PMCID: PMC8392128 DOI: 10.3390/ijerph18168313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022]
Abstract
A systematic review of published literature (2000–2019) evaluating the impact of sanitation interventions on the prevalence of disease, parasite infestation, and/or child growth using randomized controlled trials (RCTs) was done according to the PRISMA checklist. Earlier reviews indicated mixed evidence citing relatively poor quality evidence from mixed designs. Public health policy and practice appear to rely on evidence from RCTs. Records were searched in six electronic databases. The methodological quality of RCTs was assessed using the Cochrane collaboration risk of bias tool. Fifteen records (2.0%) were included for review. Impact trials were done in rural communities of African and Asian countries. The significant effect of sanitation-focus interventions was found in one trial for the prevalence of childhood diarrhea (14.3%), three trials for parasite infestation (37.5%), and two trials (25.0%) for child growth. Results indicate mixed quality evidence from RCT designs. Evidence is limited and suggestive of the impact of sanitation on parasite infestation and child growth. Further rigorous sanitation intervention trials under varying settings are needed to show what really works and under what settings. Future work may explore sanitation behavior change strategies and latrine options to address the challenges of poor latrine use under high sanitation coverage.
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Wright CM, Macpherson J, Bland R, Ashorn P, Zaman S, Ho FK. Wasting and Stunting in Infants and Young Children as Risk Factors for Subsequent Stunting or Mortality: Longitudinal Analysis of Data from Malawi, South Africa, and Pakistan. J Nutr 2021; 151:2022-2028. [PMID: 33830247 PMCID: PMC8245889 DOI: 10.1093/jn/nxab054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have had sufficient longitudinal data to track how different malnourished states relate to mortality at different ages and interrelate over time. OBJECTIVES This study aims to describe the RRs and proportions of mortality associated with wasting and stunting and the pathways into and out of these nutritional states. METHODS Longitudinal growth data sets collected for children ages 0-24 months from Malawi, South Africa, and Pakistan were combined (n = 5088). Children were classified as deceased, wasted (weight for height < -2 SD; 1-4%), stunted (length < -2SD; 20-47%), or wasted and stunted (WaSt; 2-5%) at ages 3, 6, 9, 12, 18, and 24 months. Mixed-effects Cox models were used to study the association between nutritional status and mortality. RESULTS By age 3 months, 20% of children were already stunted, rising to 49% by 24 months, while wasting (4.2% and 2.2% at 3 months, respectively) and WaSt (0.9% and 3.7% at 24 months, respectively) were less common. The HR for mortality in WaSt was 9.5 (95% CI, 5.9-15), but 60% of WaSt-associated mortality occurred at 3-6 months. Wasting or WaSt was associated with 10-23% of deaths beyond 6 months, but in the second year over half of deaths occurred in stunted, nonwasted children. Stunting persisted in 82% of children and wasting persisted in 44%. Wasted children were more likely than nonwasted, nonstunted children to become stunted (RR, 1.93; 95% CI, 1.7-2.2), but 94% of children who progressed to stunting had not been wasted in the prior period. CONCLUSIONS WaSt greatly increased the risk of death, particularly in very young infants, but more deaths overall were associated with stunting. Most stunting appeared to be either intrauterine in origin or arose in children without prior wasting. Either stunting and wasting represent alternative responses to restricted nutrition, or stunting also has other, nonnutritional causes.
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Affiliation(s)
- Charlotte M Wright
- Department of Child Health, School of Medicine, Nursing and Dentistry, University of Glasgow, Glasgow, United Kingdom
| | - John Macpherson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ruth Bland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- School of Public Health, University of Witwatersrand, Witwatersrand, South Africa
| | - Per Ashorn
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Shakila Zaman
- Department of Public Health, University of Health Sciences, Lahore, Pakistan
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Sema B, Azage M, Tirfie M. Childhood stunting and associated factors among irrigation and non-irrigation user northwest, Ethiopia: a comparative cross-sectional study. Ital J Pediatr 2021; 47:102. [PMID: 33902661 PMCID: PMC8074471 DOI: 10.1186/s13052-021-01048-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/09/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Stunting is a critical public health problem of developing countries like Ethiopia. Different interventions like irrigation activity have been carried out by the government of Ethiopia to improve the nutritional status of the community. However, there is scanty of data on childhood stunting and its associated factors between irrigation user and non-irrigation user. OBJECTIVE To assess the magnitude of childhood stunting and its associated factors between irrigation and non-irrigation user in North Mecha District, Northwest Ethiopia. METHODS A community-based comparative cross-sectional study design was employed from October to November 2019. A systematic sampling was used to draw mothers with children age 6-59 months (582 irrigated and 582 non- irrigated household users). Data were collected using questionnaire and anthropometric measurement tools. Multivariable logistic regression was used to identify the predictors of stunting. Adjusted odds ratios with 95% CI were used to determine the degree of association between independent and outcome variable. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable. RESULTS The prevalence of childhood stunting (6-59 months) among irrigation users [32.8% at 95%CI [29.1%-36.7%]] was slightly lower than non-users [40.2% at 95%CI [[36.3%-44.2%]]]. However, the difference did not show significant variation. The odds of childhood stunting were higher among a child from a mother had no antenatal visit, a child whose age was between 12 and 47 months, a child from a mother who did not use water and soap always for washing hands, and a child who had fever. CONCLUSION The prevalence of childhood stunting was high and did not show significant variation between irrigation and non-irrigation users. A child from mother had no antenatal visit, whose age was between 12 and 47 months, a mother who did not use water and soap always for washing hands, and who had fever were factors associated with higher child stunting. Thus, the identified modifiable factors should be strengthened to reduce stunting.
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Affiliation(s)
- Balew Sema
- Bahir Dar University Student Clinic, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
| | - Muluken Azage
- Department of Environmental Health, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
| | - Mulat Tirfie
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
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Yuen E, Fried J, Salvador C, Gudis DA, Schlosser RJ, Nguyen SA, Brennan EA, Rowan NR. Nonpharmacological interventions to reduce respiratory viral transmission: an evidence-based review with recommendations. Rhinology 2021; 59:114-132. [PMID: 33760909 DOI: 10.4193/rhin20.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Viral respiratory infections are a leading cause of worldwide mortality and exert the potential to cause global socioeconomic crises. However, inexpensive, efficacious, and rapidly deployable strategies to reduce viral transmission are increasingly important in the setting of an ongoing pandemic, though not entirely understood. This article provides a comprehensive review of commonly employed nonpharmacological interventions to interrupt viral spread and provides evidence-based recommendations for their use. METHODOLOGY A systematic review of three databases was performed. Studies with defined endpoints of subjects receiving one of five interventions (nasal washing, gargling, personal protective equipment (PPE), social distancing, and hand hygiene) were included. An evidence-based review of the highest level of evidence, with recommendations, was created in accordance with a previously described, rigorous, iterative process. RESULTS Fifty-four primary studies were included. The most commonly studied intervention was hand hygiene, followed by PPE, gargling, saline nasal washing, and social distancing. CONCLUSIONS Mask use and hand hygiene are strong recommendations for prevention of viral transmission. Donning gloves, gowns, and eye protection are a recommendation in healthcare settings. Saline nasal washing and gargling are options in selected populations. Although an aggregate level of evidence is not provided, the authors recommend social distancing.
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Affiliation(s)
- E Yuen
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - J Fried
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - C Salvador
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - D A Gudis
- Columbia University Irving Medical Centre, Department of Otolaryngology-Head and Neck Surgery, New York, NY, USA
| | - R J Schlosser
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - S A Nguyen
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - E A Brennan
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA
| | - N R Rowan
- The Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, USA
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Ahamad MG, Tanin F. Mental model-based repeated multifaceted (MRM) intervention design: a conceptual framework for improving preventive health behaviors and outcomes. BMC Res Notes 2021; 14:103. [PMID: 33741049 PMCID: PMC7977269 DOI: 10.1186/s13104-021-05516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Field interventions employed to improve preventive health behaviors and outcomes generally use well-established approaches; however, recent studies have reported that health education and promotional interventions have little to no impact on health behaviors, especially in low- and middle-income countries. We aimed to develop a conceptual framework to improve intervention designs that would internalize these concerns and limitations. Results We identified three major experimental design- and implementation-related concerns associated with mental models, including the balance between the treatment and control groups, the treatment group’s willingness to adopt suggested behaviors, and the type, length, frequency, intensity, and sequence of treatments. To minimize the influence of these aspects of an experimental design, we proposed a mental model-based repeated multifaceted (MRM) intervention design framework, which represents a supportive intervention design for the improvement of health education and promotional programs. The framework offers a step-by-step method that can be used for experimental and treatment design and outcome analysis, and that addresses potential implementation challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05516-9.
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Affiliation(s)
- Mazbahul G Ahamad
- University of Nebraska-Lincoln, 140 Keim Hall, 1825 N 38th St, Lincoln, NE, 68583, USA.
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Kayser GL, Chokhandre P, Rao N, Singh A, McDougal L, Raj A. Household sanitation access and risk for non-marital sexual violence among a nationally representative sample of women in India, 2015-16. SSM Popul Health 2021; 13:100738. [PMID: 33665330 PMCID: PMC7903128 DOI: 10.1016/j.ssmph.2021.100738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/07/2020] [Accepted: 01/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of household sanitation, specifically toilet facilities, can adversely affect the safety of women and girls by requiring them to leave their households to defecate alone and at night, leaving them more vulnerable to non-marital sexual violence. This study analyzes the association between household sanitation access and past year victimization from non-marital sexual violence (NMSV) in India. METHODS We analyzed 74,698 women age 15-49 from whom information on NMSV was collected in India's National Family Health Survey 2015-16 (NFHS-4). We used multivariable logistic regression to test the relationship between women's household sanitation access and recent NMSV experience, controlling for socioeconomics (SES;e.g., age, marital status, caste, wealth, employment), for the total sample and stratified by rural/urban, given lower access to sanitation and lower NMSV in rural contexts. RESULTS We found that 46.2% of households in our sample lacked their own private sanitation facilities (58.0% rural; 24.5% urban) and were forced to openly defecate (37.3%) or walk to a shared sanitation facility (8.9%), and 0.45% of women report NMSV in the last 12 months (0.33% rural; 0.68% urban). Our multivariable model indicated no significant association between having private household sanitation facilities and NMSV for the total sample, but stratified analyses indicate a significant association for rural but not urban women. In rural India, those who lack private household sanitation, compared to those with a household toilet, have significantly greater odds of NMSV (AOR = 2.45; p < 0.05). These findings persist after accounting for demographics including age and marital status, socio-economic factors related to marginalization (e.g., caste, wealth), women's employment, and the overall climate of the state. CONCLUSION Findings from this study support prior research suggesting that poor access to sanitation is associated with women's risk for NMSV in rural India. This may be via increased exposure, and/or as a marker for greater vulnerability to NMSV beyond what is explained by other SES indicators. Solutions can include increased access to private household sanitation and more targeted NMSV prevention in rural India.
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Affiliation(s)
- Georgia Lyn Kayser
- Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego (UCSD), La Jolla, CA, USA
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, UCSD, La Jolla, CA, USA
| | - Praveen Chokhandre
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India
| | - Namratha Rao
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, UCSD, La Jolla, CA, USA
| | - Abhishek Singh
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India
- GENDER Project, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India
| | - Lotus McDougal
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, UCSD, La Jolla, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Department of Medicine, School of Medicine, UCSD, La Jolla, CA, USA
- Department of Education Studies, Division of Social Science, UCSD, La Jolla, CA, USA
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Molecular Epidemiology of Human Cryptosporidiosis in Low- and Middle-Income Countries. Clin Microbiol Rev 2021; 34:34/2/e00087-19. [PMID: 33627442 DOI: 10.1128/cmr.00087-19] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Cryptosporidiosis is one of the most important causes of moderate to severe diarrhea and diarrhea-related mortality in children under 2 years of age in low- and middle-income countries. In recent decades, genotyping and subtyping tools have been used in epidemiological studies of human cryptosporidiosis. Results of these studies suggest that higher genetic diversity of Cryptosporidium spp. is present in humans in these countries at both species and subtype levels and that anthroponotic transmission plays a major role in human cryptosporidiosis. Cryptosporidium hominis is the most common Cryptosporidium species in humans in almost all the low- and middle-income countries examined, with five subtype families (namely, Ia, Ib, Id, Ie, and If) being commonly found in most regions. In addition, most Cryptosporidium parvum infections in these areas are caused by the anthroponotic IIc subtype family rather than the zoonotic IIa subtype family. There is geographic segregation in Cryptosporidium hominis subtypes, as revealed by multilocus subtyping. Concurrent and sequential infections with different Cryptosporidium species and subtypes are common, as immunity against reinfection and cross protection against different Cryptosporidium species are partial. Differences in clinical presentations have been observed among Cryptosporidium species and C. hominis subtypes. These observations suggest that WASH (water, sanitation, and hygiene)-based interventions should be implemented to prevent and control human cryptosporidiosis in low- and middle-income countries.
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Mutono N, Wright J, Mutembei H, Muema J, Thomas M, Mutunga M, Thumbi SM. The nexus between improved water supply and water-borne diseases in urban areas in Africa: a scoping review protocol. AAS Open Res 2020; 3:12. [PMID: 33629030 PMCID: PMC7883317 DOI: 10.12688/aasopenres.13063.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 01/24/2023] Open
Abstract
Introduction: Currently, an estimated two thirds of the world population is water insufficient. As of 2015, one out of every five people in developing countries do not have access to clean sufficient drinking water. In an attempt to share the limited resource, water has been distributed at irregular intervals in cities in developing countries. Residents in these cities seek alternative water sources to supplement the inadequate water supplied. Some of these alternative sources of water are unsafe for human consumption, leading to an increased risk in water-borne diseases. Africa contributes to 53% of the diarrheal cases reported globally, with contaminated drinking water being the main source of transmission. Water-borne diseases like diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus are a major public health concern. The main objective of this scoping review is to map the available evidence to understand the sources of water among residents in cities in Africa and the relationship between clean water sufficiency and water-borne diseases in urban Africa. Methods and analysis: The search strategy will identify studies published in scientific journals and reports that are directly relevant to African cities that have a population of more than half a million residents as of 2014 AND studies on the ten emerging water-borne diseases, which are diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus. Ethics and dissemination: This scoping review did not require any formal ethical approval. The findings will be published in a peer-reviewed journal.
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Affiliation(s)
- Nyamai Mutono
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya.,Washington State University Global Health - Kenya, Nairobi, Kenya
| | - James Wright
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Henry Mutembei
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya.,Department of Clinical Studies, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Josphat Muema
- Washington State University Global Health - Kenya, Nairobi, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Mair Thomas
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Mumbua Mutunga
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Samuel Mwangi Thumbi
- Wangari Maathai Institute for Peace and Environmental Studies, University of Nairobi, Nairobi, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.,Paul G Allen School for Global Animal Health, Washington State University, Pullman, USA.,Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK
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González-Fernández D, Mazzini Salom AS, Herrera Bendezu F, Huamán S, Rojas Hernández B, Pevec I, Galarza Izquierdo EM, Armstrong N, Thomas V, Vela Gonzáles S, Gonzáles Saravia C, Scott ME, Koski KG. A Multi-Sectoral Approach Improves Early Child Development in a Disadvantaged Community in Peru: Role of Community Gardens, Nutrition Workshops and Enhanced Caregiver-Child Interaction: Project "Wawa Illari". Front Public Health 2020; 8:567900. [PMID: 33240834 PMCID: PMC7681241 DOI: 10.3389/fpubh.2020.567900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Multi-dimensional monitoring evaluation and learning strategies are needed to address the complex set of factors that affect early child development in marginalized populations, but few studies have explored their effectiveness. Objective: To compare improvement of health and development of children 0–3 years between intervention communities (IC) and control communities (CC) from peripheral settlements of Lima. Sequential interventions included: (1) home and community gardens, (2) conscious nutrition, and (3) parenting workshops following the International Child Development Program (ICDP). Methods: Interventions were delivered by community health promoters (CHPs) using a “step-by-step” learning system. Both IC and CC were monitored before the interventions began, at 8 and 12 months (n = 113 IC and 127 CC children). Data were collected on household characteristics, diet, food security, health indicators (history of diarrhea and respiratory infections, hemoglobin, intestinal parasites, anthropometry), caregiver-child interactions and stress, and achievement of Pan-American Health Organization age-specific developmental milestones. Stepwise multiple logistic regressions were used to determine if the interventions affected food insecurity, as well as motor, social/cognitive and language delays. Results: At baseline, 2.6% were categorized as “suspected developmental delay” and 14.2% were on “alert for development delay.” Food insecurity, diarrhea and respiratory infections were lowered following the interventions. Through the “step-by-step” approach, caregivers in IC gained skills in gardening, conscious nutrition and parenting that reduced the risk of food insecurity [Adjusted Risk Ratio = 0.20 (95% CI: 0.08–0.51)] and language delay [0.39 (0.19–0.82)] but not motor or social/cognitive delay. Use of a multiple micronutrient supplement decreased the risk of motor delay [0.12 (0.03–0.56)], but more pets were associated with higher risk of motor [3.24 (1.47–7.14)] and social/cognitive delay [2.72 (1.33–5.55)], and of food insecurity [1.73 (1.13–2.66)]. Conclusion: The combined interventions delivered by CHPs helped to mitigate the impact of adversity on food insecurity and language delay. Additional improvements may have been detected if the interventions had continued for a longer time. Our results indicate that control of infections and pets may be needed to achieve measurable results for motor and social/cognitive development. Continuous monitoring facilitated adjusting implementation strategies and achieving positive developmental outcomes.
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Affiliation(s)
| | | | | | - Sonia Huamán
- Pachacámac Health Center, Ministry of Health, Lima, Peru
| | - Bertha Rojas Hernández
- Laboratory School, Faculty of Medical Technology, Federico Villarreal National University, Lima, Peru
| | - Illène Pevec
- Community Engagement, Design and Research Center (CEDaR), University of Colorado, Boulder, CO, United States
| | | | | | - Virginia Thomas
- Susila Dharma International Association, Greenfield Park, QC, Canada
| | | | - Carlos Gonzáles Saravia
- Dermatology Service, Department of Medicine, National Institute for Children's Health (INSN), Lima, Peru
| | - Marilyn E Scott
- Institute of Parasitology, McGill University, Sainte Anne de Bellevue, QC, Canada
| | - Kristine G Koski
- School of Human Nutrition, McGill University, Sainte Anne de Bellevue, QC, Canada
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Bekele T, Rawstorne P, Rahman B. Effect of water, sanitation and hygiene interventions alone and combined with nutrition on child growth in low and middle income countries: a systematic review and meta-analysis. BMJ Open 2020; 10:e034812. [PMID: 32660947 PMCID: PMC7359184 DOI: 10.1136/bmjopen-2019-034812] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/27/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to provide clarification on the benefits of water, sanitation and hygiene (WASH) alone separately and combined with nutrition in improving child growth outcomes. DESIGN Systematic review and meta-analysis. METHODS We conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed, MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science and Science Direct were searched in May 2018 and last updated in April 2019. We included studies that reported WASH interventions alone separately or combined with nutrition. Fixed and random-effects models were used to estimate pooled effect in mean difference (MD). Heterogeneity and publication bias statistics were performed. RESULTS A total of 18 studies were included: 13 cluster randomised controlled trials (RCTs) and 5 non-randomised controlled trials (non-RCTs). Non-RCTs showed effect of WASH interventions alone on height-for-age z-score (HAZ) (MD=0.14; 95% CI 0.08 to 0.21) but RCTs did not. WASH alone of non-RCTs and RCTs that were delivered over 18-60 months indicated an effect on HAZ (MD=0.04; 95% CI 0.01 to 0.08). RCTs showed an effect for children <2 years (MD=0.07; 95% CI 0.01 to 0.13). Non-RCTs of WASH alone and those that included at least two components, improved HAZ (MD=0.15; 95% CI 0.07 to 0.23) but RCTs did not. WASH alone of non-RCTs and RCTs separately or together showed no effect on weight-for-age z-score (WAZ) and weight-for-height z-score (WHZ). Combined WASH with nutrition showed an effect on HAZ (MD=0.13; 95% CI 0.08 to 0.17) and on WAZ (MD=0.09; 95% CI 0.05 to 0.13) and was borderline on WHZ. CONCLUSIONS WASH interventions alone improved HAZ when delivered over 18-60 months and for children <2 years. Combined WASH with nutrition showed a strong effect on HAZ and WAZ and a borderline effect on WHZ. Integrated WASH with nutrition interventions may be effective inimproving child growth outcomes.
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Affiliation(s)
- Tolesa Bekele
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia, Ethiopia
| | - Patrick Rawstorne
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Bayzidur Rahman
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Banerjee S, Sar AK, Pandey S. Improved yet Unsafe: An Aquatic Perspective of Indian Infant Mortality. JOURNAL OF HEALTH MANAGEMENT 2020. [DOI: 10.1177/0972063420908379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Infant mortality rate (IMR) is an important development indicator and a vital component of millennium development goals (MDGs) set by United Nations Development Programme (UNDP). According to UNDP, so far India has only fared moderately in reducing IMR (Goal 4 of MDGs). India (32) ranks 144th among 196 countries regarding IMR as per the 2017 data availed from World Development Indicators. Its adjacent countries such as Bhutan (25.6), Bangladesh (26.9) and Nepal (27.8) have fared much better regarding infant survival. Numbers within the parentheses indicate the IMR of the respective country. The United Nations Children’s Fund (UNICEF) has identified that IMR among families with better access to improved drinking water sources and toilet is much lower than those bereft of the same. This inference has been drawn from National Family Health Survey 3 data (NFHS III). The present study investigates into the aforementioned relation analysing NFHS IV data. The result depicts that contrary to UNICEF’s findings, IMR increases with better accessibility to improved water sources. Further to this, the article shows that an additional aqua-related practice together with improved drinking water sources might lead to the betterment of IMR for India.
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Affiliation(s)
| | - Ashok Kumar Sar
- Kalinga Institute of Industrial Technology, Bhubaneshwar, Odisha, India
| | - Shilpa Pandey
- Amity Business School, Amity University Chhattisgarh, India
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Ali A. Current Status of Malnutrition and Stunting in Pakistani Children: What Needs to Be Done? J Am Coll Nutr 2020; 40:180-192. [PMID: 32275484 DOI: 10.1080/07315724.2020.1750504] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Malnutrition is one of the greatest health challenges that affects about 2 billion people globally. Multiple factors including poverty, food insecurity, maternal health and nutritional status, mother's age at marriage and educational status, low birthweight or small for gestational age (SGA), premature births, suboptimal breastfeeding practices, unhealthy dietary and lifestyle patterns, health and immunization status of children, socioeconomic status of family, environmental and household conditions, together with cultural practices and myths, play vital role in affecting the growth of children at early age. Although child stunting has declined in Pakistan, the reduction rate is only 0.5%, which is very low. This may be due to ineffective or inappropriate intervention programs as they are mostly addressing only one issue at a time and don't use the multi-sector approach to address numerous determinants of stunting. It is therefore important to initiate cost-effective multi-tiered intervention approaches to be implemented at pre-conception, pregnancy and early postpartum stages to prevent the problems of malnutrition and stunting in Pakistani children. This review discusses the etiology of child malnutrition and stunting in Pakistan, role of various determinants of stunting and what type of intervention strategies and approaches should be developed and implemented to deal with these problems. Key teaching pointsMalnutrition is one of the greatest global health challenges.Poverty, food insecurity, socioeconomic status, unhealthy dietary patterns, maternal health and nutritional status, low birthweight, suboptimal breast feeding, environmental conditions, cultural practices and myths, are the main factors for child malnutrition and stunting in Pakistan.The slow reduction rate in child stunting may be due to inappropriate intervention programs.Cost-effective multi-tiered intervention approaches must be implemented at pre-conception, pregnancy and early postpartum stages to prevent child malnutrition and stunting in Pakistan.A holistic approach comprising nutrition and WASH interventions, together with strategies to improve the socioeconomic status be developed and implemented to resolve this dilemma.
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Affiliation(s)
- Amanat Ali
- School of Engineering, University of Guelph, Guelph, Ontario, Canada
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Gizaw Z, Worku A. Effects of single and combined water, sanitation and hygiene (WASH) interventions on nutritional status of children: a systematic review and meta-analysis. Ital J Pediatr 2019; 45:77. [PMID: 31272479 PMCID: PMC6610930 DOI: 10.1186/s13052-019-0666-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022] Open
Abstract
Background Under nutrition is linked with poor water, sanitation and hygiene (WASH) condition. However, there is conflicting evidence on the effect of WASH on nutritional status of children. This review was, therefore, conducted to estimate the pooled effect of WASH interventions on child under nutrition. Methods All published and unpublished cluster-randomized, non-randomized controlled trials, and before and after intervention studies conducted in developing countries were included. Relevant articles were searched from MEDLINE/PubMed, Cochrane Collaboration’s database, Web of Science, WHO Global Health Library, Google Scholar, Worldcat and ProQuest electronic databases. The methodological quality of the included studies was assessed using JBI critical appraisal checklist for randomized and non-randomized controlled trials. The risk of bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. The treatment effect was expressed as standardized mean differences (SMD) with 95% confidence interval (CI). Results This meta-analysis of 10 studies including 16,473 children (7776 in the intervention and 8687 in the control group) indicated that WASH interventions significantly associated with increased pooled mean height-for-age-z-score (SMD = 0.14, 95% CI = (0.09, 0.19); I2 = 39.3%]. The effect of WASH on HAZ was heterogeneous in age and types of interventions. WASH intervention had more effect on HAZ among under two children [SMD = 0.20, 95% CI = (0.11, 0.29); I2 = 37%]. Children who received combined WASH interventions grew better compared with children who received single interventions [SMD = 0.15, 95% CI = (0.09, 0.20); I2 = 43.8%]. Conclusion WASH interventions were significantly associated with increased mean height-for-age-z score in under 5 years old children. The effect of WASH on linear growth is markedly different with age and types of interventions, either single or combined. Implementing combined WASH interventions has a paramount benefit to improve nutritional status of children. Electronic supplementary material The online version of this article (10.1186/s13052-019-0666-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Alemayehu Worku
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Editorial. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1278-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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