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Lansbury N, Memmott PC, Wyber R, Burgen C, Barnes SK, Daw J, Cannon J, Bowen AC, Burgess R, Frank PN, Redmond AM. Housing Initiatives to Address Strep A Infections and Reduce RHD Risks in Remote Indigenous Communities in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1262. [PMID: 39338145 PMCID: PMC11431237 DOI: 10.3390/ijerph21091262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024]
Abstract
Group A Streptococcus (Strep A) skin infections (impetigo) can contribute to the development of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). This is of particular concern for Indigenous residents of remote communities, where rates of ARF and RHD are much higher than their urban and non-Indigenous counterparts. There are three main potential Strep A transmission pathways: skin to skin, surface to skin, and transmission through the air (via droplets or aerosols). Despite a lack of scientific certainty, the physical environment may be modified to prevent Strep A transmission through environmental health initiatives in the home, identifying a strong role for housing. This research sought to provide an outline of identified household-level environmental health initiatives to reduce or interrupt Strep A transmission along each of these pathways. The identified initiatives addressed the ability to wash bodies and clothes, to increase social distancing through improving the livability of yard spaces, and to increase ventilation in the home. To assist with future pilots and evaluation, an interactive costing tool was developed against each of these initiatives. If introduced and evaluated to be effective, the environmental health initiatives are likely to also interrupt other hygiene-related infections.
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Affiliation(s)
- Nina Lansbury
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Paul C Memmott
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Rosemary Wyber
- Yardhura Walani, National Centre for Epidemiology and Public Health, Australian National University, Canberra, ACT 0200, Australia
- The Kids Research Institute, Perth, WA 6009, Australia
| | | | - Samuel K Barnes
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Jessica Daw
- The Kids Research Institute, Perth, WA 6009, Australia
| | | | - Asha C Bowen
- The Kids Research Institute, Perth, WA 6009, Australia
- Perth Children's Hospital, Perth, WA 6009, Australia
| | | | | | - Andrew M Redmond
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
- Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, QLD 4072, Australia
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Sirota SB, Doxey MC, Dominguez RMV, Bender RG, Vongpradith A, Albertson SB, Novotney A, Burkart K, Carter A, Abdi P, Abdoun M, Abebe AM, Abegaz KH, Aboagye RG, Abolhassani H, Abreu LG, Abualruz H, Abu-Gharbieh E, Aburuz S, Adane MM, Addo IY, Adekanmbi V, Adnani QES, Adzigbli LA, Afzal MS, Afzal S, Ahinkorah BO, Ahmad S, Ahmed A, Ahmed H, Ahmed SA, Akinosoglou K, Akkaif MA, Al Awaidy S, Alalalmeh SO, Albashtawy M, AlBataineh MT, Al-Gheethi AAS, Alhalaiqa FN, Alhassan RK, Ali A, Ali L, Ali MU, Ali SS, Ali W, Almazan JU, Alqahtani JS, Alrawashdeh A, Al-Rifai RH, Alshahrani NZ, Altartoor K, Al-Tawfiq JA, Alvis-Guzman N, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Al-Zyoud WA, Amhare AF, Amu H, Amusa GA, Anil A, Anvari S, Anyabolo EE, Arabloo J, Arafat M, Areda D, Aregawi BB, Aremu A, Athari SS, Aujayeb A, Aynalem ZB, Azadnajafabad S, Azzam AY, Badar M, Bahrami Taghanaki P, Bahramian S, Baig AA, Bajcetic M, Balakrishnan S, Banach M, Bardhan M, Barqawi HJ, Bastan MM, Batra K, Batra R, Behnoush AH, Beiranvand M, Belete AG, Belete MA, Beloukas A, Beran A, Bhardwaj P, Bhargava A, Bhat AN, Bhuiyan MA, Bitra VR, Bodunrin AO, Bogale EK, Boppana SH, Borhany H, Bouaoud S, Brown CS, Buonsenso D, Bustanji Y, Cámera LA, Castañeda-Orjuela CA, Cegolon L, Cenderadewi M, Chakraborty S, Chattu VK, Cheng ETW, Chichagi F, Ching PR, Chopra H, Choudhari SG, Christopher DJ, Chu DT, Chukwu IS, Chung E, Corlateanu A, Cruz-Martins N, Dadana S, Dadras O, Dahiru T, Dai X, Das JK, Dash NR, Dashti M, Dashtkoohi M, De la Hoz FP, Debopadhaya S, Demessa BH, Demis AB, Devanbu VGC, Devegowda D, Dhama K, Dhulipala VR, Diaz D, Diaz MJ, Do TC, Do THP, Dodangeh M, Dorostkar F, Dsouza AC, Dsouza HL, Duraisamy S, Durojaiye OC, Dziedzic AM, Ed-Dra A, Ekholuenetale M, Ekundayo TC, El Sayed I, El-Dahiyat F, Elhadi M, Elshaer M, Eslami M, Eze UA, Fagbamigbe AF, Faramarzi A, Fasina FO, Ferreira N, Fischer F, Fitriana I, Flor LS, Gaihre S, Gajdács M, Galehdar N, Ganiyani MA, Gebregergis MW, Gebrehiwot M, Gebremeskel TG, Getahun GK, Getie M, Ghadiri K, Ghasemzadeh A, Ghorbani M, Goldust M, Golechha M, Goleij P, Gorini G, Goyal A, Guan SY, Guarducci G, Gudeta MD, Gupta R, Gupta S, Gupta VB, Gupta VK, Hadei M, Hadi NR, Haj-Mirzaian A, Halwani R, Hamidi S, Hammoud A, Hanifi N, Hanna F, Haq ZA, Haque MR, Hasan SMM, Hasani H, Hasnain MS, Hassankhani H, Haubold J, Hayat K, Hegazi OE, Hezam K, Holla R, Hoogar P, Horita N, Hostiuc M, Huynh HH, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Isa MA, Islam MR, Islam SMS, Ismail NE, Iwagami M, J V, Jafarzadeh A, Jaggi K, Jairoun AA, Jakovljevic M, Jamshidi E, Jayaram S, Jeswani BM, Jha RP, Jose J, Joseph N, Joshua CE, Jozwiak JJ, K V, Kabir Z, Kandel H, Kanmodi KK, Kant S, Kantar RS, Karaye IM, Karimi Behnagh A, Kaur N, Khajuria H, Khalaji A, Khamesipour F, Khan G, Khan MN, Khan M, Khan MJ, Kim MS, Kimokoti RW, Kochhar S, Korshunov VA, Kosen S, Krishan K, Krishna H, Krishnamoorthy V, Kuate Defo B, Kuddus MA, Kuddus M, Kuitunen I, Kulimbet M, Kumar D, Kurmi OP, Kutikuppala LVS, Lahariya C, Lal DK, Lasrado S, Latifinaibin K, Le HH, Le NHH, Le TTT, Le TDT, Lee SW, Lee WC, Li MC, Li P, Lim SS, Liu G, Liu R, Liu W, Liu X, Liu X, Lorenzovici L, Luo L, Majeed A, Malakan Rad E, Malhotra K, Malik I, Manilal A, Mehta B, Mekene Meto T, Mekonnen MM, Meles HN, Memish ZA, Mendez-Lopez MA, Meo SA, Merati M, Mestrovic T, Mettananda S, Minh LHN, Mirrakhimov EM, Misra AK, Mohamed AI, Mohamed NS, Mohammed M, Mohammed M, Mokdad AH, Monasta L, Moni MA, Moodi Ghalibaf A, Moore CE, Morawska L, Motappa R, Mougin V, Mousavi P, Mustafa G, Naghavi P, Naik GR, Nainu F, Najafi MS, Najdaghi S, Najmuldeen HHR, Nargus S, Narimani Davani D, Naser M, Natto ZS, Nayak BP, Nejadghaderi SA, Nguyen DH, Nguyen HTH, Nguyen VT, Nikolouzakis TK, Noman EA, Nri-Ezedi CA, Nuñez-Samudio V, Nwatah VE, Odetokun IA, Okekunle AP, Okonji OC, Okwute PG, Olanipekun TO, Olufadewa II, Olusanya BO, Omer GL, Onyedibe KI, Ordak M, Orish VN, Ortiz-Prado E, Otstavnov N, Ouyahia A, P A MP, Padubidri JR, Pandey A, Pantazopoulos I, Pardhan S, Parija PP, Parikh RR, Park S, Parthasarathi A, Pasovic M, Pathan AR, Patil S, Pawar S, Peprah P, Perianayagam A, Perumal D, Petcu IR, Pham HN, Pham HT, Philip AK, Pigott DM, Piracha ZZ, Poddighe D, Polibin RV, Postma MJ, Pourbabaki R, Prates EJS, Puvvula J, Qazi AS, Qian G, Rafferty Q, Rahim F, Rahimi M, Rahimi-Movaghar V, Rahman MO, Rahman M, Rahman MA, Rahmanian M, Rahmanian N, Rahmanian V, Rahmati M, Rajput P, Ramadan MM, Ramasamy SK, Ramesh PS, Rao IR, Rao M, Rao SJ, Rashedi S, Rashidi MM, Rathish D, Ravikumar N, Rawaf S, Redwan EMM, Reyes LFF, Rezaei N, Rezaei N, Rezahosseini O, Rizvi SMD, Rodriguez JAB, Ronfani L, Roudashti S, Roy P, Ruela GDA, Saddik BA, Saeb MR, Saeed U, Saeedi P, Safari M, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahu M, Sakshaug JW, Salam N, Salami AA, Saleh MA, Sallam M, Samodra YL, Sanjeev RK, Santric-Milicevic MM, Saravanan A, Sartorius B, Sathyanarayan A, Saulam J, Saxena S, Saya GK, Schaarschmidt BM, Schumacher AE, Sedighi M, Sendekie AK, Senthilkumaran S, Sethi Y, SeyedAlinaghi S, Shafie M, Shahid S, Shaikh MA, Sham S, Shamshirgaran MA, Shanawaz M, Shannawaz M, Sharifan A, Sharifi-Rad J, Shastry RP, Sheikh A, Shigematsu M, Shiri R, Shittu A, Shiue I, Shorofi SA, Siddig EE, Simpson CR, Singh JA, Singh P, Singh S, Sinto R, Solanki R, Soliman SSM, Suleman M, Suliankatchi Abdulkader R, Swain CK, Szarpak L, Tabatabaei SM, Tabish M, Taha ZMA, Taiba J, Talaat IM, Tamuzi JL, Taye BT, Tefera YM, Temsah MH, Terefa DR, Thakur R, Thapar R, Thirunavukkarasu S, Tichopad A, Ticoalu JHV, Tovani-Palone MR, Tran NM, Tran NH, Tran Minh Duc N, Tsegay GM, Tumurkhuu M, Udoakang AJ, Upadhyay E, Vahabi SM, Vaithinathan AG, Valizadeh R, Vasankari TJ, Vinayak M, Waqas M, Weldetinsaa HL, Wickramasinghe ND, Yadollahpour A, Yaghoubi S, Yezli S, Yin D, Yon DK, Yonemoto N, Yu Y, Zakham F, Zandieh GGZ, Zare I, Zarimeidani F, Zastrozhin M, Zhai C, Zhang H, Zhang ZJ, Zhao Y, Zhou J, Zia H, Zielińska M, Zoladl M, Zyoud SH, Aravkin AY, Kassebaum NJ, Naghavi M, Vos T, Hay SI, Murray CJL, Kyu HH. Global, regional, and national burden of upper respiratory infections and otitis media, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00430-4. [PMID: 39265593 DOI: 10.1016/s1473-3099(24)00430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Upper respiratory infections (URIs) are the leading cause of acute disease incidence worldwide and contribute to a substantial health-care burden. Although acute otitis media is a common complication of URIs, the combined global burden of URIs and otitis media has not been studied comprehensively. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to explore the fatal and non-fatal burden of the two diseases across all age groups, including a granular analysis of children younger than 5 years, in 204 countries and territories from 1990 to 2021. METHODS Mortality due to URIs and otitis media was estimated with use of vital registration and sample-based vital registration data, which are used as inputs to the Cause of Death Ensemble model to separately model URIs and otitis media mortality by age and sex. Morbidity was modelled with a Bayesian meta-regression tool using data from published studies identified via systematic reviews, population-based survey data, and cause-specific URI and otitis media mortality estimates. Additionally, we assessed and compared the burden of otitis media as it relates to URIs and examined the collective burden and contributing risk factors of both diseases. FINDINGS The global number of new episodes of URIs was 12·8 billion (95% uncertainty interval 11·4 to 14·5) for all ages across males and females in 2021. The global all-age incidence rate of URIs decreased by 10·1% (-12·0 to -8·1) from 1990 to 2019. From 2019 to 2021, the global all-age incidence rate fell by 0·5% (-0·8 to -0·1). Globally, the incidence rate of URIs was 162 484·8 per 100 000 population (144 834·0 to 183 289·4) in 2021, a decrease of 10·5% (-12·4 to -8·4) from 1990, when the incidence rate was 181 552·5 per 100 000 population (160 827·4 to 206 214·7). The highest incidence rates of URIs were seen in children younger than 2 years in 2021, and the largest number of episodes was in children aged 5-9 years. The number of new episodes of otitis media globally for all ages was 391 million (292 to 525) in 2021. The global incidence rate of otitis media was 4958·9 per 100 000 (3705·4 to 6658·6) in 2021, a decrease of 16·3% (-18·1 to -14·0) from 1990, when the incidence rate was 5925·5 per 100 000 (4371·8 to 8097·9). The incidence rate of otitis media in 2021 was highest in children younger than 2 years, and the largest number of episodes was in children aged 2-4 years. The mortality rate of URIs in 2021 was 0·2 per 100 000 (0·1 to 0·5), a decrease of 64·2% (-84·6 to -43·4) from 1990, when the mortality rate was 0·7 per 100 000 (0·2 to 1·1). In both 1990 and 2021, the mortality rate of otitis media was less than 0·1 per 100 000. Together, the combined burden accounted for by URIs and otitis media in 2021 was 6·86 million (4·24 to 10·4) years lived with disability and 8·16 million (4·99 to 12·0) disability-adjusted life-years (DALYs) for all ages across males and females. Globally, the all-age DALY rate of URIs and otitis media combined in 2021 was 103 per 100 000 (63 to 152). Infants aged 1-5 months had the highest combined DALY rate in 2021 (647 per 100 000 [189 to 1412]), followed by early neonates (aged 0-6 days; 582 per 100 000 [176 to 1297]) and late neonates (aged 7-24 days; 482 per 100 000 [161 to 1052]). INTERPRETATION The findings of this study highlight the widespread burden posed by URIs and otitis media across all age groups and both sexes. There is a continued need for surveillance, prevention, and management to better understand and reduce the burden associated with URIs and otitis media, and research is needed to assess their impacts on individuals, communities, economies, and health-care systems worldwide. FUNDING Bill & Melinda Gates Foundation.
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Caruso BA, Ballard AM, Sobolik J, Patrick M, Dsouza J, Sinharoy SS, Cumming O, Wolf J, Ray I. Systematic re-review of WASH trials to assess women's engagement in intervention delivery and research activities. NATURE WATER 2024; 2:827-836. [PMID: 39309371 PMCID: PMC11412895 DOI: 10.1038/s44221-024-00299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 08/05/2024] [Indexed: 09/25/2024]
Abstract
Water, sanitation and hygiene (WASH) interventions significantly reduce health risks in low- and middle-income countries. Many rely on women, but the extent of women's engagement remains undocumented. Here we conducted a re-review of papers from two systematic reviews that assessed the effectiveness of water, sanitation and/or handwashing with soap interventions on diarrhoeal disease and acute respiratory infections to assess women's roles in WASH research and intervention activities. A total of 133 studies were included. Among studies that specified gender, women were the most sought-after group for engagement in research (n = 91/132; 68.9%) and intervention (n = 49/120; 40.8%) activities. Reporting time burden for research (n = 1; 1%) and intervention activities (n = 3; 2.5%) was rare. All interventions were classified as gender unequal (36.7%) or gender unaware (63.3%) according to the World Health Organization Gender Responsiveness Assessment Scale, indicating exploitative engagement. Women play a critical but instrumentalized role in WASH, and both research and interventions need to change to enable, and not hinder, gender equality.
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Affiliation(s)
- Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - April M. Ballard
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Julia Sobolik
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Madeleine Patrick
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Janice Dsouza
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Sheela S. Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennyfer Wolf
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley, CA USA
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Armitage EP, de Crombrugghe G, Keeley AJ, Senghore E, Camara FE, Jammeh M, Bittaye A, Ceesay H, Ceesay I, Samateh B, Manneh M, Kampmann B, Turner CE, Kucharski A, Botteaux A, Smeesters PR, de Silva TI, Marks M. Streptococcus pyogenes carriage and infection within households in The Gambia: a longitudinal cohort study. THE LANCET. MICROBE 2024; 5:679-688. [PMID: 38735305 DOI: 10.1016/s2666-5247(24)00046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Streptococcus pyogenes causes more than 500 000 deaths per year globally, which occur disproportionately in low-income and middle-income countries. The roles of S pyogenes skin and pharyngeal carriage in transmission are unclear. We aimed to investigate the clinical epidemiology and household transmission dynamics of both S pyogenes asymptomatic carriage and infection in a high-burden setting. METHODS We did a 1-year prospective, longitudinal, household cohort study, recruiting healthy participants from households in Sukuta, The Gambia. Households were eligible if they comprised at least three members, including one child younger than 18 years, and were excluded if more than half of household members declined to participate. Households were identified by random GPS coordinates derived from census data. At monthly visits, pharyngeal and normal skin swabs were collected for S pyogenes culture, and sociodemographic data were recorded by interview. Incident pharyngitis and pyoderma infections were captured. Cultured isolates underwent emm genotyping. The primary outcome measures were incidence of S pyogenes carriage and disease. Additional outcomes were prevalence of S pyogenes skin and pharyngeal carriage, S pyogenes skin and pharyngeal clearance time, S pyogenes emm type, risk factors for carriage and disease events, household secondary attack rate, and emm-linked household transmission events. The study is registered on ClinicalTrials.gov, NCT05117528. FINDINGS Between July 27, 2021, and Sept 28, 2022, 442 participants were enrolled from 44 households. The median age was 15 years (IQR 6-28) and 233 (53%) were female. We identified 17 pharyngitis and 99 pyoderma events and 49 pharyngeal and 39 skin S pyogenes carriage acquisition events. Mean monthly prevalence was 1·4% (95% CI 1·1-1·9) for S pyogenes pharyngeal carriage and 1·2% (0·9-1·6) for S pyogenes skin carriage. Incidence was 120 per 1000 person-years (95% CI 87-166) for S pyogenes pharyngeal carriage, 124 per 1000 person-years (90-170) for S pyogenes skin carriage, 51 per 1000 person-years (31-84) for S pyogenes pharyngitis, and 263 per 1000 person-years (212-327) for S pyogenes pyoderma. Pharyngeal carriage risk was higher during the rainy season (HR 5·67, 95% CI 2·19-14·69) and in larger households (per additional person: 1·03, 1·00-1·05), as was pharyngitis risk (rainy season: 3·00, 1·10-8·22; household size: 1·04, 1·02-1·07). Skin carriage risk was not affected by season or household size, but was lower in female than in male participants (0·45, 0·22-0·92) and highest in children younger than 5 years compared with adults (22·69, 3·08-167·21), with similar findings for pyoderma (female sex: 0·34, 0·19-0·61; age <5 years: 7·00, 2·78-17·64). Median clearance time after carriage acquisition was 4·0 days for both skin (IQR 3·5-7·0) and pharynx (3·5-7·3). The mean household secondary attack rate was 4·9 (95% CI 3·5-6·3) for epidemiologically linked S pyogenes events and 0·74 (0·3-1·2) for emm-linked S pyogenes events. Of the 204 carriage and disease events, emm types were available for 179 (88%). Only 18 emm-linked between-visit household transmission events were identified. Pyoderma was the most common source of S pyogenes household transmissions in 11 (61%) of 18 emm-linked transmissions. Both pharynx to skin and skin to pharynx transmission events were observed. INTERPRETATION S pyogenes carriage and infection are common in The Gambia, particularly in children. Most events are non-household acquisitions, but skin carriage and pyoderma have an important role in S pyogenes household transmission and bidirectional transmission between skin and pharynx occurs. FUNDING Wellcome Trust, Chadwick Trust, Fonds National de la Recherche Scientifique (Belgium), European Society for Paediatric Infectious Diseases, and Medical Research Council (UK).
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Affiliation(s)
- Edwin P Armitage
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Gabrielle de Crombrugghe
- Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Université libre de Bruxelles, Brussels, Belgium; Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium
| | - Alexander J Keeley
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; The Florey Institute of Infection, University of Sheffield, Sheffield, UK; Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Elina Senghore
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Fatoumata E Camara
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Musukoi Jammeh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Amat Bittaye
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Haddy Ceesay
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Isatou Ceesay
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bunja Samateh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Muhammed Manneh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Centre for Global Health and Institut für Internationale Gesundheit, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claire E Turner
- The Florey Institute of Infection, University of Sheffield, Sheffield, UK; School of Biosciences, University of Sheffield, Sheffield, UK
| | - Adam Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Botteaux
- Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Université libre de Bruxelles, Brussels, Belgium
| | - Pierre R Smeesters
- Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Université libre de Bruxelles, Brussels, Belgium; Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Thushan I de Silva
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; The Florey Institute of Infection, University of Sheffield, Sheffield, UK; Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Michael Marks
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK; Division of Infection and Immunity, University College London, London, UK
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Amoako YA, Laryea DO, Agbanyo A, Agbavor B, Oppong MN, Kyem G, Abass KM, van Bentum R, Phillips RO, Stienstra Y. Prevalence and determinants of impetigo in Ghana: a cross-sectional study. BMC Infect Dis 2024; 24:349. [PMID: 38528449 DOI: 10.1186/s12879-024-09242-y] [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: 08/30/2023] [Accepted: 03/21/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Skin diseases such as impetigo pose a significant public health challenge in low resource settings. Despite this, there is a dearth of epidemiological data on the prevalence of this condition in Ghana. METHODS We conducted a cross sectional study in three settings in Ghana: community members in East Mamprusi district in the North East region, a secondary school in Sekyere East district, and inmates of the Kumasi central prisons both in the Ashanti region. Following a period of training, we performed a standardised skin examination on each participant to assess for scabies and impetigo. We calculated the prevalence of each skin condition and investigated determinants of impetigo. RESULTS/ FINDINGS Of the 1327 participants [males 64.1% and median age 22 (16-29) years], 746 (56.2%) had scabies and 186 (14%) had impetigo which was usually very mild or mild in severity. Most participants with impetigo also had scabies (161/186, 86.6%). Having an itch [RR 6.05 (95% CI 2.53-14.47)], presence of scabies burrows [RR 1.99 (95% CI 1.54-2.59)], clinical scabies [RR 3.15 (2.11-4.72)] or being in preschool [RR 4.56 (1.78-11.67)] increased the risk for impetigo. A combination of the presence of clinical scabies, age, sex and itch most accurately predicted the odds of having impetigo. CONCLUSIONS There is substantial burden of impetigo and scabies in Ghana. There is a need to institute measures to improve detection and control of these common dermatoses as part of Universal Health Coverage package to reduce the scourge of the diseases in this setting.
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Affiliation(s)
- Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | | | - Abigail Agbanyo
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernadette Agbavor
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gloria Kyem
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Renee van Bentum
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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6
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Behbehani F, Kowalski AJ, Selam H, Dombrowski E, Black MM. Childcare centre attendance and health, growth, and development among children aged 0-3 years in low- and middle-income countries: A systematic review. J Glob Health 2024; 14:04028. [PMID: 38385435 PMCID: PMC10882641 DOI: 10.7189/jogh.14.04028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Background Lack of childcare for children aged 0-3 years has emerged as a global crisis, accentuated by women's increasing workforce participation and recognition that young children require nurturing care. Through this systematic review, we sought to examine associations between childcare centre attendance in low- and middle-income countries (LMICs) and children's health, growth, and development, and to generate childcare centre programmatic and research recommendations for children aged 0-3 years. Methods We systematically searched PsycINFO, MEDLINE, PubMed, and Cochrane for articles on centre-based childcare for children aged 0-3 years in LMICs, published between 2000 and 2021 in English (or which were translated into English). We excluded articles on specialised subgroups or interventions. We imported the retrieved articles into Covidence for review and assessed them for bias using the National Institutes of Health (NIH) quality assessment tool. Results Twenty-two articles (24 studies) met the inclusion criteria, encompassing 36 927 children from 10 countries across Mexico and South America (n = 12), Africa (n = 5), and Asia (n = 5). Outcomes included health (n = 12), growth/nutrition (n = 6), and development (n = 6). Study quality assessments were low; 41% exceeded 50% of quality criteria and 45% adjusted for confounders. Associations between childcare attendance and outcome measures were primarily negative for health (n/N = 7/12) and positive for growth/nutrition (n/N = 5/6) and development (n/N = 4/6). Childcare centre programmatic recommendations for children aged 0-3 years included: age-specific policies; program quality, including safety, hygiene, nutrition, and curriculum; access and affordability; parent engagement; financial support; and workforce development. Research recommendations included: study design, including enrolment age, frequency, duration, childcare type, home and childcare sociodemographic and cultural environments, child and caregiver outcomes, and analytical approaches; longitudinal studies; and implementation research. Conclusions Rigorous primary research in global childcare for young children is urgently needed. Policies, programmes, and investments in high-quality childcare can promote nurturing care for young children, enabling mothers to participate in the workforce. Registration PROSPERO: CRD42018105576.
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Affiliation(s)
- Farah Behbehani
- Department of Public Health Practice, Kuwait University College of Public Health, Kuwait City, Kuwait
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alysse J Kowalski
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Helina Selam
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Vermont Oxford Network, Burlington, Vermont, USA
| | | | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- RTI International, Research Triangle Park, North Carolina, USA
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7
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Asiniwasis R, Merati N, Roesler J, Simpson EL, Aubry R, McMullen E, Fraess L, Choi UY, Hinther K, Chu DK, Jack C. The Social and Home Environment: Impacts of Determinants of Health on Atopic Dermatitis, Pathways Toward Solutions, and Unique Considerations for Rural and Remote North American Indigenous Populations. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:290-299. [PMID: 38013155 DOI: 10.1016/j.jaip.2023.11.034] [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: 07/29/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
Disparities in environmental and social determinants of health (DOH) are associated with morbidity in atopic dermatitis (AD). The socioecological model (SEM) is a framework that can be applied to better understand how such DOH impacts patients with AD. We include a case scenario of a remote Indigenous patient reflective of real-world situations of living with AD and examine relevant impact, gaps in knowledge, and further research needs. This review highlights a variety of social and environmental exposures as important DOH which must be addressed to achieve optimal management in AD. The "rainbow model" is a modified framework to help illustrate how complex environmental and social forces impact both AD presentation and therapeutic success. However, practical applications and outcome metrics for health promotion are limited. An inter- and transdisciplinary approach is paramount to address the complex challenges associated with AD care, as well as multistakeholder approach integrating culturally-competent equitable health frameworks. This review underscores the importance of expanding the focus of AD management beyond basic science and clinical trials to recognize and address health disparities and to promote optimal health and well-being in patients with AD, and contributes a working approach to mapping the complex interventions and patient-oriented research needed using a focus on remote North American Indigenous patients affected by AD.
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Affiliation(s)
- Rachel Asiniwasis
- Division of Dermatology, University of Saskatchewan, Regina, Saskatchewan, Canada.
| | - Nickoo Merati
- Division of Dermatology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jordanna Roesler
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Ore
| | - Rachel Aubry
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eric McMullen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lauren Fraess
- College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - U Yeong Choi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kelsey Hinther
- Division of Allergy and Clinical Immunology, McGill University, Montreal, Quebec, Canada
| | - Derek K Chu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carolyn Jack
- Division of Dermatology, Department of Medicine, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
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Chai Y, Nandi A, Heymann J. Is the impact of paid maternity leave policy on the prevalence of childhood diarrhoea mediated by breastfeeding duration? A causal mediation analysis using quasi-experimental evidence from 38 low-income and middle-income countries. BMJ Open 2024; 14:e071520. [PMID: 38216191 PMCID: PMC10806753 DOI: 10.1136/bmjopen-2022-071520] [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: 12/31/2022] [Accepted: 09/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Quasi-experimental evidence suggests that extending the duration of legislated paid maternity leave is associated with lower prevalence of childhood diarrhoea in low-income and middle-income countries (LMICs). This could be due to a variety of mechanisms. This study examines whether this effect is mediated by changes in breastfeeding duration. DESIGN AND SETTING Difference-in-difference approach and causal mediation analysis were used to perform secondary statistical analysis of cross-sectional data from Demographic and Health Surveys (DHSs) in 38 LMICs. PARTICIPANTS We merged longitudinal data on national maternity leave policies with information on childhood diarrhoea related to 639 153 live births between 1996 and 2014 in 38 LMICs that participated in the DHS at least twice between 1995 and 2015. PRIMARY OUTCOME MEASURE Our outcome was whether the child had bloody stools in the 2 weeks prior to the interview. This measure was used as an indicator of severe diarrhoea because the frequency of loose stools in breastfed infants can be difficult to distinguish from pathological diarrhoea based on survey data. RESULTS A 1-month increase in the legislated duration of paid maternity leave was associated with a 34% (risk ratio 0.66, 95% CI 0.47 to 0.91) reduction in the prevalence of bloody diarrhoea. Breast feeding for at least 6 months and 12 months mediated 10.6% and 7.4% of this effect, respectively. CONCLUSION Extending the duration of paid maternity leave appears to lower diarrhoea prevalence in children under 5 years of age in LMICs. This effect is slightly mediated by changes in breastfeeding duration.
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Affiliation(s)
- Yan Chai
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jody Heymann
- Department of Epidemiology, University of California, Los Angeles, California, USA
- Department of Health Policy and Management, University of California, Los Angeles, California, USA
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Joseph G, Milusheva S, Sturrock H, Mapako T, Ayling S, Hoo YR. Estimating spatially disaggregated probability of severe COVID-19 and the impact of handwashing interventions: The case of Zimbabwe. PLoS One 2023; 18:e0292644. [PMID: 38019836 PMCID: PMC10686513 DOI: 10.1371/journal.pone.0292644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The severity of COVID-19 disease varies substantially between individuals, with some infections being asymptomatic while others are fatal. Several risk factors have been identified that affect the progression of SARS-CoV-2 to severe COVID-19. They include age, smoking and presence of underlying comorbidities such as respiratory illness, HIV, anemia and obesity. Given that respiratory illness is one such comorbidity and is affected by hand hygiene, it is plausible that improving access to handwashing could lower the risk of severe COVID-19 among a population. In this paper, we estimate the potential impact of improved access to handwashing on the risk of respiratory illness and its knock-on impact on the risk of developing severe COVID-19 disease across Zimbabwe. METHODS Spatial generalized additive models were applied to cluster level data from the 2015 Demographic and Health Survey. These models were used to generate continuous (1km resolution) estimates of risk factors for severe COVID-19, including prevalence of major comorbidities (respiratory illness, HIV without viral load suppression, anemia and obesity) and prevalence of smoking, which were aggregated to district level alongside estimates of the proportion of the population under 50 from Worldpop data. The risk of severe COVID-19 was then calculated for each district using published estimates of the relationship between comorbidities, smoking and age (under 50) and severe COVID-19. Two scenarios were then simulated to see how changing access to handwashing facilities could have knock on implications for the prevalence of severe COVID-19 in the population. RESULTS This modeling conducted in this study shows that (1) current risk of severe disease is heterogeneous across the country, due to differences in individual characteristics and household conditions and (2) that if the quantifiable estimates on the importance of handwashing for transmission are sound, then improvements in handwashing access could lead to reductions in the risk of severe COVID-19 of up to 16% from the estimated current levels across all districts. CONCLUSIONS Taken alongside the likely impact on transmission of SARS-CoV-2 itself, as well as countless other pathogens, this result adds further support for the expansion of access to handwashing across the country. It also highlights the spatial differences in risk of severe COVID-19, and thus the opportunity for better planning to focus limited resources in high-risk areas in order to potentially reduce the number of severe cases.
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Affiliation(s)
- George Joseph
- Water Global Practice, World Bank, Washington, DC, United States of America
| | - Sveta Milusheva
- Development Impact Evaluation Group, World Bank, Washington, DC, United States of America
| | - Hugh Sturrock
- Spatial Analysis and Modeling, Locational, London, United Kingdom
| | - Tonderai Mapako
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Sophie Ayling
- Water Global Practice, World Bank, Washington, DC, United States of America
| | - Yi Rong Hoo
- Water Global Practice, World Bank, Washington, DC, United States of America
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10
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Wu CC, Chen CY, Zhong LS, Bao LJ, Zeng EY. Particle transfer mediates dermal exposure of consumers to plasticizers in eraser and pen accessories. ENVIRONMENT INTERNATIONAL 2023; 180:108191. [PMID: 37716339 DOI: 10.1016/j.envint.2023.108191] [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: 06/04/2023] [Revised: 08/18/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
Dermal exposure to chemicals released from daily consumer products is a rising concern, particularly for children who are susceptible to unintentional hand-to-mouth transfer and related chemical exposure risk. However, chemical transfer induced by tiny particles of intact products has yet to be adequately addressed. The objective of the present study was to determine the potentiality of particles release from intact erasers and pen grips upon dermal contact by measuring the migration rates of the embedded plasticizers (phthalates and its alternatives). The results showed that billions of particles were released from erasers (0.6-1.2 × 109) and pen grips (0.2-1.6 × 108) upon dermal contact at ambient temperature, with sizes mainly smaller than 1 μm. The composition of eraser leachates was identical to that of the corresponding bulk eraser, as confirmed by Fourier-transform infrared spectroscopy and pyrolysis. Migrated hydrophobic plasticizers may be used as indicators of particle release from erasers and pen grips. The potentiality of particle release was negatively correlated with the total plasticizer contents (r = -0.51; p < 0.05) for both erasers and pen grips. These findings indicated that particles directly released from school supplies and accessories could be a non-negligible source of human exposure to plasticizers.
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Affiliation(s)
- Chen-Chou Wu
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 511443, China
| | - Chun-Yan Chen
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 511443, China
| | - Li-Shan Zhong
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 511443, China
| | - Lian-Jun Bao
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 511443, China
| | - Eddy Y Zeng
- Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, Guangzhou 511443, China.
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Boatwright MA, Kuo HC, Lindholm DA, Griffith T, Colombo RE, Tribble DR, O’Connell R, Lalani T. The Impact of Infectious Disease Syndromes on Activities During Military Travel. Open Forum Infect Dis 2023; 10:ofad461. [PMID: 37771853 PMCID: PMC10533202 DOI: 10.1093/ofid/ofad461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
Background We evaluated the impact of infectious disease (ID) syndromes on US active duty (AD) servicemembers returning from overseas deployment (DEP), military training exercises (EXR), or short-term military travel (eg, temporary assignment of duty [TDY]). Methods We conducted a survey-based assessment of US AD servicemembers returning from DEP, EXR, or TDY between 2015 and 2019. Subjects completed a post-travel survey capturing symptoms of travelers' diarrhea (TD), influenza-like illness (ILI), and febrile illness (FI). Risk factors associated with any ID syndrome (ie, either TD, ILI, or FI) that impacted daily activities were assessed using a logistic regression model with backward selection. Results One-third of servicemembers (654/1822) experienced an ID syndrome, and 26% (471/1822) reported a ≥50% reduction in activity level due to an ID syndrome (median duration, 3 days). TD was the most common ID syndrome experienced and accounted for 73% (346/471) of ID syndromes impacting daily activities. The greatest impact of ID syndromes was observed in servicemembers on DEP. Compared with servicemembers on EXR or TDY, those on DEP had a longer duration of travel and a delayed period of risk for ID syndromes. Multivariate analysis identified high-risk exposures (ie, environmental exposures, close contact with locals, consuming food from street vendors) and behaviors (ie, inability to sanitize hands before meals) that could be used to inform mitigation strategies. Conclusions ID syndromes result in a significant loss of productivity during military travel. Addressing modifiable risk factors and access to TD self-treatment in high-risk settings may help mitigate the impact of ID threats during military travel.
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Affiliation(s)
| | - Huai-Ching Kuo
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - David A Lindholm
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam, Houston, Texas, USA
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tara Griffith
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Rhonda E Colombo
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
- Madigan Army Medical Center, Joint Base Lewis, McChord, Washington, USA
| | - David R Tribble
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Robert O’Connell
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tahaniyat Lalani
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
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12
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Ross I, Bick S, Ayieko P, Dreibelbis R, Wolf J, Freeman MC, Allen E, Brauer M, Cumming O. Effectiveness of handwashing with soap for preventing acute respiratory infections in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 2023; 401:1681-1690. [PMID: 37121242 DOI: 10.1016/s0140-6736(23)00021-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/07/2022] [Accepted: 01/03/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Acute respiratory infection (ARI) is a leading cause of morbidity and mortality globally, with 83% of ARI mortality occurring in low-income and middle-income countries (LMICs) before the COVID-19 pandemic. We aimed to estimate the effect of interventions promoting handwashing with soap on ARI in LMICs. METHODS In our systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, Global Health, and Global Index Medicus for studies of handwashing with soap interventions in LMICs from inception to May 25, 2021. We included randomised and non-randomised controlled studies of interventions conducted in domestic, school, or childcare settings. Interventions promoting hand hygiene methods other than handwashing with soap were excluded, as were interventions in health-care facilities or the workplace. The primary outcome was ARI morbidity arising from any pathogen for participants of any age. Secondary outcomes were lower respiratory infection, upper respiratory infection, influenza confirmed by diagnostic test, COVID-19 confirmed by diagnostic test, and all-cause mortality. We extracted relative risks (RRs), using random-effects meta-analysis to analyse study results, and metaregression to evaluate heterogeneity. We assessed risk of bias in individual studies using an adapted Newcastle-Ottawa scale, and assessed the overall body of evidence using a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The study is registered with PROSPERO, CRD42021231414. FINDINGS 26 studies with 161 659 participants met inclusion criteria, providing 27 comparisons (21 randomised). Interventions promoting handwashing with soap reduced any ARI compared with no handwashing intervention (RR 0·83 [95% CI 0·76-0·90], I2 88%; 27 comparisons). Interventions also reduced lower respiratory infections (0·78 [0·64-0·94], I2 64%; 12 comparisons) and upper respiratory infections (0·74 [0·59-0·93], I2 91%; seven comparisons), but not test-confirmed influenza (0·94 [0·42-2·11], I2 90%; three comparisons), test-confirmed COVID-19 (no comparisons), or all-cause mortality (prevalence ratio 0·95 [95% CI 0·71-1·27]; one comparison). For ARI, no heterogeneity covariates were significant at p<0·1 and the GRADE rating was moderate certainty evidence. INTERPRETATION Interventions promoting handwashing with soap can reduce ARI in LMICs, and could help to prevent the large burden of respiratory disease. FUNDING Bill & Melinda Gates Foundation, Reckitt Global Hygiene Institute, and UK FCDO.
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Affiliation(s)
- Ian Ross
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Sarah Bick
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Philip Ayieko
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Dreibelbis
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennyfer Wolf
- Department of Environmental, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - 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
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Changes in water treatment, hygiene practices, household floors, and child health in times of Covid-19: A longitudinal cross-sectional survey in Surkhet District, Nepal. Int J Hyg Environ Health 2023; 249:114138. [PMID: 36821912 PMCID: PMC9925420 DOI: 10.1016/j.ijheh.2023.114138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/25/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Consistent and effective practice of water treatment, sanitation, and hygiene (WASH) behaviour is an indispensable requisite for realizing health improvements among children living in low-income areas with challenging hygienic conditions. Sustainably achieving such a behaviour change is challenging but more likely to be realized during epidemics, when health threats are high and the dissemination of information on preventative measures is intense. Our study conducted cross-sectional surveys in Surkhet District Nepal, before and during the Covid-19 pandemic to assess the impact of water safety interventions and hygiene training implemented before and during the pandemic on WASH conditions and practices and to assess the association of these changes with child health. METHODS Information on WASH infrastructure, WASH behaviour, nutrition, and child health, including on parasitic infections, was obtained before and during the Covid-19 pandemic in spring 2018 and spring 2021, from 589 children aged between 6 months and 10 years and their caregivers. Data was collected through quantitative, structured face-to-face interviews, observations, health examinations of children including anthropometric measurements, analysis of children's stool, and water quality analysis. The association of changes in WASH factors with changes in child health was analysed using multivariate generalized estimating equations for repeated measures. RESULTS Water safety management was significantly improved by the introduction of chlorination to piped water supply systems, which served 40% of households. In addition, the percentage of households using a ceramic water filter increased from 12.2% to 34.8%. Large and significant changes were observed in handwashing behaviour (frequency, use of soap and washing at critical times) and infrastructure: 35% of households constructed a new handwashing station. Kitchen and household hygiene also improved. An additional 22% of households improved the cleanliness of the toilet. The number of houses with a cemented floor increased by 20%. WASH changes were significantly associated with improved child health: the chlorination of piped water supply reduced odds ratios for diarrhoea (OR = 0.36, 95% CI = 0.15-0.88, p = 0.025), respiratory difficulties (OR = 0.39, 95% CI = 0.16-0.92, p = 0.033), fever (OR = 0.42, 95% CI = 0.26-0.71, p = 0.001) and cough (OR = 0.58, 95% CI = 0.36-0.93, p = 0.024), and. The frequency of handwashing with soap was associated with significantly reduced odds ratios for infections with Giardia lamblia (OR = 0.68, 95% CI = 0.50-0.91, p = 0.011), stunting and wasting (OR = 0.75, 95% CI = 0.66-0.92, p = 0.003) and fever (OR = 0.85, 95% CI = 0.75-0.96, p = 0.008),. The presence of a handwashing station at baseline was associated with significantly reduced odds ratios for respiratory difficulties (OR = 0.45, 95% CI = 0.26-0.78, p = 0.004). The construction of a handwashing station between baseline and endline was significantly associated with reduced odds ratios for pale conjunctiva (OR = 0.32, 95% CI = 0.17-0.60, p < 0.001), which is a clinical sign of iron deficiency and anaemia, respiratory difficulties (OR = 0.39, 95% CI = 0.17-0.89, p = 0.026) and cough (OR = 0.44, 95% CI = 0.26-0.76, p = 0.003). Using a clean container for the transport of drinking water was significantly associated with reduced odds ratios for infections with Giardia lamblia (OR = 0.39, 95% CI = 0.16-0.93, p = 0.033) and diarrhoea (OR = 0.48, 95% CI = 0.24-0.96, p = 0.038). Similarly, a cemented floor in the household was significantly associated with reduced odd ratios for diarrhoea (OR = 0.38, 95% CI = 0.16-0.87, p = 0.022) and infections with Giardia lamblia (OR = 0.44, 95% CI = 0.19-1.02, p = 0.056). CONCLUSION WASH training and the promotion of preventative measures during the Covid-19 pandemic supported improved water safety management and hygiene behaviour, which resulted in a reduction in infectious diseases among children in the study area.
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Gasson S, Solari F, Jesudason EP. Sustainable Hand Surgery: Incorporating Water Efficiency Into Clinical Practice. Cureus 2023; 15:e38331. [PMID: 37266048 PMCID: PMC10230851 DOI: 10.7759/cureus.38331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Public health and well-being outcomes are intimately connected with the health of our planet. Climate change has numerous far-reaching effects. Managing and mitigating these risks to human health presents one of the next challenges to global healthcare. The current usage of planetary resources is unsustainable. Surgical procedures are particularly resource-intensive, often utilising vast amounts of single-use consumables, like water. In the last 100 years global usage of fresh water has increased six-fold and continues to rise by 1% year on year. It is well established that initial hand sterilization and maintenance of hand sterility during the surgical list are essential for preventing hospital-acquired infections and associated morbidity and mortality. This study aims to estimate the current daily water usage of two typical hand surgery lists from a District General Hospital in North Wales, to determine potential water savings by switching exclusively to an alcohol-based hand rub for subsequent scrubs, in line with current national guidelines. Methods Observational study estimation of water consumption from a temperature-controlled manual tap required using a 1 litre volumetric jug where the time taken to fill was recorded. Three separate observational samples were taken, and a mean was calculated. This mean determined the amount of water dispensed from the tap in a standard 3 min scrub and subsequent 1 min scrub. Two different theatre schedules were analysed: 1. A trauma list (five cases) and 2. A higher volume minor elective procedure schedule (16 cases), in this case a wide-awake local anaesthetic no tourniquet (WALANT) carpal tunnel release (CTR). Results Each case regardless of procedure had approximately three persons scrubbed. 20.57L of water is used for one person to scrub for 3 mins and an extra 6.8574L for each subsequent 1 min scrub. Therefore, current daily water consumption could reach 143.99L during the major hand trauma list and 411.4L during a high-volume carpal tunnel release list. Conclusion Simply following current guidelines by switching to alcohol-based hand rub just for subsequent scrubs could reduce water consumption by 57.2% for hand trauma lists and 70.2% for high-volume CTR lists.
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Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, Jones MA, Hoffmann TC, Clark J, Beller EM, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2023; 1:CD006207. [PMID: 36715243 PMCID: PMC9885521 DOI: 10.1002/14651858.cd006207.pub6] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review last published in 2020. We include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL, and two trials registers in October 2022, with backwards and forwards citation analysis on the new studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, glasses, and gargling) to prevent respiratory virus transmission. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS We included 11 new RCTs and cluster-RCTs (610,872 participants) in this update, bringing the total number of RCTs to 78. Six of the new trials were conducted during the COVID-19 pandemic; two from Mexico, and one each from Denmark, Bangladesh, England, and Norway. We identified four ongoing studies, of which one is completed, but unreported, evaluating masks concurrent with the COVID-19 pandemic. Many studies were conducted during non-epidemic influenza periods. Several were conducted during the 2009 H1N1 influenza pandemic, and others in epidemic influenza seasons up to 2016. Therefore, many studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Adherence with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included 12 trials (10 cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate-certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate-certainty evidence). Harms were rarely measured and poorly reported (very low-certainty evidence). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; 3 trials, 7779 participants; very low-certainty evidence). N95/P2 respirators compared with medical/surgical masks may be effective for ILI (RR 0.82, 95% CI 0.66 to 1.03; 5 trials, 8407 participants; low-certainty evidence). Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate-certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low-certainty evidence). One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non-inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID-19 patients. Hand hygiene compared to control Nineteen trials compared hand hygiene interventions with controls with sufficient data to include in meta-analyses. Settings included schools, childcare centres and homes. Comparing hand hygiene interventions with controls (i.e. no intervention), there was a 14% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.86, 95% CI 0.81 to 0.90; 9 trials, 52,105 participants; moderate-certainty evidence), suggesting a probable benefit. In absolute terms this benefit would result in a reduction from 380 events per 1000 people to 327 per 1000 people (95% CI 308 to 342). When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.94, 95% CI 0.81 to 1.09; 11 trials, 34,503 participants; low-certainty evidence), and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials, 8332 participants; low-certainty evidence), suggest the intervention made little or no difference. We pooled 19 trials (71, 210 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. Pooled data showed that hand hygiene may be beneficial with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.83 to 0.94; low-certainty evidence), but with high heterogeneity. In absolute terms this benefit would result in a reduction from 200 events per 1000 people to 178 per 1000 people (95% CI 166 to 188). Few trials measured and reported harms (very low-certainty evidence). We found no RCTs on gowns and gloves, face shields, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children. There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory-confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Department for Continuing Education, University of Oxford, Oxford OX1 2JA, UK
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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Maréchal JYA, Hendriksen K, Hansen LT, Gundelund C, Jensen PE. Domestic water supply in rural Greenland – sufficiency, affordability and accessibility. Int J Circumpolar Health 2022; 81:2138095. [DOI: 10.1080/22423982.2022.2138095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Judith Y. A. Maréchal
- Arctic DTU Sisimiut Ilinniarfeqarfik Sisimiut, DTU Sustain, Technical University of Denmark, Greenland, Sisimiut
| | - Kåre Hendriksen
- Department of Planning, Aalborg University Copenhagen, Kongens Lyngby, Denmark
| | | | - Casper Gundelund
- Section of Freshwater Fisheries and Ecology, Technical University of Denmark, DTU Aqua, Silkeborg, Denmark
| | - Pernille Erland Jensen
- Arctic DTU Sisimiut Ilinniarfeqarfik Sisimiut, DTU Sustain, Technical University of Denmark, Greenland, Sisimiut
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Ikuta KS, Swetschinski LR, Robles Aguilar G, Sharara F, Mestrovic T, Gray AP, Davis Weaver N, Wool EE, Han C, Gershberg Hayoon A, Aali A, Abate SM, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abd-Elsalam S, Abebe G, Abedi A, Abhari AP, Abidi H, Aboagye RG, Absalan A, Abubaker Ali H, Acuna JM, Adane TD, Addo IY, Adegboye OA, Adnan M, Adnani QES, Afzal MS, Afzal S, Aghdam ZB, Ahinkorah BO, Ahmad A, Ahmad AR, Ahmad R, Ahmad S, Ahmad S, Ahmadi S, Ahmed A, Ahmed H, Ahmed JQ, Ahmed Rashid T, Ajami M, Aji B, Akbarzadeh-Khiavi M, Akunna CJ, Al Hamad H, Alahdab F, Al-Aly Z, Aldeyab MA, Aleman AV, Alhalaiqa FAN, Alhassan RK, Ali BA, Ali L, Ali SS, Alimohamadi Y, Alipour V, Alizadeh A, Aljunid SM, Allel K, Almustanyir S, Ameyaw EK, Amit AML, Anandavelane N, Ancuceanu R, Andrei CL, Andrei T, Anggraini D, Ansar A, Anyasodor AE, Arabloo J, Aravkin AY, Areda D, Aripov T, Artamonov AA, Arulappan J, Aruleba RT, Asaduzzaman M, Ashraf T, Athari SS, Atlaw D, Attia S, Ausloos M, Awoke T, Ayala Quintanilla BP, Ayana TM, Azadnajafabad S, Azari Jafari A, B DB, Badar M, Badiye AD, Baghcheghi N, Bagherieh S, Baig AA, Banerjee I, Barac A, Bardhan M, Barone-Adesi F, Barqawi HJ, Barrow A, Baskaran P, Basu S, Batiha AMM, Bedi N, Belete MA, Belgaumi UI, Bender RG, Bhandari B, Bhandari D, Bhardwaj P, Bhaskar S, Bhattacharyya K, Bhattarai S, Bitaraf S, Buonsenso D, Butt ZA, Caetano dos Santos FL, Cai J, Calina D, Camargos P, Cámera LA, Cárdenas R, Cevik M, Chadwick J, Charan J, Chaurasia A, Ching PR, Choudhari SG, Chowdhury EK, Chowdhury FR, Chu DT, Chukwu IS, Dadras O, Dagnaw FT, Dai X, Das S, Dastiridou A, Debela SA, Demisse FW, Demissie S, Dereje D, Derese M, Desai HD, Dessalegn FN, Dessalegni SAA, Desye B, Dhaduk K, Dhimal M, Dhingra S, Diao N, Diaz D, Djalalinia S, Dodangeh M, Dongarwar D, Dora BT, Dorostkar F, Dsouza HL, Dubljanin E, Dunachie SJ, Durojaiye OC, Edinur HA, Ejigu HB, Ekholuenetale M, Ekundayo TC, El-Abid H, Elhadi M, Elmonem MA, Emami A, Engelbert Bain L, Enyew DB, Erkhembayar R, Eshrati B, Etaee F, Fagbamigbe AF, Falahi S, Fallahzadeh A, Faraon EJA, Fatehizadeh A, Fekadu G, Fernandes JC, Ferrari A, Fetensa G, Filip I, Fischer F, Foroutan M, Gaal PA, Gadanya MA, Gaidhane AM, Ganesan B, Gebrehiwot M, Ghanbari R, Ghasemi Nour M, Ghashghaee A, Gholamrezanezhad A, Gholizadeh A, Golechha M, Goleij P, Golinelli D, Goodridge A, Gunawardane DA, Guo Y, Gupta RD, Gupta S, Gupta VB, Gupta VK, Guta A, Habibzadeh P, Haddadi Avval A, Halwani R, Hanif A, Hannan MA, Harapan H, Hassan S, Hassankhani H, Hayat K, Heibati B, Heidari G, Heidari M, Heidari-Soureshjani R, Herteliu C, Heyi DZ, Hezam K, Hoogar P, Horita N, Hossain MM, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hoveidamanesh S, Huang J, Hussain S, Hussein NR, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Immurana M, Inbaraj LR, Iradukunda A, Ismail NE, Iwu CCD, Iwu CJ, J LM, Jakovljevic M, Jamshidi E, Javaheri T, Javanmardi F, Javidnia J, Jayapal SK, Jayarajah U, Jebai R, Jha RP, Joo T, Joseph N, Joukar F, Jozwiak JJ, Kacimi SEO, Kadashetti V, Kalankesh LR, Kalhor R, Kamal VK, Kandel H, Kapoor N, Karkhah S, Kassa BG, Kassebaum NJ, Katoto PDMC, Keykhaei M, Khajuria H, Khan A, Khan IA, Khan M, Khan MN, Khan MAB, Khatatbeh MM, Khater MM, Khayat Kashani HR, Khubchandani J, Kim H, Kim MS, Kimokoti RW, Kissoon N, Kochhar S, Kompani F, Kosen S, Koul PA, Koulmane Laxminarayana SL, Krapp Lopez F, Krishan K, Krishnamoorthy V, Kulkarni V, Kumar N, Kurmi OP, Kuttikkattu A, Kyu HH, Lal DK, Lám J, Landires I, Lasrado S, Lee SW, Lenzi J, Lewycka S, Li S, Lim SS, Liu W, Lodha R, Loftus MJ, Lohiya A, Lorenzovici L, Lotfi M, Mahmoodpoor A, Mahmoud MA, Mahmoudi R, Majeed A, Majidpoor J, Makki A, Mamo GA, Manla Y, Martorell M, Matei CN, McManigal B, Mehrabi Nasab E, Mehrotra R, Melese A, Mendoza-Cano O, Menezes RG, Mentis AFA, Micha G, Michalek IM, Micheletti Gomide Nogueira de Sá AC, Milevska Kostova N, Mir SA, Mirghafourvand M, Mirmoeeni S, Mirrakhimov EM, Mirza-Aghazadeh-Attari M, Misganaw AS, Misganaw A, Misra S, Mohammadi E, Mohammadi M, Mohammadian-Hafshejani A, Mohammed S, Mohan S, Mohseni M, Mokdad AH, Momtazmanesh S, Monasta L, Moore CE, Moradi M, Moradi Sarabi M, Morrison SD, Motaghinejad M, Mousavi Isfahani H, Mousavi Khaneghah A, Mousavi-Aghdas SA, Mubarik S, Mulita F, Mulu GBB, Munro SB, Muthupandian S, Nair TS, Naqvi AA, Narang H, Natto ZS, Naveed M, Nayak BP, Naz S, Negoi I, Nejadghaderi SA, Neupane Kandel S, Ngwa CH, Niazi RK, Nogueira de Sá AT, Noroozi N, Nouraei H, Nowroozi A, Nuñez-Samudio V, Nutor JJ, Nzoputam CI, Nzoputam OJ, Oancea B, Obaidur RM, Ojha VA, Okekunle AP, Okonji OC, Olagunju AT, Olusanya BO, Omar Bali A, Omer E, Otstavnov N, Oumer B, P A M, Padubidri JR, Pakshir K, Palicz T, Pana A, Pardhan S, Paredes JL, Parekh U, Park EC, Park S, Pathak A, Paudel R, Paudel U, Pawar S, Pazoki Toroudi H, Peng M, Pensato U, Pepito VCF, Pereira M, Peres MFP, Perico N, Petcu IR, Piracha ZZ, Podder I, Pokhrel N, Poluru R, Postma MJ, Pourtaheri N, Prashant A, Qattea I, Rabiee M, Rabiee N, Radfar A, Raeghi S, Rafiei S, Raghav PR, Rahbarnia L, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahmani AM, Rahmanian V, Ram P, Ranjha MMAN, Rao SJ, Rashidi MM, Rasul A, Ratan ZA, Rawaf S, Rawassizadeh R, Razeghinia MS, Redwan EMM, Regasa MT, Remuzzi G, Reta MA, Rezaei N, Rezapour A, Riad A, Ripon RK, Rudd KE, Saddik B, Sadeghian S, Saeed U, Safaei M, Safary A, Safi SZ, Sahebazzamani M, Sahebkar A, Sahoo H, Salahi S, Salahi S, Salari H, Salehi S, Samadi Kafil H, Samy AM, Sanadgol N, Sankararaman S, Sanmarchi F, Sathian B, Sawhney M, Saya GK, Senthilkumaran S, Seylani A, Shah PA, Shaikh MA, Shaker E, Shakhmardanov MZ, Sharew MM, Sharifi-Razavi A, Sharma P, Sheikhi RA, Sheikhy A, Shetty PH, Shigematsu M, Shin JI, Shirzad-Aski H, Shivakumar KM, Shobeiri P, Shorofi SA, Shrestha S, Sibhat MM, Sidemo NB, Sikder MK, Silva LMLR, Singh JA, Singh P, Singh S, Siraj MS, Siwal SS, Skryabin VY, Skryabina AA, Socea B, Solomon DD, Song Y, Sreeramareddy CT, Suleman M, Suliankatchi Abdulkader R, Sultana S, Szócska M, Tabatabaeizadeh SA, Tabish M, Taheri M, Taki E, Tan KK, Tandukar S, Tat NY, Tat VY, Tefera BN, Tefera YM, Temesgen G, Temsah MH, Tharwat S, Thiyagarajan A, Tleyjeh II, Troeger CE, Umapathi KK, Upadhyay E, Valadan Tahbaz S, Valdez PR, Van den Eynde J, van Doorn HR, Vaziri S, Verras GI, Viswanathan H, Vo B, Waris A, Wassie GT, Wickramasinghe ND, Yaghoubi S, Yahya GATY, Yahyazadeh Jabbari SH, Yigit A, Yiğit V, Yon DK, Yonemoto N, Zahir M, Zaman BA, Zaman SB, Zangiabadian M, Zare I, Zastrozhin MS, Zhang ZJ, Zheng P, Zhong C, Zoladl M, Zumla A, Hay SI, Dolecek C, Sartorius B, Murray CJL, Naghavi M. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 400:2221-2248. [PMID: 36423648 PMCID: PMC9763654 DOI: 10.1016/s0140-6736(22)02185-7] [Citation(s) in RCA: 443] [Impact Index Per Article: 221.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/13/2022] [Accepted: 11/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. METHODS We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. FINDINGS From an estimated 13·7 million (95% UI 10·9-17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7-10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2-18·1) of all global deaths and 56·2% (52·1-60·1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54·9% (52·9-56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4-71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. INTERPRETATION The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund.
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The Effect of Face Mask, Air Temperature, and Humidity on COVID-19 Transmission: A Systematic Review and Meta-analysis. HEALTH SCOPE 2022. [DOI: 10.5812/jhealthscope-129121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Context: At the beginning of the COVID-19 pandemic, the effects of personal protective equipment (PPE) such as face masks, as well as environmental conditions, including temperature and humidity changes, were discussed due to the lack of effective medicine. Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) were implemented to conduct the present systematic review. The articles were selected from papers published by May 2020 in PubMed, Web of Science, Science Direct, Scopus, and Google Scholar databases. This meta-analysis estimated relative risk (RR) and pooled mean depicted as effect size (ES) using the random or fixed effects methods. Results: Ten studies met inclusion criteria, four of which addressed the effect of face masks and six of which dealt with temperature and humidity changes. This eta-analysis study showed that wearing face masks against the COVID-19 virus had a remarkable safety impact with RR (%95 CI) 8.56 (2.10 - 34.90), (I2 = %0.0 P = 0.999), and the pooled mean changes in temperature and humidity were estimated to be with ES (%95 CI) 9.03 (4.32 - 13.74), (I2 = %99.7, P = 0.0001) and with ES (%95 CI) 56.82 (46.12 - 67.51), ( I2 = %99.3, P = 0.0001) during the outbreak of the COVID-19. Conclusions: The findings of this systematic review and meta-analysis illustrate the effectiveness of face masks, in general, in preventing the transmission of the COVID-19 virus. According to the findings, temperature and humidity changes do not increase the outbreak of the COVID-19 virus.
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Berhanu A, Mengistu DA, Temesgen LM, Mulat S, Dirirsa G, Alemu FK, Mangasha AE, Gobena T, Geremew A. Hand washing practice among public primary school children and associated factors in Harar town, eastern Ethiopia: An institution-based cross-sectional study. Front Public Health 2022; 10:975507. [PMID: 36408055 PMCID: PMC9670311 DOI: 10.3389/fpubh.2022.975507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background Hand washing with soap and water reduces the risk of diarrheal episode by 28-48% and acute respiratory infection by 20-50%. However, there is limited evidence on hand washing practices among students in Eastern Ethiopia, particularly in Harari town. Therefore, this study aimed to determine hand washing practice among primary school students and associated factors in Harar town, Eastern Ethiopia. Methods An institution-based cross-sectional study was applied among 670 students in Harar town from June 1 to 30, 2021. A multi-stage sampling was employed; 6 out of 20 schools were selected through simple random sampling, while eligible children from each school was selected by probability proportional to size sampling method. Data were collected using a pre-tested questionnaire with a face-to-face interview technique and via observation. The data were analyzed using SPSS software version 23. Binary and mult-variable analysis were used to determine the association between factors and outcome variable. Finally, a p-value of < 0.05 was considered to declare a statistically significant association. Results A total of 670 participants were included in the study, of which 248 (37.0%) had washed their hands [95% CI: 33.3-40.06]. Being in grade 8 Adjusted Odd Ratio[AOR = 4.9; 95% Confidence Interval (CI): 2.28-10.52], living in an urban area [AOR = 3.49; 95% CI: 1.29-9.40], having role models (parents [AOR = 4.41; 95% CI: 1.79-10.86], teachers [AOR = 3.69; 95% CI: 1.39-8.81], and health professionals [AOR = 3.17, 95% CI: 1.17-8.63]), availability of hand washing facility [AOR = 3.62; 95% CI: 1.57-8.34], access to soap and water [AOR = 2.89; 95% CI: 1.39-5.98] and being membership of water sanitation and hygiene (WASH) club [AOR = 2.39; 95% CI: 1.41-4.03] were found to be significantly associated with hand washing practice. Conclusions The current study found that nearly a third of students practiced proper hand washing. Hand washing practice was influenced by students' grade level, residence, referents (role models for hand washing), presence of a hand washing facility, access to water and soap, and membership of WASH club. Therefore, the finding revealed that there is a need to improve hand-washing practices in schools by concerned agencies.
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Affiliation(s)
- Ashenafi Berhanu
- Department Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,*Correspondence: Ashenafi Berhanu
| | - Dechasa Adare Mengistu
- Department Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Liku Muche Temesgen
- Department Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Salie Mulat
- Department Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gebisa Dirirsa
- Department Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fekade Ketema Alemu
- Department Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Tesfaye Gobena
- Department Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Geremew
- Department Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Baker MG, Gurney J, Moreland NJ, Bennett J, Oliver J, Williamson DA, Pierse N, Wilson N, Merriman TR, Percival T, Jackson C, Edwards R, Mow FC, Thomson WM, Zhang J, Lennon D. Risk factors for acute rheumatic fever: A case-control study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 26:100508. [PMID: 36213134 PMCID: PMC9535428 DOI: 10.1016/j.lanwpc.2022.100508] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain an inequitable cause of avoidable suffering and early death in many countries, including among Indigenous Māori and Pacific populations in New Zealand. There is a lack of robust evidence on interventions to prevent ARF. This study aimed to identify modifiable risk factors, with the goal of producing evidence to support policies and programs to decrease rates of ARF. METHODS A case-control study was undertaken in New Zealand using hospitalised, first episode ARF cases meeting a standard case-definition. Population controls (ratio of 3:1) were matched by age, ethnicity, socioeconomic deprivation, location, sex, and recruitment month. A comprehensive, pre-tested questionnaire was administered face-to-face by trained interviewers. FINDINGS The study included 124 cases and 372 controls. Multivariable analysis identified strong associations between ARF and household crowding (OR 3·88; 95%CI 1·68-8·98) and barriers to accessing primary health care (OR 2·07; 95% CI 1·08-4·00), as well as a high intake of sugar-sweetened beverages (OR 2·00; 1·13-3·54). There was a marked five-fold higher ARF risk for those with a family history of ARF (OR 4·97; 95% CI 2·53-9·77). ARF risk was elevated following self-reported skin infection (aOR 2·53; 1·44-4·42) and sore throat (aOR 2·33; 1·49-3·62). INTERPRETATION These globally relevant findings direct attention to the critical importance of household crowding and access to primary health care as strong modifiable causal factors in the development of ARF. They also support a greater focus on the role of managing skin infections in ARF prevention. FUNDING This research was funded by the Health Research Council of New Zealand (HRC) Rheumatic Fever Research Partnership (supported by the New Zealand Ministry of Health, Te Puni Kōkiri, Cure Kids, Heart Foundation, and HRC) award number 13/959.
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Affiliation(s)
- Michael G. Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
- Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J. Moreland
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jane Oliver
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Victoria, Australia
| | - Deborah A. Williamson
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nigel Wilson
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland, New Zealand
- Green Lane Paediatric and Congenital Cardiac Services, Auckland, New Zealand
| | - Tony R. Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, United States of America
| | - Teuila Percival
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Moana Research, Auckland, New Zealand
| | | | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | | | - Jane Zhang
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Lennon
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Soboksa NE. Environmental and Behavioral Factors Associated With Handwashing With Soap After Defecation in a Rural Setting of 2 Districts of the Jimma Zone, Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221091421. [PMID: 35431553 PMCID: PMC9008808 DOI: 10.1177/11786302221091421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Handwashing with soap can prevent the spread of fecal oral microbes in the home environment. Despite the lack of water and for a variety of reasons, soap-based handwashing is not practiced in developing countries after defecation. OBJECTIVE The objective of the study was to determine the environmental and behavioral factors associated with hand washing with soap after defecation of respondents with children under the age of 5 years in a rural setting. METHODS Data used were taken from 756 households with children under the age of 5 that participated in a cross-sectional study conducted from July 22 to August 9, 2018, in 2 selected districts in the Jimma Zone, Southwest Ethiopia. It included post-defecation hand washing with soap and other variables such as sociodemographic information, environmental and behavioral factors. Stata version 16 was used to analyze the data. We use binary logistic regression models. To declare statistical significance, a P-value of less than .05 with an adjusted odds ratio and a confidence interval of 95% was used. RESULTS The prevalence of soap-based post defecation hand washing practices among respondents was 64.4%. Hand washing practice after defecation with soap has a significant association with having more than 1 child under 5 years of age (AOR = 1.60; 95% CI: 1.05-2.45), households living with cattle (AOR = 2.00; 95% CI: 1.30-3.07), use of unimproved latrine (AOR = 0.55; 95%CI: 0.31-0.98), with the presence of feces in the compound of the households interviewed (AOR = 7.08; 95% CI: 4.07-12.35) and regular cleaning water containers before filling drinking water (AOR = 2.16; 95% CI: 1.13-4.15). CONCLUSIONS Most of the study participants washed their hands with soap after defecation. The presence of feces in the compound, having more than 1 child, living with cattle, and cleaning water containers routinely before filling drinking water all enhanced post-defecation handwashing with soap. However, when using unimproved latrines, respondents' post-defecation handwashing behavior with soap may be significantly reduced.
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Affiliation(s)
- Negasa Eshete Soboksa
- Negasa Eshete Soboksa, Department of
Environmental Health, College of Health Sciences and Medicine, Dilla University,
P.O.Box 419 Dilla, Ethiopia.
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Guan X, Lan T, Liao W, Wu X, Pan J. Exploring the effect of the primary care health workers number on infectious diarrhea morbidity and where the health resources should go. Sci Rep 2022; 12:6060. [PMID: 35411117 PMCID: PMC9001693 DOI: 10.1038/s41598-022-10060-y] [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: 04/28/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
We aimed to explore the association between the number of primary healthcare workers and infectious diarrhea morbidity at community levels and to provide evidence-based implications for optimizing primary healthcare manpower resource allocations. We collected annual infectious diarrhea morbidity and relevant data of 4321 communities in Sichuan Province, China, from 2017 to 2019. Global and local Moran’s I were calculated to detect the spatial clustering of infectious diarrhea morbidity and to identify areas where increased primary healthcare manpower resources should be allocated. The spatial lag fixed effects panel data model was adopted to explore the association between the number of primary healthcare workers per 1000 residents and infectious diarrhea morbidity. Significantly high–high and low–low clusters of infectious diarrhea cases were found to be mainly distributed in underdeveloped and developed areas during the studied period years, respectively. The infectious diarrhea morbidity was found to be statistically negatively associated with the number of primary healthcare workers per 1000 residents with a coefficient of − 0.172, indicating that a 0.172 reduction of infectious diarrhea morbidity (1/10,000) was associated with doubled amounts of primary healthcare workers per 1000 residents. Our findings highlighted the role of primary healthcare in the process of infectious diarrhea prevention and control, and implied that constant efforts should be addressed to facilitate infectious diarrhea prevention and control, especially in the underdeveloped areas.
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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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Ofori SK, Hung YW, Schwind JS, Muniz-Rodriguez K, Kakou RJ, Alade SE, Diallo K, Sullivan KL, Cowling BJ, Fung ICH. The use of digital technology to improve and monitor handwashing among children 12 years or younger in educational settings: a scoping review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:547-564. [PMID: 32579032 DOI: 10.1080/09603123.2020.1784398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
Our scoping review aimed to identify and describe the application of digital technology in hand hygiene research among children in educational settings. We searched for articles in PubMed, IEEE Xplore, and Web of Science. Original hand hygiene research with a form of digital technology used among children ≤12 years in educational settings was eligible for inclusion. Twelve studies met the eligibility criteria and the data were extracted by two teams of independent co-authors for narrative synthesis. Ten studies used digital technology as an intervention tool and two for monitoring purposes. Three main digital technologies were identified including computer games (n = 2), videos (n = 8), and video cameras (n = 2). Digital technologies found in our scoping review were reported to be effective in hand hygiene studies over short temporal periods especially when used in combination with other measures. Future research may demonstrate the effectiveness of digital technology in helping children develop sustainable handwashing behaviors.
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Affiliation(s)
- Sylvia K Ofori
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Yuen Wai Hung
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Jessica S Schwind
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Kamalich Muniz-Rodriguez
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Reece J Kakou
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Sunmisola E Alade
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Kadiatou Diallo
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Kelly L Sullivan
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - I C H Fung
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
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Sylvia S, Ma X, Shi Y, Rozelle S. Ordeal mechanisms, information, and the cost-effectiveness of strategies to provide subsidized eyeglasses. JOURNAL OF HEALTH ECONOMICS 2022; 82:102594. [PMID: 35193056 PMCID: PMC9811338 DOI: 10.1016/j.jhealeco.2022.102594] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 05/14/2023]
Abstract
The cost-effectiveness of policies providing subsidized health goods is often compromised by limited use of the goods provided. Through a randomized trial involving 251 primary schools in western China, we tested two approaches to improve the cost-effectiveness of a program distributing free eyeglasses to myopic children. Relative to delivery of free eyeglasses to schools, we find that providing vouchers redeemable in local optical shops modestly improved the targeting of eyeglasses to those who would use them without reducing effective coverage. Information provided through a health education campaign increased eyeglass use when eyeglasses were delivered to schools, but had no effect when requiring voucher redemption or when families were only given a prescription for eyeglasses to be purchased on the market. Though most expensive, free delivery to schools with a health education campaign was the most socially cost-effective approach tested and increased effective coverage of eyeglasses by 18.5 percentage points after seven months.
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Affiliation(s)
- Sean Sylvia
- University of North Carolina at Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, United States.
| | - Xiaochen Ma
- Peking University, 112 Shu Wahh Building, 38 XueYuan Road, Haidian District, Beijing 100191, China.
| | - Yaojiang Shi
- Shaanxi Normal University, 620 Chang'an Road West, Xi'an 710119, China.
| | - Scott Rozelle
- Stanford University, 616 Serra Street, Encina Hall East Wing, Room 401, Stanford, CA 94305, United States.
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Krishna N, Ramesh A, Hegde AM. Knowledge, Attitude, and Practice Toward Mask-Wearing Behaviors During Covid-19 Pandemic Among Mangalore Residents: A Cross-Sectional Study. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0041-1741414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Objectives The objective of this study is to assess the knowledge, awareness, and practice toward mask-wearing behaviors of Mangalore residents during the coronavirus disease 2019 (COVID-19) outbreak.
Materials and Methods This survey was conducted at A B Shetty Memorial Institute of Dental Sciences in Mangalore. The questionnaire consisted of 18 questions that were prepared as an online form (Google Forms), and a total of 172 responses were received among the residents of Mangalore who visited the hospital.The questions were distributed based on knowledge, attitude, and practice regarding the mask-wearing behaviors, and the distribution of responses was presented as frequency and percentages. Prior to the inception of the study, the nature and purpose of the study were explained to each respondent, and informed consent was obtained by all participants in this study.Statistical analysis was done using SPSS software version 23.
Results It was evident that the COVID-19 knowledge scores were found to be significantly associated with a lower likelihood of negative attitudes and potentially dangerous practices toward the COVID-19 epidemic in this study. These findings clearly indicate the importance of improving residents' COVID-19 knowledge via health education, which may also result in improvements in their attitudes and practices toward COVID-19.
Conclusion In summary, our findings suggest that Mangalore residents have fair knowledge and optimistic attitudes, despite the current lockdown measures undertaken during the second wave of COVID-19, The positivity rate in Mangalore has not reduced satisfactorily. Self-protection, testing, and vaccination would help to reduce the spread and mortality rate due to coronavirus. The residents of Mangalore should abide by the COVID -19 preventive measures and implement this knowledge into their daily practices.
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Affiliation(s)
- Nidhish Krishna
- Department of Pediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed-to-be-University), Mangalore, Karnataka, India
| | - Athul Ramesh
- Department of Pediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed-to-be-University), Mangalore, Karnataka, India
| | - Amitha M. Hegde
- Department of Pediatric and Preventive Dentistry, A B Shetty Memorial Institute of Dental Sciences, Nitte (Deemed-to-be-University), Mangalore, Karnataka, India
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Gastaldi A, Donà D, Barbieri E, Giaquinto C, Bont LJ, Baraldi E. COVID-19 Lesson for Respiratory Syncytial Virus (RSV): Hygiene Works. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121144. [PMID: 34943339 PMCID: PMC8700687 DOI: 10.3390/children8121144] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 02/05/2023]
Abstract
Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections (LRTIs) in infants worldwide. The global direct medical cost associated with RSV LRTIs reaches billions of dollars, with the highest burden in low–middle-income countries. Many efforts have been devoted to improving its prevention and management, including both non-pharmaceutical and pharmaceutical strategies, often with limited routine use in high-income countries due to high costs. During the ongoing COVID-19 pandemic, a dramatic decrease in RSV infections (up to 70–90%) has been reported around the globe, directly related to the implementation of containment measures (face masks, hand hygiene, and social distancing). Primary prevention has demonstrated the highest cost effectiveness ratio in reducing the burden of a respiratory infection such as RSV, never reached before. Thus, we emphasize the importance of non-pharmaceutical preventive hygiene measures that should be implemented and maintained even after the COVID-19 outbreak.
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Affiliation(s)
- Andrea Gastaldi
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (A.G.); (E.B.); (C.G.)
- Department of Pediatrics, Woman and Child Hospital, University of Verona, 37126 Verona, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (A.G.); (E.B.); (C.G.)
- Correspondence:
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (A.G.); (E.B.); (C.G.)
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy; (A.G.); (E.B.); (C.G.)
| | - Louis J. Bont
- Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
- Respiratory Syncytial Virus Network (ReSViNET) Foundation, 3703 CD Zeist, The Netherlands
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University of Padua, 35128 Padua, Italy;
- Fondazione Istituto di Ricerca Pediatrica, 35127 Padua, Italy
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Gothankar J, Pore P, Dhumale G, Doke P, Lalwani S, Quraishi S, Murarkar K S, Patil R, Waghachavare V, Dhobale R, Rasote K, Palkar S. Effect of Behavior Change Communication on the Incidence of Pneumonia in Under Five Children: A Cluster Randomized Controlled Trial. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Amon-Tanoh MA, McCambridge J, Blon PK, Kouamé HA, Nguipdop-Djomo P, Biran A, Cousens S. Effects of a social norm-based handwashing intervention including handwashing stations, and a handwashing station-only intervention on handwashing with soap in urban Côte d'Ivoire: a cluster randomised controlled trial. Lancet Glob Health 2021; 9:e1707-e1718. [DOI: 10.1016/s2214-109x(21)00387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 06/18/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
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Chirgwin H, Cairncross S, Zehra D, Sharma Waddington H. Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1194. [PMID: 36951806 PMCID: PMC8988822 DOI: 10.1002/cl2.1194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Background Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vulnerable populations, especially for women and girls. The hardest hit regions are sub-Saharan Africa and South Asia. Sustainable Development Goal (SDG) 6 calls for the end of open defecation, and universal access to safely managed water and sanitation facilities, and basic hand hygiene, by 2030. WASH access and use also underpin progress in other areas such as SDG1 poverty targets, SDG3 health and SDG4 education targets. Meeting the SDG equity agenda to "leave none behind" will require WASH providers prioritise the hardest to reach including those living remotely and people who are disadvantaged. Objectives Decision makers need access to high-quality evidence on what works in WASH promotion in different contexts, and for different groups of people, to reach the most disadvantaged populations and thereby achieve universal targets. The WASH evidence map is envisioned as a tool for commissioners and researchers to identify existing studies to fill synthesis gaps, as well as helping to prioritise new studies where there are gaps in knowledge. It also supports policymakers and practitioners to navigate the evidence base, including presenting critically appraised findings from existing systematic reviews. Methods This evidence map presents impact evaluations and systematic reviews from the WASH sector, organised according to the types of intervention mechanisms, WASH technologies promoted, and outcomes measured. It is based on a framework of intervention mechanisms (e.g., behaviour change triggering or microloans) and outcomes along the causal pathway, specifically behavioural outcomes (e.g., handwashing and food hygiene practices), ill-health outcomes (e.g., diarrhoeal morbidity and mortality), nutrition and socioeconomic outcomes (e.g., school absenteeism and household income). The map also provides filters to examine the evidence for a particular WASH technology (e.g., latrines), place of use (e.g., home, school or health facility), location (e.g., global region, country, rural and urban) and group (e.g., people living with disability). Systematic searches for published and unpublished literature and trial registries were conducted of studies in low- and middle-income countries (LMICs). Searches were conducted in March 2018, and searches for completed trials were done in May 2020. Coding of information for the map was done by two authors working independently. Impact evaluations were critically appraised according to methods of conduct and reporting. Systematic reviews were critically appraised using a new approach to assess theory-based, mixed-methods evidence synthesis. Results There has been an enormous growth in impact evaluations and systematic reviews of WASH interventions since the International Year of Sanitation, 2008. There are now at least 367 completed or ongoing rigorous impact evaluations in LMICs, nearly three-quarters of which have been conducted since 2008, plus 43 systematic reviews. Studies have been done in 83 LMICs, with a high concentration in Bangladesh, India, and Kenya. WASH sector programming has increasingly shifted in focus from what technology to supply (e.g., a handwashing station or child's potty), to the best way in which to do so to promote demand. Research also covers a broader set of intervention mechanisms. For example, there has been increased interest in behaviour change communication using psychosocial "triggering", such as social marketing and community-led total sanitation. These studies report primarily on behavioural outcomes. With the advent of large-scale funding, in particular by the Bill & Melinda Gates Foundation, there has been a substantial increase in the number of studies on sanitation technologies, particularly latrines. Sustaining behaviour is fundamental for sustaining health and other quality of life improvements. However, few studies have been done of intervention mechanisms for, or measuring outcomes on sustained adoption of latrines to stop open defaecation. There has also been some increase in the number of studies looking at outcomes and interventions that disproportionately affect women and girls, who quite literally carry most of the burden of poor water and sanitation access. However, most studies do not report sex disaggregated outcomes, let alone integrate gender analysis into their framework. Other vulnerable populations are even less addressed; no studies eligible for inclusion in the map were done of interventions targeting, or reporting on outcomes for, people living with disabilities. We were only able to find a single controlled evaluation of WASH interventions in a health care facility, in spite of the importance of WASH in health facilities in global policy debates. The quality of impact evaluations has improved, such as the use of controlled designs as standard, attention to addressing reporting biases, and adequate cluster sample size. However, there remain important concerns about quality of reporting. The quality and usefulness of systematic reviews for policy is also improving, which draw clearer distinctions between intervention mechanisms and synthesise the evidence on outcomes along the causal pathway. Adopting mixed-methods approaches also provides information for programmes on barriers and enablers affecting implementation. Conclusion Ensuring everyone has access to appropriate water, sanitation, and hygiene facilities is one of the most fundamental of challenges for poverty elimination. Researchers and funders need to consider carefully where there is the need for new primary evidence, and new syntheses of that evidence. This study suggests the following priority areas:Impact evaluations incorporating understudied outcomes, such as sustainability and slippage, of WASH provision in understudied places of use, such as health care facilities, and of interventions targeting, or presenting disaggregated data for, vulnerable populations, particularly over the life-course and for people living with a disability;Improved reporting in impact evaluations, including presentation of participant flow diagrams; andSynthesis studies and updates in areas with sufficient existing and planned impact evaluations, such as for diarrhoea mortality, ARIs, WASH in schools and decentralisation. These studies will preferably be conducted as mixed-methods systematic reviews that are able to answer questions about programme targeting, implementation, effectiveness and cost-effectiveness, and compare alternative intervention mechanisms to achieve and sustain outcomes in particular contexts, preferably using network meta-analysis.
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Affiliation(s)
- Hannah Chirgwin
- International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
| | | | | | - Hugh Sharma Waddington
- London School of Hygiene and Tropical Medicine and International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
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Association between Handwashing Behavior and Infectious Diseases among Low-Income Community Children in Urban New Delhi, India: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312535. [PMID: 34886261 PMCID: PMC8657428 DOI: 10.3390/ijerph182312535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 01/02/2023]
Abstract
Diarrheal diseases and respiratory infections (RI) are two leading causes of childhood mortality in low and middle-income countries. Effective handwashing at critical time-points may mitigate these diseases. However, there is a lack of published data investigating this association in school-aged children in India. This study is part of a larger prospective handwashing intervention study in a low-income community in New Delhi, India examining the associations between handwashing behavior and diarrhea and RI in schoolchildren. This current study reports the findings of the baseline survey administered to 272 mother–child dyads. Children aged 8–12 years, and their mothers, were recruited from six schools. A baseline questionnaire was used to collect sociodemographic data, handwash behavior, and mother-reported recent diarrhea and RI incidence among the children. Handwashing before and after preparing food, after defecation, and after cleaning dishes significantly reduced the odds of diarrhea by over 70%, and of RI by over 56%. Using a clean cloth after handwashing lowered odds of diarrhea and RI by 72% and 63% respectively. Around 60% of the participants believed that handwashing could prevent diarrhea and RI in their children. There was a low prevalence of handwashing at critical time-points and a poor perception regarding handwashing benefits. To improve handwashing behavior, hygiene promotion programs need to understand what motivates and hinders handwashing in vulnerable populations.
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Chan EYY, Tong KHY, Dubois C, Mc Donnell K, Kim JH, Hung KKC, Kwok KO. Narrative Review of Primary Preventive Interventions against Water-Borne Diseases: Scientific Evidence of Health-EDRM in Contexts with Inadequate Safe Drinking Water. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312268. [PMID: 34885995 PMCID: PMC8656607 DOI: 10.3390/ijerph182312268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/22/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Waterborne diseases account for 1.5 million deaths a year globally, particularly affecting children in low-income households in subtropical areas. It is one of the most enduring and economically devastating biological hazards in our society today. The World Health Organization Health Emergency and Disaster Risk Management (health-EDRM) Framework highlights the importance of primary prevention against biological hazards across all levels of society. The framework encourages multi-sectoral coordination and lessons sharing for community risk resilience. A narrative review, conducted in March 2021, identified 88 English-language articles published between January 2000 and March 2021 examining water, sanitation, and hygiene primary prevention interventions against waterborne diseases in resource-poor settings. The literature identified eight main interventions implemented at personal, household and community levels. The strength of evidence, the enabling factors, barriers, co-benefits, and alternative measures were reviewed for each intervention. There is an array of evidence available across each intervention, with strong evidence supporting the effectiveness of water treatment and safe household water storage. Studies show that at personal and household levels, interventions are effective when applied together. Furthermore, water and waste management will have a compounding impact on vector-borne diseases. Mitigation against waterborne diseases require coordinated, multi-sectoral governance, such as building sanitation infrastructure and streamlined waste management. The review showed research gaps relating to evidence-based alternative interventions for resource-poor settings and showed discrepancies in definitions of various interventions amongst research institutions, creating challenges in the direct comparison of results across studies.
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Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, Hong Kong, China;
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-2252-8850
| | - Kimberley Hor Yee Tong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
| | - Caroline Dubois
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
| | | | - Jean H. Kim
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, Hong Kong, China;
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Kin On Kwok
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong, China
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Handwashing Knowledge, Attitudes, and Practices among Students in Eastern Province Schools, Saudi Arabia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:6638443. [PMID: 34567132 PMCID: PMC8457965 DOI: 10.1155/2021/6638443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/23/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
Background. Lack of knowledge about appropriate handwashing practices has caused great concerns for human health, especially in the risk of many communicable diseases. The objective of the current study is to determine the level of handwashing knowledge, attitudes, and practices among school students in Eastern Province Schools, Saudi Arabia. A cross-sectional survey was recruited from November 2019 to March 2020 to assess the level of the students' handwashing knowledge. A reliable questionnaire was prepared (Cronbach's alpha = 0.608) and conducted using a two-stage sampling technique. A total of 271 students participated in the study from primary, middle, and high schools; 80% were boys, most of whom displayed an acceptable level of knowledge on hand hygiene. Nearly 75% and 74% of boys and girls, respectively, gained knowledge about hand hygiene practices from their parents. Only 46% of the students thought that handwashing is a potential protective measure against diseases, whereas 34% thought it only removes dirt. Prevalence of handwashing with soap after using the toilet was recognized among 52% of the students. Additionally, 93% of the students used water and soap to wash their hands (p value < 0.001) and 97% suggested that soap and water are the best methods to wash their hands (p value < 0.001). There was a positive correlation between the mother's education and hand hygiene practices (p value = 0.044). Results collectively indicated that handwashing knowledge and practices among school students in the Eastern Province are acceptable interventions in preventing the transmission of infectious diseases such as COVID-19. Indeed, further improvement conducted through specific health education programs to emphasize the role of handwashing in health hygiene is highly recommended.
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Nishioka Y, Nagano K, Koga Y, Okada Y, Mori I, Hayase A, Mori T, Manabe K. Lactic acid as a major contributor to hand surface infection barrier and its association with morbidity to infectious disease. Sci Rep 2021; 11:18608. [PMID: 34545150 PMCID: PMC8452697 DOI: 10.1038/s41598-021-98042-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023] Open
Abstract
Although the surface of the human hands contains high antimicrobial activity, studies investigating the precise components involved and the relationship between natural antimicrobial activity and morbidity in infectious diseases are limited. In this study, we developed a method to quantitatively measure the antimicrobial activity of hand surface components. Using a clinical survey, we validated the feasibility of our method and identified antimicrobial factors on the surface of the human hand. In a retrospective observational study, we compared the medical histories of the participants to assess infectious diseases. We found that the antimicrobial activity on the surface of the hands was significantly lower in the high morbidity group (N = 55) than in the low morbidity group (N = 54), indicating a positive association with the history of infection in individuals. A comprehensive analysis of the hand surface components indicated that organic acids, especially lactic acid and antimicrobial peptides, are highly correlated with antimicrobial activity. Moreover, the application of lactic acid using the amount present on the surface of the hand significantly improved the antimicrobial activity. These findings suggest that hand hygiene must be improved to enhance natural antimicrobial activity on the surface of the hands.
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Affiliation(s)
- Yuki Nishioka
- Personal Health Care Products Research, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501, Japan
| | - Kenichi Nagano
- Analytical Science Laboratories, Kao Corporation, 2606 Akabane, Ichikai, Haga, Tochigi, 321-3497, Japan
| | - Yoshitaka Koga
- Biological Science Laboratories, Kao Corporation, 2606 Akabane, Ichikai, Haga, Tochigi, 321-3497, Japan
| | - Yasuhiro Okada
- Personal Health Care Products Research, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501, Japan
| | - Ichiro Mori
- Personal Health Care Products Research, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501, Japan
| | - Atsuko Hayase
- Biological Science Laboratories, Kao Corporation, 2606 Akabane, Ichikai, Haga, Tochigi, 321-3497, Japan
| | - Takuya Mori
- Biological Science Laboratories, Kao Corporation, 2606 Akabane, Ichikai, Haga, Tochigi, 321-3497, Japan
| | - Kenji Manabe
- Personal Health Care Products Research, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501, Japan.
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Ijaz MK, Nims RW, de Szalay S, Rubino JR. Soap, water, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): an ancient handwashing strategy for preventing dissemination of a novel virus. PeerJ 2021; 9:e12041. [PMID: 34616601 PMCID: PMC8451441 DOI: 10.7717/peerj.12041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/02/2021] [Indexed: 12/23/2022] Open
Abstract
Public Health Agencies worldwide (World Health Organization, United States Centers for Disease Prevention & Control, Chinese Center for Disease Control and Prevention, European Centre for Disease Prevention and Control, etc.) are recommending hand washing with soap and water for preventing the dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. In this review, we have discussed the mechanisms of decontamination by soap and water (involving both removal and inactivation), described the contribution of the various components of formulated soaps to performance as cleansers and to pathogen inactivation, explained why adherence to recommended contact times is critical, evaluated the possible contribution of water temperature to inactivation, discussed the advantages of antimicrobial soaps vs. basic soaps, discussed the differences between use of soap and water vs. alcohol-based hand sanitizers for hand decontamination, and evaluated the limitations and advantages of different methods of drying hands following washing. While the paper emphasizes data applicable to SARS-CoV-2, the topics discussed are germane to most emerging and re-emerging enveloped and non-enveloped viruses and many other pathogen types.
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Affiliation(s)
- M. Khalid Ijaz
- Global Research & Development for Lysol and Dettol, Reckitt Benckiser LLC, Montvale, New Jersey, United States
- Department of Biology, Medgar Evers College of the City University of New York (CUNY), Brooklyn, New York, United States
| | - Raymond W. Nims
- RMC Pharmaceutical Solutions, Inc., Longmont, Colorado, United States
| | - Sarah de Szalay
- Global Research & Development for Lysol and Dettol, Reckitt Benckiser LLC, Montvale, New Jersey, United States
| | - Joseph R. Rubino
- Global Research & Development for Lysol and Dettol, Reckitt Benckiser LLC, Montvale, New Jersey, United States
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Establishing Healthy Personal Hygiene Habits with Young Children in Australia: A Cross-Sectional Mixed Methods Study. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Effective and consistent engagement in personal hygiene practices is important for preventing the acquisition and transmission of communicable diseases in childhood. This study aimed to investigate trends in adherence to recommended hygiene practices and identify factors contributing to difficulties in establishing good hygiene habits with young children (0–4 years) in Australia. A self-selected community sample of parents (N = 426) completed an online survey assessing children's adherence to recommended hygiene practices and barriers and enablers of establishing good personal hygiene habits. Parents reported interest in receiving information/tips on children's personal hygiene (yes/no) and nominated topics of interest. Less than half of children in any age group consistently (always/almost always) covered coughs and sneezes, washed hands after toileting, or washed hands before meals or when dirty. Children's non-compliance (i.e. resistance, refusal) was the most commonly reported barrier to establishing good personal hygiene habits, while children's compliance (i.e. cooperative behaviour, following or complying with caregivers’ instructions) was the most commonly cited enabler. Despite low levels of adherence, less than half (41.2%) of parents wanted information/tips on children's hygiene. Results suggest a disconnect between parents’ knowledge about recommended hygiene practices and actual behaviour. Development and testing of approaches to behaviour change that incorporate evidence-based strategies to manage children's resistance and support parents to encourage the development of healthy hygiene habits is warranted.
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Hayashi K, Mori I, Takeda K, Okada Y, Hayase A, Mori T, Nishioka Y, Manabe K. Analysis of hand environment factors contributing to the hand surface infection barrier imparted by lactic acid. Skin Res Technol 2021; 27:1135-1144. [PMID: 34532902 PMCID: PMC9293006 DOI: 10.1111/srt.13078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Organic acids on the surface of human hands contribute to the barrier against transient pathogens. This is the first study to explore the synergistic contribution of lactic acid and other hand environment-related features on the antibacterial properties of the hand surface. MATERIALS AND METHODS We estimated the contribution of fingerprint depth, skin pH, stratum corneum water content, skin temperature, and sweat rate of the hands to the infection barrier using an observational survey of 105 subjects. The relationship between each factor and the antibacterial activity of the hands was analyzed using Pearson's correlation coefficient. We performed molecular dynamics simulations to study the interaction between lactic acid and bacterial membranes. RESULTS The amount of lactic acid on the hands and skin temperature contributed positively to the antimicrobial activity (r = 0.437 and P = 3.18 × 10-6 , r = 0.500 and P = 5.66 × 10-8 , respectively), while the skin pH contributed negatively (r = -0.471, P = 3.99 × 10-7 ). The predicted value of the combined antimicrobial effect of these parameters was [antimicrobial activity] = 0.21 × [lactic acid] - 0.25 × [skin pH] + 0.26 × [skin temperature] + 0.98. The coefficient of determination (R2 ) was 0.50. CONCLUSION The increase in the amount of non-ionic lactic acid due to lower pH and improvement in the fluidity of the cell membrane due to higher temperatures enable the efficient transport of lactic acid into cells and subsequent antimicrobial activity. The proposed mechanism could help to develop an effective hand infection barrier technology.
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Affiliation(s)
- Kaori Hayashi
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
| | - Ichiro Mori
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
| | - Kouske Takeda
- Analytical Science Laboratories, Kao Corporation, Wakayama, Japan
| | - Yasuhiro Okada
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
| | - Atsuko Hayase
- Biological Science Laboratories, Kao Corporation, Tochigi, Japan
| | - Takuya Mori
- Biological Science Laboratories, Kao Corporation, Tochigi, Japan
| | - Yuki Nishioka
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
| | - Kenji Manabe
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
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Engelman D, Marks M, Steer AC, Beshah A, Biswas G, Chosidow O, Coffeng LE, Lardizabal Dofitas B, Enbiale W, Fallah M, Gasimov E, Hopkins A, Jacobson J, Kaldor JM, Ly F, Mackenzie CD, McVernon J, Parnaby M, Rainima-Qaniuci M, Sokana O, Sankara D, Yotsu R, Yajima A, Cantey PT. A framework for scabies control. PLoS Negl Trop Dis 2021; 15:e0009661. [PMID: 34473725 PMCID: PMC8412357 DOI: 10.1371/journal.pntd.0009661] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.
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Affiliation(s)
- Daniel Engelman
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | - Andrew C. Steer
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Abate Beshah
- Communicable Diseases, Neglected Tropical Diseases, WHO Regional Office for Africa, Brazzaville, Congo
| | - Gautam Biswas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Olivier Chosidow
- Faculté de Santé de Créteil et Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Belen Lardizabal Dofitas
- College of Medicine, University of the Philippines, Manila, Philippines
- Philippine Leprosy Mission, Inc., Manila, Philippines
| | - Wendemagegn Enbiale
- Department of Dermatovenerology, Bahir Dar University, Medicine and Health Science College, Addis Ababa, Ethiopia
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mosoka Fallah
- University of Liberia, Monrovia, Liberia
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Elkhan Gasimov
- Division of Country Health Programmes, Malaria, Neglected Tropical Diseases and Other Vector-borne Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Julie Jacobson
- Bridges to Development, Seattle, Washington, United States of America
| | - John M. Kaldor
- Public Health Interventions Research Group, Kirby Institute University of New South Wales, Sydney, Australia
| | - Fatimata Ly
- Dermatology Unit, EPS Institut d’Hygiéne Sociale de Dakar, Dakar, Senegal
- University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | | | - Jodie McVernon
- Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Infection Modelling, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Matthew Parnaby
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
| | | | | | - Dieudonne Sankara
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Rie Yotsu
- Tulane School of Public Health and Tropical Medicine, New Orleans, United States of America
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aya Yajima
- Division of Communicable Diseases, Medicines, Vaccines and Pharmaceuticals, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Paul T. Cantey
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Former Medical Officer, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Natnael T, Adane M, Alemnew Y, Andualem A, Hailu F. COVID-19 knowledge, attitude and frequent hand hygiene practices among taxi drivers and associated factors in urban areas of Ethiopia. PLoS One 2021; 16:e0253452. [PMID: 34359068 PMCID: PMC8346291 DOI: 10.1371/journal.pone.0253452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/06/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although several studies have been conducted on COVID-19 knowledge, attitude and prevention practices among healthcare workers and the general population, there has not been any study among taxi drivers in Ethiopia, including Dessie City and Kombolcha Town, the lack of which hinders providing evidence-based interventions to this target group. Thus, this study was designed to contribute to proper planning of COVID-19 intervention measures among taxi drivers in Dessie City and Kombolcha Town, Ethiopia. METHODS A cross-sectional study was conducted among 417 taxi drivers in Dessie City and Kombolcha Town during July to August, 2020. The data was collected using a structured questionnaire and an observational checklist. The collected data was checked, coded and entered to EpiData version 4.6 and exported to Statistical Package for the Social Sciences (SPSS) version 25.0 for data cleaning and analysis. The outcome variables of this study were good or poor knowledge, positive or negative attitude and good or poor frequent hand hygiene practices towards COVID-19. Bivariate (Crude Odds Ratio [COR]) and multivariable (Adjusted Odds Ratio [AOR]) logistic regression analysis were employed to identify factors significantly associated with good knowledge, positive attitude and good frequent hand hygiene practices among taxi drivers. Significance level of variables was declared at a p < 0.05 from the adjusted analysis. MAIN FINDINGS Out of the total 417 taxi drivers, 69.8% [95% CI: 65.2-73.9], 67.6% [95%CI: 63.1-72.2] and 66.4% [95% CI: 62.1-71.0] of the drivers had good knowledge, positive attitude and good frequent hand hygiene practices, respectively. Educational level (AOR = 7.55, 95% CI = 4.55-12.54), place of residence (AOR = 5.41, 95% CI = 1.4-20.08) and attitude towards COVID-19 prevention (AOR = 1.67, 95% CI = 1.02-2.74) were factors associated with good knowledge about COVID-19. Further, age of taxi drivers greater than 30 years (AOR = 3.01, 95% CI = 1.76-5.13), educational level of secondary or above (AOR = 3.16, 95% CI = 1.88-5.31), income (AOR = 3.36, 95% CI = 1.48-7.61), and knowledge about COVID-19 (AOR = 2.1, 95% CI = 1.21-3.54) were factors associated with positive attitude towards COVID-19 prevention. In addition, attitude towards COVID-19 (AOR = 5.5, 95% CI = 3.40-8.88) and educational level (AOR = 1.84, 95% CI = 1.15-2.95) were the factors associated with good frequent hand hygiene practices. CONCLUSION We concluded that the rates of good knowledge, positive attitude and good frequent hand hygiene practices were relatively low among taxi drivers in Dessie City and Kombolcha Town. We strongly recommended providing training about COVID-19 prevention measures for taxi drivers that considers age, education status and attitude areas essential to improve their knowledge, attitude and frequent hand hygiene practices to prevent the spread of COVID-19.
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Affiliation(s)
- Tarikuwa Natnael
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Metadel Adane
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yeshiwork Alemnew
- Department of Biology, College of Natural Sciences, Wollo University, Dessie, Ethiopia
| | - Atsedemariam Andualem
- Department of Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Faris Hailu
- Department of Biology, College of Natural Sciences, Wollo University, Dessie, Ethiopia
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Kim EJ, Lee HJ. Relationship between the Toothbrushing Behavior and Hand Hygiene Practices of Korean Adolescents: A Study Focused on the 15th Korea Youth Risk Behavior Survey Conducted in 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115913. [PMID: 34072944 PMCID: PMC8198789 DOI: 10.3390/ijerph18115913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/04/2022]
Abstract
Hand hygiene is one of the most important measures available to prevent infectious diseases such as COVID-19, and it is recommended that individuals wash their hands periodically before and after meals, after using toilets, before preparing food at home, at schools, and in public places. The aim of this study was to investigate the relationship between oral hygiene and hand hygiene in Korean adolescents. Data from 57,303 adolescents who participated in the 2019 Korea Youth Risk Behavior web-based survey were analyzed to determine the relationship between oral hygiene and hand hygiene. A complex sample logistic regression analysis was performed to determine association between toothbrushing behavior and handwashing practices. According to the results of this study, adolescents who brushed their teeth after lunch were 1.48 times more likely to practice handwashing before lunch than were those who did not brush their teeth after lunch (p < 0.001). In addition, the odds ratios adjusted for gender, grade, school type, and residence were found to be 1.87 (p < 0.001). Moreover, these adjusted odds ratios were higher in students who received personal hygiene education (OR: 1.98, p < 0.001). Oral hygiene practices were found to be related to personal hygiene, as assessed by handwashing, in Korean adolescents. Additional studies are needed to develop ways of improving the hygiene and health of adolescents.
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Affiliation(s)
- Eun-Jeong Kim
- Department of Dental hygiene, Gangdong University, Eumseong-gun 27600, Chungcheongbuk-do, Korea;
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul 03080, Gwanak-gu, Korea
| | - Hye-Ju Lee
- Department of Dental Hygiene, College of Health Science, Sun Moon University, Asan-si 31460, Chungcheongnam-do, Korea
- Correspondence: ; Tel.: +82-41-530-2761
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Gahlawat G, Tesfaye W, Bushell M, Abrha S, Peterson GM, Mathew C, Sinnollareddy M, McMillan F, Samarawickrema I, Calma T, Chang AY, Engelman D, Steer A, Thomas J. Emerging Treatment Strategies for Impetigo in Endemic and Nonendemic Settings: A Systematic Review. Clin Ther 2021; 43:986-1006. [PMID: 34053699 DOI: 10.1016/j.clinthera.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Impetigo affects approximately 162 million children worldwide at any given time. Lack of consensus on the most effective treatment strategy for impetigo and increasing antibiotic resistance continue to drive research into newer and alternative treatment options. We conducted a systematic review to assess the effectiveness of new treatments for impetigo in endemic and nonendemic settings. METHODS We searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that explored treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. We also searched online trial registries and hand-searched the reference lists of the included studies. We used the revised Cochrane risk of bias (version 2.0) tool for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies to assess the risk of bias. FINDINGS We included 10 studies that involved 6651 participants and reported on 9 treatments in the final analysis. Most clinical trials targeted nonbullous impetigo or did not specify this. The risk of bias varied among the studies. In nonendemic settings, ozenoxacin 1% cream appeared to have the strongest evidence base compared with retapamulin and a new minocycline formulation. In endemic settings, oral co-trimoxazole and benzathine benzylpenicillin G injection were equally effective in the treatment of severe impetigo. Mass drug administration intervention emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings. IMPLICATIONS This review highlights the limited research into new drugs used for the treatment of impetigo in endemic and nonendemic settings. Limited recent evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings, whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings. Given the troubling increase in resistance to existing treatments, there is a clear need to ensure the judicious use of antibiotics and to develop new treatments and alternative strategies; this is particularly important in endemic settings. PROSPERO identifier: CRD42020173042.
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Affiliation(s)
- Garima Gahlawat
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Wubshet Tesfaye
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Mary Bushell
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Solomon Abrha
- Faculty of Health, University of Canberra, Canberra, Australia; Mekelle University, Mekelle, Ethiopia
| | - Gregory M Peterson
- Faculty of Health, University of Canberra, Canberra, Australia; University of Tasmania, Hobart, Tasmania, Australia
| | - Cynthia Mathew
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Faye McMillan
- School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Bathurst, Australia
| | | | - Tom Calma
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Daniel Engelman
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Andrew Steer
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Canberra, Australia.
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Wyber R, Kelly A, Lee AM, Mungatopi V, Kerrigan V, Babui S, Black N, Wade V, Fitzgerald C, Peiris D, Ralph AP. Formative evaluation of a community-based approach to reduce the incidence of Strep A infections and acute rheumatic fever. Aust N Z J Public Health 2021; 45:449-454. [PMID: 34028929 DOI: 10.1111/1753-6405.13127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/01/2021] [Accepted: 04/01/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To explore the acceptability of a novel, outreached-based approach to improve primary and primordial prevention of Strep A skin sores, sore throats and acute rheumatic fever in remote Aboriginal communities. METHODS A comprehensive prevention program delivered by trained Aboriginal Community Workers was evaluated using approximately fortnightly household surveys about health and housing and clinical records. RESULTS Twenty-seven primary participants from three remote Aboriginal communities in the Northern Territory consented, providing 37.8 years of retrospective baseline data and 18.5 years of prospective data during the study period. Household members were considered to be secondary participants. Five Aboriginal Community Workers were trained and employed, delivering a range of supports to households affected by acute rheumatic fever including environmental health support and education. Clinical record audit and household self-report of Strep A infections were compared. No association between clinical- and self-report was identified. CONCLUSIONS Ongoing participation suggests this outreach-based prevention program was acceptable and associated with improved reporting of household maintenance issues and awareness of prevention opportunities for Strep A infections. Implications for public health: Biomedical, clinic-based approaches to the management of Strep A infections in remote communities can be usefully augmented by outreach-based supports delivered by Aboriginal Community Workers responding to community needs.
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Affiliation(s)
- Rosemary Wyber
- George Institute for Global Health, New South Wales.,Telethon Kids Institute, Western Australia
| | - Angela Kelly
- Menzies School of Health Research, Northern Territory
| | | | | | | | - Segora Babui
- Menzies School of Health Research, Northern Territory
| | - Nina Black
- Menzies School of Health Research, Northern Territory
| | - Vicki Wade
- Menzies School of Health Research, Northern Territory
| | - Christine Fitzgerald
- Northern Territory Government, Department of Territory Families, Housing and Communities
| | - David Peiris
- George Institute for Global Health, New South Wales
| | - Anna P Ralph
- Menzies School of Health Research, Northern Territory
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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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Solomon ET, Gari SR, Kloos H, Alemu BM. Handwashing effect on diarrheal incidence in children under 5 years old in rural eastern Ethiopia: a cluster randomized controlled trial. Trop Med Health 2021; 49:26. [PMID: 33757600 PMCID: PMC7989202 DOI: 10.1186/s41182-021-00315-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Handwashing with soap reduces diarrheal diseases burden considerably. However, the importance of handwashing in homes has received little attention in rural eastern Ethiopia. The effectiveness of handwashing may be reduced by lack of information on when and in what event hands must be washed, the frequency of handwashing, the individual who should wash his/her hands, and the procedure of handwashing. In these areas, indicators of adherence to handwashing are yet to be established. This study aimed at assessing the efficiency of handwashing on reducing diarrheal disease in children under 5 years old in rural kebeles of Dire Dawa, east Ethiopia. METHODS Community-based cluster randomized controlled trial was conducted in rural kebeles of Dire Dawa for 4 months starting from October 2018 to January 2019. Selected clusters were randomized in intervention and control arms using draw method and data collectors conducted the baseline survey. Households assigned to the intervention group were given two bars of plain soap on a bi-monthly basis together with information promoting hand hygiene. Control households were allowed to continue their habitual handwashing practices. We compared the diarrheal incidences of the intervention and non-intervention households. Generalized estimation equations using Poisson family and log choice of the link was employed to calculate adjusted incidence rate ratio with its 95% confidence interval. RESULTS We recorded a significant lesser diarrheal incidence in the handwashing arm than in the non-intervention arm (6.9 versus 13.8 episodes per 100 person weeks of observation). In all, there was a 41% reduction in diarrheal incidence in the intervention arm in relation to the non-intervention arm. CONCLUSION Handwashing with soap complemented with hand hygiene promotion significantly decreased diarrheal episodes in children under 5 years old in rural kebeles of Dire Dawa. We recommend the promotion and adaptation of washing hands using soap at recommended times to be an effective means of reducing childhood diarrhea morbidity in rural populations of Ethiopia towards achieving the Sustainable Development Goal 6. TRIAL REGISTRATION PACTR, PACTR201807815961394 . Registered 16 July 2018.
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Affiliation(s)
- Ephrem Tefera Solomon
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sirak Robele Gari
- Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Helmut Kloos
- San Francisco Medical Center, University of California, San Francisco, CA USA
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Wyber R, Wade V, Anderson A, Schreiber Y, Saginur R, Brown A, Carapetis J. Rheumatic heart disease in Indigenous young peoples. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:437-446. [PMID: 33705693 DOI: 10.1016/s2352-4642(20)30308-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 01/17/2023]
Abstract
Indigenous children and young peoples live with an inequitable burden of acute rheumatic fever and rheumatic heart disease. In this Review, we focus on the epidemiological burden and lived experience of these conditions for Indigenous young peoples in Australia, New Zealand, and Canada. We outline the direct and indirect drivers of rheumatic heart disease risk and their mitigation. Specifically, we identify the opportunities and limitations of predominantly biomedical approaches to the primary, secondary, and tertiary prevention of disease among Indigenous peoples. We explain why these biomedical approaches must be coupled with decolonising approaches to address the underlying cause of disease. Initiatives underway to reduce acute rheumatic fever and rheumatic heart disease in Australia, New Zealand, and Canada are reviewed to identify how an Indigenous rights-based approach could contribute to elimination of rheumatic heart disease and global disease control goals.
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Affiliation(s)
- Rosemary Wyber
- The George Institute for Global Health, Newtown, NSW, Australia.
| | - Vicki Wade
- RHDAustralia, Menzies School of Health Research, Darwin, NT, Australia
| | - Anneka Anderson
- Tomaiora Research Group, University of Auckland, Auckland, New Zealand
| | - Yoko Schreiber
- Section of Infectious Diseases, University of Manitoba, Clinical Sciences Division, Northern Ontario School of Medicine, ON, Canada
| | | | - Alex Brown
- South Australian Health and Medical Research Institute, University of Adelaide, SA, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth Children's Hospital, Perth, WA, Australia
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Safe Reopening of Schools during COVID-19: An Evaluation of Handwash Facilities and Students’ Hand Hygiene Knowledge and Practices. ACTA ACUST UNITED AC 2021. [DOI: 10.21601/ejeph/9704] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Islam M, Benjamin-Chung J, Sultana S, Unicomb L, Alam M, Rahman M, Ercumen A, Luby SP. Effectiveness of Mass Media Campaigns to Improve Handwashing-Related Behavior, Knowledge, and Practices in Rural Bangladesh. Am J Trop Med Hyg 2021; 104:1546-1553. [PMID: 33534770 PMCID: PMC8045613 DOI: 10.4269/ajtmh.20-1154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/16/2020] [Indexed: 11/07/2022] Open
Abstract
Water, sanitation, and handwashing interventions that use intensive interpersonal communication improve targeted behaviors, but are expensive at scale. Mass media is an alternative that could reach more people at lower cost but has rarely been rigorously evaluated. We assessed the effectiveness of a mass media campaign in improving handwashing knowledge and practices in rural Bangladesh. We conducted a cross-sectional assessment before the campaign among 8,947 households and again after 4 months of the campaign among 8,400 different households in the same areas. Trained enumerators conducted spot checks of water, sanitation, and hygiene facilities, and recorded reported knowledge and practices. We compared these outcomes after versus before the campaign using generalized linear models with robust standard errors. After the media campaign, caregivers were more likely to recall ≥ 3 messages regarding handwashing (prevalence ratio [PR] = 1.44, 1.34-1.55), sanitation (PR = 1.45, 1.35-1.55), and safe water (PR = 1.17, 1.08-1.26). After the campaign, the prevalence of using soap and water during handwashing demonstrations was higher among caregivers (PR = 1.15, 1.12-1.19) and children (PR = 1.31, 1.22-1.41). Hands were more commonly observed to be visibly clean among caregivers (PR = 1.14, 1.07-1.20) and children (PR = 1.13, 1.05-1.21). Soap and water was more commonly observed in handwashing stations near latrines (PR = 1.12, 1.06-1.19) and in cooking/eating places (PR = 1.09, 1.01-1.18). Our findings indicate improved handwashing knowledge and behaviors following a mass media campaign. This promising approach can be deployed to improve water, sanitation, and hygiene practices at scale and should be evaluated in other contexts.
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Affiliation(s)
- Mahfuza Islam
- Infectious Disease Division, Environmental Intervention Unit, icddr,b, Dhaka, Bangladesh
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California
| | - Sonia Sultana
- Infectious Disease Division, Environmental Intervention Unit, icddr,b, Dhaka, Bangladesh
| | - Leanne Unicomb
- Infectious Disease Division, Environmental Intervention Unit, icddr,b, Dhaka, Bangladesh
| | - Monirul Alam
- WASH Specialist, Water, Sanitation and Hygiene (WASH) Section, UNICEF, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Disease Division, Environmental Intervention Unit, icddr,b, Dhaka, Bangladesh
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina
| | - Stephen P. Luby
- Woods Institute for the Environment, Stanford University, Stanford, California
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Robina-Ramírez R, Medina-Merodio JA, Moreno-Luna L, Jiménez-Naranjo HV, Sánchez-Oro M. Safety and Health Measures for COVID-19 Transition Period in the Hotel Industry in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E718. [PMID: 33467614 PMCID: PMC7830642 DOI: 10.3390/ijerph18020718] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/01/2021] [Accepted: 01/12/2021] [Indexed: 11/16/2022]
Abstract
The health crisis caused by the outbreak of the COVID-19 disease has devastated the worldwide hospitality sector. The current situation has led many countries to implement drastic rules to stop the spread of the virus. According to the Spanish health authority decisions need to be made in the context of uncertainty and lack of knowledgeable experiences through a gradual and asymmetric de-escalation process planned in four phases. Although the vast majority of studies refer to economic risks and impacts on tourist flows and economic income, few of them explicitly investigates safety and health measures that hotel managers should implement to their customers. Over a population of 12,740 hotels, 823 Spanish hotel managers have been involved in a participatory study. With the aim of assessing the actions taken to stop the spread of the virus, empirical research was implemented. A model presented four variables and 13 indicators which have been previously tested among hotel managers in the tourism sector. Five conclusions are drawn from the hypotheses: (1) Mass testing surveillance in customers and employees should be quick, affordable, and homogeneous throughout the European Union. (2) Training measures need to be taken by both public authorities and the private sector to reach a knowledgeable crisis management team with high commitment to the customer's health and safety. (3) Protocols established by public authorities should be observed and adjusted gradually not only in hotels but also in tourist arrivals. (4) Healthy measures need to be periodically updated. (5) Each hotel should set up a surveillance process to guarantee the safety to their customers.
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Affiliation(s)
- Rafael Robina-Ramírez
- Department of Business and Sociology, Universidad de Extremadura, 10071 Cáceres, Spain; (L.M.-L.); (M.S.-O.)
| | | | - Libertad Moreno-Luna
- Department of Business and Sociology, Universidad de Extremadura, 10071 Cáceres, Spain; (L.M.-L.); (M.S.-O.)
| | | | - Marcelo Sánchez-Oro
- Department of Business and Sociology, Universidad de Extremadura, 10071 Cáceres, Spain; (L.M.-L.); (M.S.-O.)
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Noguchi Y, Nonaka D, Kounnavong S, Kobayashi J. Effects of Hand-Washing Facilities with Water and Soap on Diarrhea Incidence among Children under Five Years in Lao People's Democratic Republic: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020687. [PMID: 33466953 PMCID: PMC7829977 DOI: 10.3390/ijerph18020687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 01/16/2023]
Abstract
Diarrhea is a leading cause of death among children under five (U5) in Lao People’s Democratic Republic (PDR). This study assessed the association between the presence of household hand-washing facilities with water and soap and diarrhea episodes among children U5 in Lao PDR. Data from the Lao Social Indicator Survey II were used. The outcome variable was diarrhea episodes in the two weeks preceding the survey. The main predictor variable was the presence of household hand-washing facilities with or without water and/or soap. Mixed-effect logistic regression analysis was used to assess the association, controlling for clustering, and other predictor variables. Of the 8640 households surveyed with 11,404 children, 49.1% possessed hand-washing facilities with both water and soap and 34.7% possessed hand-washing facilities with water alone. Children whose households possessed hand-washing facilities with water alone were significantly more likely to have a diarrhea episode compared to children whose households possessed hand-washing facilities with both water and soap (8.1% vs. 5.9%; odds ratio, 1.49; 95% confidence interval, 1.22–1.81). The association remained significant even after adjusting for other predictors. The absence of soap in hand-washing facilities was associated with higher odds of having a diarrhea episode among children U5 in Lao PDR.
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Affiliation(s)
- Yuko Noguchi
- Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0125, Japan; (Y.N.); (J.K.)
| | - Daisuke Nonaka
- Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0125, Japan; (Y.N.); (J.K.)
- Correspondence: ; Tel.: +81-98-895-1666
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Samsenthai Road, Ban Kaognot, Sisattanack District, Vientiane 01030, Laos;
| | - Jun Kobayashi
- Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0125, Japan; (Y.N.); (J.K.)
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Abstract
BACKGROUND Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing. OBJECTIVES To assess the effects of hand-washing promotion interventions on diarrhoeal episodes in children and adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, nine other databases, the World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), and metaRegister of Controlled Trials (mRCT) on 8 January 2020, together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA Individually-randomized controlled trials (RCTs) and cluster-RCTs that compared the effects of hand-washing interventions on diarrhoea episodes in children and adults with no intervention. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trial eligibility, extracted data, and assessed risks of bias. We stratified the analyses for child day-care centres or schools, community, and hospital-based settings. Where appropriate, we pooled incidence rate ratios (IRRs) using the generic inverse variance method and a random-effects model with a 95% confidence interval (CI). We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 29 RCTs: 13 trials from child day-care centres or schools in mainly high-income countries (54,471 participants), 15 community-based trials in LMICs (29,347 participants), and one hospital-based trial among people with AIDS in a high-income country (148 participants). All the trials and follow-up assessments were of short-term duration. Hand-washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevent around one-third of diarrhoea episodes in high-income countries (incidence rate ratio (IRR) 0.70, 95% CI 0.58 to 0.85; 9 trials, 4664 participants, high-certainty evidence) and may prevent a similar proportion in LMICs, but only two trials from urban Egypt and Kenya have evaluated this (IRR 0.66, 95% CI 0.43 to 0.99; 2 trials, 45,380 participants; low-certainty evidence). Only four trials reported measures of behaviour change, and the methods of data collection were susceptible to bias. In one trial from the USA hand-washing behaviour was reported to improve; and in the trial from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; 3 trials, 1845 participants; low-certainty evidence). Hand-washing promotion among communities in LMICs probably prevents around one-quarter of diarrhoea episodes (IRR 0.71, 95% CI 0.62 to 0.81; 9 trials, 15,950 participants; moderate-certainty evidence). However, six of these nine trials were from Asian settings, with only one trial from South America and two trials from sub-Saharan Africa. In seven trials, soap was provided free alongside hand-washing education, and the overall average effect size was larger than in the two trials which did not provide soap (soap provided: RR 0.66, 95% CI 0.58 to 0.75; 7 trials, 12,646 participants; education only: RR 0.84, 95% CI 0.67 to 1.05; 2 trials, 3304 participants). There was increased hand washing at major prompts (before eating or cooking, after visiting the toilet, or cleaning the baby's bottom) and increased compliance with hand-hygiene procedure (behavioural outcome) in the intervention groups compared with the control in community trials (data not pooled: 4 trials, 3591 participants; high-certainty evidence). Hand-washing promotion for the one trial conducted in a hospital among a high-risk population showed significant reduction in mean episodes of diarrhoea (1.68 fewer) in the intervention group (mean difference -1.68, 95% CI -1.93 to -1.43; 1 trial, 148 participants; moderate-certainty evidence). Hand-washing frequency increased to seven times a day in the intervention group versus three times a day in the control arm in this hospital trial (1 trial, 148 participants; moderate-certainty evidence). We found no trials evaluating the effects of hand-washing promotions on diarrhoea-related deaths or cost effectiveness. AUTHORS' CONCLUSIONS Hand-washing promotion probably reduces diarrhoea episodes in both child day-care centres in high-income countries and among communities living in LMICs by about 30%. The included trials do not provide evidence about the long-term impact of the interventions.
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Affiliation(s)
- Regina I Ejemot-Nwadiaro
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - John E Ehiri
- Division of Health Promotion Sciences, University of Arizona, Mel & Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Martin M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Julia A Critchley
- Population Health Sciences Institute, St George's, University of London, London, UK
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