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Somji S, Ashorn P, Manji K, Ahmed T, Chisti M, Dhingra U, Sazawal S, Singa B, Walson JL, Pavlinac P, Bar-Zeev N, Houpt E, Dube Q, Kotloff K, Sow S, Yousafzai MT, Qamar F, Bahl R, De Costa A, Simon J, Sudfeld CR, Duggan CP. Clinical and nutritional correlates of bacterial diarrhoea aetiology in young children: a secondary cross-sectional analysis of the ABCD trial. BMJ Paediatr Open 2024; 8:e002448. [PMID: 38604769 PMCID: PMC11015214 DOI: 10.1136/bmjpo-2023-002448] [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: 12/13/2023] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE The objective was to assess the association between nutritional and clinical characteristics and quantitative PCR (qPCR)-diagnosis of bacterial diarrhoea in a multicentre cohort of children under 2 years of age with moderate to severe diarrhoea (MSD). DESIGN A secondary cross-sectional analysis of baseline data collected from the AntiBiotics for Children with Diarrhoea trial (NCT03130114). PATIENTS Children with MSD (defined as >3 loose stools within 24 hours and presenting with at least one of the following: some/severe dehydration, moderate acute malnutrition (MAM) or severe stunting) enrolled in the ABCD trial and collected stool sample. STUDY PERIOD June 2017-July 2019. INTERVENTIONS None. MAIN OUTCOME MEASURES Likely bacterial aetiology of diarrhoea. Secondary outcomes included specific diarrhoea aetiology. RESULTS A total of 6692 children with MSD had qPCR results available and 28% had likely bacterial diarrhoea aetiology. Compared with children with severe stunting, children with MAM (adjusted OR (aOR) (95% CI) 1.56 (1.18 to 2.08)), some/severe dehydration (aOR (95% CI) 1.66 (1.25 to 2.22)) or both (aOR (95% CI) 2.21 (1.61 to 3.06)), had higher odds of having likely bacterial diarrhoea aetiology. Similar trends were noted for stable toxin-enterotoxigenic Escherichia coli aetiology. Clinical correlates including fever and prolonged duration of diarrhoea were not associated with likely bacterial aetiology; children with more than six stools in the previous 24 hours had higher odds of likely bacterial diarrhoea (aOR (95% CI) 1.20 (1.05 to 1.36)) compared with those with fewer stools. CONCLUSION The presence of MAM, dehydration or high stool frequency may be helpful in identifying children with MSD who might benefit from antibiotics.
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Affiliation(s)
- Sarah Somji
- Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Per Ashorn
- Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Karim Manji
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Tahmeed Ahmed
- Division of Nutrition and Clinical Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Chisti
- Division of Nutrition and Clinical Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Usha Dhingra
- Centre for Public Health Kinetics (CPHK), Delhi, India
| | - Sunil Sazawal
- Centre for Public Health Kinetics (CPHK), Delhi, India
| | - Benson Singa
- Centre for Public Health Kinetics (CPHK), Delhi, India
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Pediatrics and Medicine (Infectious Diseases), University of Washington, Seattle, Washington, USA
| | - Patricia Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Naor Bar-Zeev
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric Houpt
- Department of Medicine, Infectious Diseases, University of Virginia, Charlottesville, Virginia, USA
| | - Queen Dube
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Karen Kotloff
- Center for Vaccine Development and Global Health, University of Maryland Baltimore, Baltimore, Maryland, USA
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland, College Park, Maryland, USA
| | - Samba Sow
- Centre pour le Developpement des Vaccins Mali, Bamako, Mali
| | | | - Farah Qamar
- Department of Pediatrics and Child Heath, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Rajiv Bahl
- Department of Maternal, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Ayesha De Costa
- Department of Maternal, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Jonathon Simon
- Department of Maternal, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Christopher R Sudfeld
- Department of Global Health and Population and Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Christopher P Duggan
- Department of Global Health and Population and Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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Nasim N, El-Zein A, Thomas J. A review of rural and peri-urban sanitation infrastructure in South-East Asia and the Western Pacific: Highlighting regional inequalities and limited data. Int J Hyg Environ Health 2022; 244:113992. [PMID: 35752101 DOI: 10.1016/j.ijheh.2022.113992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/22/2022] [Accepted: 06/03/2022] [Indexed: 12/16/2022]
Abstract
Rural and peri-urban communities in developing countries rely on sanitation systems which are often unsafely managed. One of the major barriers to assess safely managed sanitation is a lack of data about the existing sanitation infrastructure and levels of containment safety. The aim was to review rural and peri-urban on-site sanitation studies in order to understand different infrastructure types, associated management practices and any impacts on human health. The scope was limited to South-East Asia and Western Pacific regions in order to better identify regional inequalities. Among the 155 reviewed articles, 73 studies (47%) linked sanitation infrastructure to poor human health. Nearly all articles reported latrine ownership (n = 149, 96%) while sanitation infrastructure types were covered less frequently (n = 104, 67%). In particular, there was a lack of published literature describing back-end characteristics (dimension and materials) (n = 12, 8%) and/or management practices (n = 4, 3%). This stems from a limited application of research methodologies that characterise sanitation infrastructure and faecal sludge management (containment, emptying and on-site treatment). Inequality between regions was prevalent with three quarters of the studies on latrine back-end infrastructure from Bangladesh and India in South-East Asia. A strategic research approach is needed to address the current knowledge gaps regarding sanitation infrastructure and safe faecal sludge management.
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Affiliation(s)
- Nabeela Nasim
- School of Civil Engineering, The University of Sydney, Australia.
| | - Abbas El-Zein
- School of Civil Engineering, The University of Sydney, Australia.
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Solomon ET, Gari SR, Kloos H, Mengistie B. Diarrheal morbidity and predisposing factors among children under 5 years of age in rural East Ethiopia. Trop Med Health 2020; 48:66. [PMID: 32774129 PMCID: PMC7409453 DOI: 10.1186/s41182-020-00253-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diarrheal diseases remain a leading cause of preventable death among children under-five in low- and middle-income countries (LMICs). In Ethiopia, diarrhea is the major contributor to deaths for children under the age of 5 years. In order to develop prevention strategies for the alleviation of childhood diarrhea, it is necessary to identify the important predisposing factors. These predisposing factors have been observed to vary by location across Eastern Ethiopia. Moreover, the evidence on prevalence and determinants of diarrhea among children under 5 years of age in Dire Dawa and its suburbs is very limited and those available have been erratic. The objective of this study was to determine the prevalence and predisposing factors of diarrhea among children under the age of 5 years in rural Dire Dawa, East Ethiopia. METHODS A community-based cross-sectional study was conducted in rural Dire Dawa City Administration in May 2018. Multistage sampling technique was employed to recruit 1180 under-five children from the rural population of Dire Dawa City Administration. Data on socio-demographic, environmental, and child hygiene-related factors were collected by trained data collectors using a structured questionnaire. Logistic regression was used to identify independent risk factors for childhood diarrhea. RESULTS The 2-week prevalence of diarrhea among the under-five children was 23% (95% CI 20.8-25.7%). Maternal diarrhea (AOR = 2.22, 95% CI 1.10-4.47), handwashing after contact with child feces (AOR = 6.27, 95% CI 2.01-19.55), use of a dipper to draw water from containers (AOR = 2.88, 95% CI 1.41-5.89), and presence of a refuse disposal facility (AOR = 2.47, 95% CI 1.09-5.60) were the significant predisposing factors of diarrhea. CONCLUSION Our study identified a high burden of childhood diarrheal disease in rural Dire Dawa City Administration in Eastern Ethiopia. The identified risk factors were maternal diarrhea, handwashing after contact with child feces, use of a dipper to draw water from containers, and presence of refuse disposal facility. To minimize the risk of diarrhea, health education programs focusing on good hygiene practice and sanitation as well as early treatment are recommended.
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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
| | - Bezatu Mengistie
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Contreras JD, Eisenberg JN. Does Basic Sanitation Prevent Diarrhea? Contextualizing Recent Intervention Trials through a Historical Lens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E230. [PMID: 31905628 PMCID: PMC6981821 DOI: 10.3390/ijerph17010230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/19/2019] [Accepted: 12/25/2019] [Indexed: 12/14/2022]
Abstract
Three of four recent major sanitation intervention trials found no effect on diarrhea. These results conflicted with longstanding beliefs from decades of literature. To understand this discordance, we placed recent trials into the historical context that preceded them in two ways. First, we evaluated the history of published literature reviews on sanitation and diarrhea. Second, we conducted meta-analyses on studies from the most recent systematic review to uncover features that predict effectiveness. We found that 13 literature reviews dating to 1983 consistently estimated a significant protective effect of sanitation against diarrhea. However, these were marred by flawed studies and inappropriately averaged effects across widely heterogeneous interventions and contexts. Our meta-analyses highlight that the overall effect of sanitation on diarrhea was largely driven by sewerage and interventions that improved more than sanitation alone. There is no true overall effect of sanitation because variability between intervention types and implementation contexts is too complex to average. Ultimately, the null effects of recent latrine interventions are not surprising. Instead, the one trial that found a strong relative reduction in diarrhea is the historical outlier. The development of transformative sanitation interventions requires a better understanding of the social and environmental contexts that determine intervention effectiveness.
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Boiocchi F, Davies MP, Hilton AC. An Examination of Flying Insects in Seven Hospitals in the United Kingdom and Carriage of Bacteria by True Flies (Diptera: Calliphoridae, Dolichopodidae, Fanniidae, Muscidae, Phoridae, Psychodidae, Sphaeroceridae). JOURNAL OF MEDICAL ENTOMOLOGY 2019; 56:1684-1697. [PMID: 31225584 DOI: 10.1093/jme/tjz086] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Indexed: 06/09/2023]
Abstract
Insects are efficient vectors of bacteria and in the hospital environment may have a role in spreading nosocomial infections. This study sampled the flying insect populations of seven hospitals in the United Kingdom and characterized the associated culturome of Diptera, including the antibiotic resistance profile of bacterial isolates. Flying insects were collected in seven U.K. hospitals between the period March 2010 to August 2011. The bacteria carried by Diptera were isolated using culture-based techniques, identified and characterized by antimicrobial susceptibility testing. A total of 19,937 individual insects were collected with Diptera being the most abundant (73.6% of the total), followed by Hemiptera (13.9%), Hymenoptera (4.7%), Lepidoptera (2.9%), and Coleoptera (2%). From Diptera, 82 bacterial strains were identified. The majority of bacteria belonged to the Enterobacteriaceae (42%), followed by Bacillus spp. (24%) and Staphylococcus spp. (19%). Less abundant were bacteria of the genus Clostridium (6%), Streptococcus (5%), and Micrococcus (2%). A total of 68 bacterial strains were characterized for their antibiotic resistance profile; 52.9% demonstrated a resistant phenotype to at least one class of antibiotic. Staphylococcus spp. represented the highest proportion of resistant strains (83.3%), followed by Bacillus spp. (60%) and Enterobacteriaceae (31.3%). Diptera were the predominant flying insects present in the U.K. hospital environments sampled and found to harbor a variety of opportunistic human pathogens with associated antimicrobial resistance profiles. Given the ability of flies to act as mechanical vectors of bacteria, they present a potential to contribute to persistence and spread of antimicrobial-resistant pathogenic bacteria in the hospital environment.
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Affiliation(s)
- Federica Boiocchi
- School of Life and Health Sciences, Aston University, The Aston Triangle, Birmingham, United Kingdom
| | | | - Anthony C Hilton
- School of Life and Health Sciences, Aston University, The Aston Triangle, Birmingham, United Kingdom
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Majorin F, Torondel B, Ka Seen Chan G, Clasen T. Interventions to improve disposal of child faeces for preventing diarrhoea and soil-transmitted helminth infection. Cochrane Database Syst Rev 2019; 9:CD011055. [PMID: 31549742 PMCID: PMC6757260 DOI: 10.1002/14651858.cd011055.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diarrhoea and soil-transmitted helminth (STH) infections represent a large disease burden worldwide, particularly in low-income countries. As the aetiological agents associated with diarrhoea and STHs are transmitted through faeces, the safe containment and management of human excreta has the potential to reduce exposure and disease. Child faeces may be an important source of exposure even among households with improved sanitation. OBJECTIVES To assess the effectiveness of interventions to improve the disposal of child faeces for preventing diarrhoea and STH infections. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, and 10 other databases. We also searched relevant conference proceedings, contacted researchers, searched websites for organizations, and checked references from identified studies. The date of last search was 27 September 2018. SELECTION CRITERIA We included randomized controlled trials (RCTs) and non-randomized controlled studies (NRS) that compared interventions aiming to improve the disposal of faeces of children aged below five years in order to decrease direct or indirect human contact with such faeces with no intervention or a different intervention in children and adults. DATA COLLECTION AND ANALYSIS Two review authors selected eligible studies, extracted data, and assessed the risk of bias. We used meta-analyses to estimate pooled measures of effect where appropriate, or described the study results narratively. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS Sixty-three studies covering more than 222,800 participants met the inclusion criteria. Twenty-two studies were cluster RCTs, four were controlled before-and-after studies (CBA), and 37 were NRS (27 case-control studies (one that included seven study sites), three controlled cohort studies, and seven controlled cross-sectional studies). Most study sites (56/69) were in low- or lower middle-income settings. Among studies using experimental study designs, most interventions included child faeces disposal messages along with other health education messages or other water, sanitation, and hygiene (WASH) hardware and software components. Among observational studies, the main risk factors relevant to this review were safe disposal of faeces in the latrine or defecation of children under five years of age in a latrine.Education and hygiene promotion interventions, including child faeces disposal messages (no hardware provision)Four RCTs found that diarrhoea incidence was lower, reducing the risk by an estimated 30% in children under six years old (rate ratio 0.71, 95% confidence interval (CI) 0.59 to 0.86; 2 trials, low-certainty evidence). Diarrhoea prevalence measured in two other RCTs in children under five years of age was lower, but evidence was low-certainty (risk ratio (RR) 0.93, 95% CI 0.84 to 1.04; low-certainty evidence).Two controlled cohort studies that evaluated such an intervention in Bangladesh did not detect a difference on diarrhoea prevalence (RR 0.91, 95% CI 0.64 to 1.28; very low-certainty evidence). Two controlled cross-sectional studies that evaluated the Health Extension Package in Ethiopia were associated with a lower two-week diarrhoea prevalence in 'model' households than in 'non-model households' (odds ratio (OR) 0.26, 95% CI 0.16 to 0.42; very low-certainty evidence).Programmes to end open defecation by all (termed community-led total sanitation (CLTS) interventions plus adaptations)Four RCTs measured diarrhoea prevalence and did not detect an effect in children under five years of age (RR 0.92, 95% CI 0.79 to 1.07; moderate-certainty evidence). The analysis of two trials did not demonstrate an effect of the interventions on STH infection prevalence in children (pooled RR 1.03, 95% CI 0.64 to 1.65; low-certainty evidence).One controlled cross-sectional study compared the prevalence of STH infection in open defecation-free (ODF) villages that had received a CLTS intervention with control villages and reported a higher level of STH infection in the intervention villages (RR 2.51, 95% CI 1.74 to 3.62; very low-certainty evidence).Sanitation hardware and behaviour change interventions, that included child faeces disposal hardware and messagingTwo RCTs had mixed results, with no overall effect on diarrhoea prevalence demonstrated in the pooled analysis (RR 0.79, 95% CI 0.49 to 1.26; very low-certainty evidence).WASH hardware and education/behaviour change interventionsOne RCT did not demonstrate an effect on diarrhoea prevalence (RR 1.15, 95% CI 0.93 to 1.41; very low-certainty evidence).Two CBAs reported that the intervention reduced diarrhoea incidence by about a quarter in children under five years of age, but evidence was very low-certainty (rate ratio 0.77, 95% CI 0.71 to 0.84). Another CBA reported that the intervention reduced the prevalence of STH in an intervention village compared to a control village, again with GRADE assessed at very low-certainty (OR 0.17, 95% CI 0.02 to 0.73).Case-control studiesPooled results from case-control studies that presented data for child faeces disposal indicated that disposal of faeces in the latrine was associated with lower odds of diarrhoea among all ages (OR 0.73, 95% CI: 0.62 to 0.85; 23 comparisons; very low-certainty evidence). Pooled results from case-control studies that presented data for children defecating in the latrine indicated that children using the latrine was associated with lower odds of diarrhoea in all ages (OR 0.54, 95% CI 0.33 to 0.90; 7 studies; very low-certainty evidence). AUTHORS' CONCLUSIONS Evidence suggests that the safe disposal of child faeces may be effective in preventing diarrhoea. However, the evidence is limited and of low certainty. The limited research on STH infections provides only low and very-low certainty evidence around effects, which means there is currently no reliable evidence that interventions to improve safe disposal of child faeces are effective in preventing such STH infections.While child faeces may represent a source of exposure to young children, interventions generally only address it as part of a broader sanitation initiative. There is a need for RCTs and other rigorous studies to assess the effectiveness and sustainability of different hardware and software interventions to improve the safe disposal of faeces of children of different age groups.
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Affiliation(s)
- Fiona Majorin
- London School of Hygiene & Tropical MedicineFaculty of Infectious and Tropical DiseasesKeppel StreetLondonUKWC1E 7HT
| | - Belen Torondel
- London School of Hygiene & Tropical MedicineFaculty of Infectious and Tropical DiseasesKeppel StreetLondonUKWC1E 7HT
| | - Gabrielle Ka Seen Chan
- London School of Hygiene & Tropical MedicineFaculty of Infectious and Tropical DiseasesKeppel StreetLondonUKWC1E 7HT
| | - Thomas Clasen
- Rollins School of Public Health, Emory UniversityDepartment of Environmental Health1518 Clifton Road NEAtlantaGAUSA30322
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Perceived water insecurity among adults from urban and peri-urban Haiti: A qualitative study. PLoS One 2019; 14:e0214790. [PMID: 31017919 PMCID: PMC6481792 DOI: 10.1371/journal.pone.0214790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/20/2019] [Indexed: 11/20/2022] Open
Abstract
Water and sanitation services are fundamental in preventing the spread of waterborne and hygiene-related diseases. However, in developing countries, such as Haiti, access to clean water continues to pose major challenges despite efforts to improve quality and reduce distance. With Léogâne being the epicenter of the earthquake in Haiti in 2010, there were dozens of interventions aimed to improve access to clean water, specifically well construction and use of water treatment strategies. Using the socioecological framework, this study collected qualitative data to supplement a household water insecurity experiences (HWISE) survey in order to fully understand the narratives around water in Léogâne (urban) and its neighboring commune Gressier (peri-urban). The inclusion criteria for this study was that the participant must be a resident of either site, at least 18 years or older, and a female. Only females were included in this study so that researchers could better understand how perceived water insecurity impacts reproductive health, specifically gynecological infections. This cross-sectional study yielded 61 total in-depth interviews using a semi-structured open ended questionnaire to allow participants the ability to elaborate. Results suggest that there are common misconceptions about water and reproductive health specifically that engaging in sexual intercourse in saltwater will not result in pregnancy. Relevant narratives among the two communes included water acquisition, use of water, and bathing practices, among several others. Through understanding the local Haitian perspective and practices that surround water insecurity, we can better tailor public health interventions to improve access to water, female hygiene practices, and ultimately lower and prevent disease transmission.
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Cohen A, Colford JM. Effects of Boiling Drinking Water on Diarrhea and Pathogen-Specific Infections in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2017; 97:1362-1377. [PMID: 29016318 PMCID: PMC5817760 DOI: 10.4269/ajtmh.17-0190] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022] Open
Abstract
Globally, approximately 2 billion people lack microbiologically safe drinking water. Boiling is the most prevalent household water treatment method, yet evidence of its health impact is limited. To conduct this systematic review, we searched four online databases with no limitations on language or publication date. Studies were eligible if health outcomes were measured for participants who reported consuming boiled and untreated water. We used reported and calculated odds ratios (ORs) and random-effects meta-analysis to estimate pathogen-specific and pooled effects by organism group and nonspecific diarrhea. Heterogeneity and publication bias were assessed using I2, meta-regression, and funnel plots; study quality was also assessed. Of the 1,998 records identified, 27 met inclusion criteria and reported extractable data. We found evidence of a significant protective effect of boiling for Vibrio cholerae infections (OR = 0.31, 95% confidence interval [CI] = 0.13-0.79, N = 4 studies), Blastocystis (OR = 0.35, 95% CI = 0.17-0.69, N = 3), protozoal infections overall (pooled OR = 0.61, 95% CI = 0.43-0.86, N = 11), viral infections overall (pooled OR = 0.83, 95% CI = 0.7-0.98, N = 4), and nonspecific diarrheal outcomes (OR = 0.58, 95% CI = 0.45-0.77, N = 7). We found no evidence of a protective effect for helminthic infections. Although our study was limited by the use of self-reported boiling and non-experimental designs, the evidence suggests that boiling provides measureable health benefits for pathogens whose transmission routes are primarily water based. Consequently, we believe a randomized controlled trial of boiling adherence and health outcomes is needed.
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Affiliation(s)
- Alasdair Cohen
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
- Department of Environmental Science, Policy and Management, University of California at Berkeley, Berkeley, California
| | - John M. Colford
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
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Jung YT, Hum RJ, Lou W, Cheng YL. Effects of neighbourhood and household sanitation conditions on diarrhea morbidity: Systematic review and meta-analysis. PLoS One 2017; 12:e0173808. [PMID: 28296946 PMCID: PMC5351971 DOI: 10.1371/journal.pone.0173808] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 02/27/2017] [Indexed: 11/19/2022] Open
Abstract
Sanitation in neighbourhood and household domains can provide primary protection against diarrhea morbidity, yet their distinct health benefits have not been succinctly distinguished and reviewed. We present here the first systematic review and meta-analysis of the distinct effect of neighbourhood and household sanitation conditions on diarrhea morbidity. We identified studies reporting the effect of neighbourhood-level exposure to wastewater or household sanitation facilities on diarrhea, by performing comprehensive search on five databases, namely the Cochrane library, PubMed, Embase, Scopus and Web of Science, from the earliest date available to February 2015. Twenty-one non-randomized studies and one randomized controlled trial met the pre-determined inclusion criteria, consisting of six datasets on neighbourhood sanitation conditions (total 8271 subjects) and 20 datasets on household sanitation (total 20021 subjects). We calculated the pooled effect estimates of neighbourhood and household sanitation conditions on diarrhea morbidity using the inverse variance random-effects model. The pooled effect estimates showed that both neighbourhood sanitation conditions (odds ratio = 0.56, 95%CI: 0.40-0.79) and household sanitation (odds ratio = 0.64, 95%CI: 0.55-0.75) are associated with reduced diarrheal illness, and that the magnitudes of the associations are comparable. Evidence of risk of bias and heterogeneity were found in the included studies. Our findings confirm that both neighbourhood sanitation conditions and household sanitation are associated with considerable reduction in diarrhea morbidity, in spite of a number of methodological shortcomings in the included studies. Furthermore, we find evidence that neighbourhood sanitation conditions is associated with similar magnitude of reduction in diarrhea morbidity as household sanitation. The findings suggest that, in addition to household sanitation provision, dual emphasis on neighbourhood sanitation through public sanitation infrastructure provision and community-wide sanitation adoption is advisable for effective reduction of diarrheal disease burden.
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Affiliation(s)
- Youngmee Tiffany Jung
- Centre for Global Engineering and the Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Ryan James Hum
- Centre for Global Engineering and the Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yu-Ling Cheng
- Centre for Global Engineering and the Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
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Overbo A, Williams AR, Evans B, Hunter PR, Bartram J. On-plot drinking water supplies and health: A systematic review. Int J Hyg Environ Health 2016; 219:317-30. [PMID: 27118130 DOI: 10.1016/j.ijheh.2016.04.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/26/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
Many studies have found that household access to water supplies near or within the household plot can reduce the probability of diarrhea, trachoma, and other water-related diseases, and it is generally accepted that on-plot water supplies produce health benefits for households. However, the body of research literature has not been analyzed to weigh the evidence supporting this. A systematic review was conducted to investigate the impacts of on-plot water supplies on diarrhea, trachoma, child growth, and water-related diseases, to further examine the relationship between household health and distance to water source and to assess whether on-plot water supplies generate health gains for households. Studies provide evidence that households with on-plot water supplies experience fewer diarrheal and helminth infections and greater child height. Findings suggest that water-washed (hygiene associated) diseases are more strongly impacted by on-plot water access than waterborne diseases. Few studies analyzed the effects of on-plot water access on quantity of domestic water used, hygiene behavior, and use of multiple water sources, and the lack of evidence for these relationships reveals an important gap in current literature. The review findings indicate that on-plot water access is a useful health indicator and benchmark for the progressive realization of the Sustainable Development Goal target of universal safe water access as well as the human right to safe water.
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Affiliation(s)
- Alycia Overbo
- The Water Institute, University of North Carolina at Chapel Hill, United States.
| | - Ashley R Williams
- The Water Institute, University of North Carolina at Chapel Hill, United States
| | - Barbara Evans
- Institute of Public Health and Environmental Engineering, University of Leeds,United Kingdom
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, United Kingdom
| | - Jamie Bartram
- The Water Institute, University of North Carolina at Chapel Hill, United States.
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Oloruntoba EO, Folarin TB, Ayede AI. Hygiene and sanitation risk factors of diarrhoeal disease among under-five children in Ibadan, Nigeria. Afr Health Sci 2014; 14:1001-11. [PMID: 25834513 DOI: 10.4314/ahs.v14i4.32] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Diarrhoea diseases are among the leading causes of morbidity and mortality in under-five-children (U-5C) in Nigeria. Inadequate safe water, sanitation, and hygiene account for the disease burden. Cases of diarrhoea still occur in high proportion in the study area despite government-oriented interventions. OBJECTIVE To determine the hygiene and sanitation risk factors predisposing U-5C to diarrhoea in Ibadan, Nigeria. METHODS Two hundred and twenty pairs of children, matched on age, were recruited as cases and controls over a period of 5 months in Ibadan. Questionnaire and observation checklist were used to obtain information on hygiene practices from caregivers/mothers and sanitation conditions in the households of 30% of the consenting mothers/caregivers. Data were analysed using descriptive and inferential statistics. RESULTS Caregivers/mothers' mean ages were 31.3 ±7.5 (cases) and 30.6 ±6.0(controls) years. The risk of diarrhoea was significantly higher among children whose mothers did not wash hands with soap before food preparation (OR=3.0, p<0.05), before feeding their children (OR=3.0, p<0.05) and after leaving the toilet (OR=4.7, p<0.05). Factors significantly associated with diarrhoea were: poor water handling (OR=2.0,CI=1.2-3.5), presence of clogged drainage near the house (OR=2.1,CI=1.2-3.7) and breeding places for flies (OR=2.7,CI=1.6-4.7). The mean risk score among cases and controls from the sanitary inspection of drinking water sources were 5.4 ± 2.2 and 3.2 ± 1.9 (p<0.05) and household storage containers were 2.4 ± 1.8 and 1.2 ± 0.7 (p<0.05) respectively. CONCLUSION Hygiene and sanitation conditions within households were risk factors for diarrhoea. This study revealed the feasibility of developing and implementing an adequate model to establish intervention priorities in sanitation in Ibadan, Nigeria.
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Affiliation(s)
- Elizabeth Omoladun Oloruntoba
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Taiwo Bukola Folarin
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Gruber JS, Ercumen A, Colford JM. Coliform bacteria as indicators of diarrheal risk in household drinking water: systematic review and meta-analysis. PLoS One 2014; 9:e107429. [PMID: 25250662 PMCID: PMC4175079 DOI: 10.1371/journal.pone.0107429] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 06/18/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Current guidelines recommend the use of Escherichia coli (EC) or thermotolerant ("fecal") coliforms (FC) as indicators of fecal contamination in drinking water. Despite their broad use as measures of water quality, there remains limited evidence for an association between EC or FC and diarrheal illness: a previous review found no evidence for a link between diarrhea and these indicators in household drinking water. OBJECTIVES We conducted a systematic review and meta-analysis to update the results of the previous review with newly available evidence, to explore differences between EC and FC indicators, and to assess the quality of available evidence. METHODS We searched major databases using broad terms for household water quality and diarrhea. We extracted study characteristics and relative risks (RR) from relevant studies. We pooled RRs using random effects models with inverse variance weighting, and used standard methods to evaluate heterogeneity and publication bias. RESULTS We identified 20 relevant studies; 14 studies provided extractable results for meta-analysis. When combining all studies, we found no association between EC or FC and diarrhea (RR 1.26 [95% CI: 0.98, 1.63]). When analyzing EC and FC separately, we found evidence for an association between diarrhea and EC (RR: 1.54 [95% CI: 1.37, 1.74]) but not FC (RR: 1.07 [95% CI: 0.79, 1.45]). Across all studies, we identified several elements of study design and reporting (e.g., timing of outcome and exposure measurement, accounting for correlated outcomes) that could be improved upon in future studies that evaluate the association between drinking water contamination and health. CONCLUSIONS Our findings, based on a review of the published literature, suggest that these two coliform groups have different associations with diarrhea in household drinking water. Our results support the use of EC as a fecal indicator in household drinking water.
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Affiliation(s)
- Joshua S. Gruber
- Division of Epidemiology, University of California, Berkeley, California, United States of America
| | - Ayse Ercumen
- Division of Epidemiology, University of California, Berkeley, California, United States of America
| | - John M. Colford
- Division of Epidemiology, University of California, Berkeley, California, United States of America
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Dachew BA, Bifftu BB. Breastfeeding practice and associated factors among female nurses and midwives at North Gondar Zone, Northwest Ethiopia: a cross-sectional institution based study. Int Breastfeed J 2014; 9:11. [PMID: 25057283 PMCID: PMC4107598 DOI: 10.1186/1746-4358-9-11] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care workers have a duty to promote and support breastfeeding among their clients. Although their ability to do this may be influenced by their knowledge and personal experience; little is known about breastfeeding practices and the perceived barriers. The objective of this study was to assess the breastfeeding practices and the associated factors among female nurses and midwives in North Gondar Zone; Northwest Ethiopia. METHODS An institution based cross-sectional study design was conducted in 2013 among 178 nurses and midwives. In this study exclusive breastfeeding refers to breastfeeding exclusively for the first six months of a child's life. Bivariate and multivariate logistic regressions were performed to identify the presence and strength of association. Odds ratios with 95% confidence interval were computed to determine the level of significance. RESULTS Exclusive breastfeeding rate among respondents was found to be 35.9%. Nearly half (49.4%) of the respondents exclusively breastfed for only 3 months or less. The mean duration exclusive breastfeeding was 4.1 ± 1.7 months. Older women (AOR = 2.8; 95% CI 2.16, 3.24), rural residence (AOR = 3.01; 95% CI 2.65, 3.84), being midwife (AOR = 2.01; 95% CI 1.83, 2.56), a women who gave birth through vaginal delivery (AOR = 2.0; 95% CI 1.68, 2.87), multiparous women (AOR = 2.20; 95% CI 1.74, 2.67) and resumption of work after 3 months (AOR = 1.61; 95% CI 1.24, 2.35) were independently associated with exclusive breastfeeding. CONCLUSION Though respondents had adequate knowledge on breastfeeding, the practice of exclusive breastfeeding was low. Maternal age, place of residence, profession, mode of delivery, parity and the time before resuming work were factors associated with exclusive breastfeeding. Appropriate education concerning breastfeeding, directed at nurses and midwives is required to enhance exclusive breastfeeding and duration of breastfeeding.
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Affiliation(s)
- Berihun Assefa Dachew
- College of Medicine and Health Science, Department of Nursing, University of Gondar, Gondar, Ethiopia
| | - Berhanu Boru Bifftu
- College of Medicine and Health Science, Department of Nursing, University of Gondar, Gondar, Ethiopia
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Bain R, Cronk R, Wright J, Yang H, Slaymaker T, Bartram J. Fecal contamination of drinking-water in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001644. [PMID: 24800926 PMCID: PMC4011876 DOI: 10.1371/journal.pmed.1001644] [Citation(s) in RCA: 269] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 04/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator "use of an improved source," which does not account for water quality measurements. Our objectives were to determine whether water from "improved" sources is less likely to contain fecal contamination than "unimproved" sources and to assess the extent to which contamination varies by source type and setting. METHODS AND FINDINGS Studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of Escherichia coli or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for "improved" sources than "unimproved" sources (odds ratio [OR] = 0.15 [0.10-0.21], I2 = 80.3% [72.9-85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52-3.71]; p<0.001) and rural areas (OR = 2.37 [1.47-3.81] p<0.001) were more likely to be contaminated. Studies rarely reported stored water quality or sanitary risks and few achieved robust random selection. Safety may be overestimated due to infrequent water sampling and deterioration in quality prior to consumption. CONCLUSION Access to an "improved source" provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe drinking-water and do not fully reflect disparities in access. An enhanced monitoring strategy would combine indicators of sanitary protection with measures of water quality.
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Affiliation(s)
- Robert Bain
- The Water Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ryan Cronk
- The Water Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jim Wright
- University of Southampton, Southampton, United Kingdom
| | - Hong Yang
- University of Southampton, Southampton, United Kingdom
| | | | - Jamie Bartram
- The Water Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Abstract
SUMMARYBy conducting a case-control study in two university hospitals, we explored the association between modifiable risk behaviours and diarrhoea. Children aged <5 years attending outpatient clinics for diarrhoea were matched by age and sex with controls. Data were collected on family demographics, socioeconomic indicators, and risk behaviour practices. Two rectal swabs and a stool specimen were collected from cases and controls. Samples were cultured for bacterial pathogens using standard techniques and tested by ELISA to detect rotavirus andCryptosporidiumspp. Four hundred cases and controls were enrolled between 2007 and 2009. The strongest independent risk factors for diarrhoea were: presence of another household member with diarrhoea [matched odds ratio (mOR) 4·9, 95% CI 2·8–8·4] in the week preceding the survey, introduction to a new kind of food (mOR 3, 95% CI 1·7–5·4), and the child being cared for outside home (mOR 2·6, 95% CI 1·3–5·2). While these risk factors are not identifiable, in some age groups more easily modifiable risk factors were identified including: having no soap for handwashing (mOR 6·3, 95% CI 1·2–33·9) for children aged 7–12 months, and pacifier use (mOR 1·9, 95% CI 1·0–3·5) in children aged 0–6 months. In total, the findings of this study suggest that community-based interventions to improve practices related to sanitation and hygiene, handwashing and food could be utilized to reduce the burden of diarrhoea in Egyptian children aged <5 years.
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Shahrul Anuar T, M. Al-Mekhlafi H, Abdul Ghani MK, Osman E, Mohd Yasin A, Nordin A, Nor Azreen S, Md Salleh F, Ghazali N, Bernadus M, Moktar N. Prevalence and risk factors associated with Entamoeba histolytica/dispar/moshkovskii infection among three Orang Asli ethnic groups in Malaysia. PLoS One 2012; 7:e48165. [PMID: 23133561 PMCID: PMC3485054 DOI: 10.1371/journal.pone.0048165] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 09/21/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Entamoeba histolytica/Entamoeba dispar/Entamoeba moshkovskii infection is still prevalent in rural Malaysia especially among Orang Asli communities. Currently, information on prevalence of this infection among different ethnic groups of Orang Asli is unavailable in Malaysia. To contribute to a better comprehension of the epidemiology of this infection, a cross-sectional study aimed at providing the first documented data on the prevalence and risk factors associated with E. histolytica/E. dispar/E. moshkovskii infection was carried out among three Orang Asli ethnic groups (Proto-Malay, Negrito, and Senoi) in selected villages in Negeri Sembilan, Perak, and Pahang states, Malaysia. METHODS/FINDINGS Faecal samples were examined by formalin-ether sedimentation and trichrome staining techniques. Of 500 individuals, 8.7% (13/150) of Proto-Malay, 29.5% (41/139) of Negrito, and 18.5% (39/211) of Senoi were positive for E. histolytica/E. dispar/E. moshkovskii, respectively. The prevalence of this infection showed an age-dependency relationship, with higher rates observed among those aged less than 15 years in all ethnic groups studied. Multivariate analysis confirmed that not washing hands after playing with soils or gardening and presence of other family members infected with E. histolytica/E. dispar/E. moshkovskii were significant risk factors of infection among all ethnic groups. However, eating with hands, the consumption of raw vegetables, and close contact with domestic animals were identified as significant risk factors in Senoi. CONCLUSIONS Essentially, the findings highlighted that E. histolytica/E. dispar/E. moshkovskii parasites are still prevalent in Malaysia. Further studies using molecular approaches to distinguish the morphologically identical species of pathogenic, E. histolytica from the non-pathogenic, E. dispar and E. moshkovskii are needed. The establishment of such data will be beneficial for the public health authorities in the planning and implementation of specific prevention and control strategies of this infection in different Orang Asli ethnic groups in Malaysia.
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Affiliation(s)
- Tengku Shahrul Anuar
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Hesham M. Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohamed Kamel Abdul Ghani
- Programme of Biomedical Sciences, School of Diagnostic and Applied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Emelia Osman
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Azlin Mohd Yasin
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Anisah Nordin
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siti Nor Azreen
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Fatmah Md Salleh
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nuraffini Ghazali
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mekadina Bernadus
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Moktar
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
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Alyousefi NA, Mahdy MAK, Mahmud R, Lim YAL. Factors associated with high prevalence of intestinal protozoan infections among patients in Sana'a City, Yemen. PLoS One 2011; 6:e22044. [PMID: 21789210 PMCID: PMC3138770 DOI: 10.1371/journal.pone.0022044] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 06/14/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intestinal protozoan diseases in Yemen are a significant health problem with prevalence ranging from 18% to 27%. The present study is a cross-sectional study aimed at determining the factors associated with the high prevalence of intestinal protozoan infections among patients seeking health care in Sana'a City, the capital of Yemen. METHODOLOGY/PRINCIPAL FINDINGS Stool samples were collected from 503 patients aged between 1 and 80 years old; 219 were males and 284 females. Biodata were collected via pretested standard questionnaire. Faecal samples were processed and examined for (oo)cysts or ova using a wet mount preparation after formal-ether concentration technique. Cryptosporidium oocysts were detected using the Ziehl-Neelsen staining technique. The overall prevalence of intestinal protozoan infections was 30.9%. Infection rates of Giardia duodenalis, Entamoeba histolytica/dispar and Cryptosporidium were 17.7%, 17.1% and 1%, respectively. Other parasites detected included Ascaris lumbricoides (2.4%), Schistosoma mansoni (0.3%), Hymenolepis nana (1.4%) and Enterobius vermicularis (0.4%). Multivariate analysis using forward stepwise logistic regression based on intestinal protozoan infections showed that contact with animals (OR = 1.748, 95% CI = 1.168-2.617) and taking bath less than twice a week (OR = 1.820, 95% CI = 1.192-2.779) were significant risk factors of protozoan infections. CONCLUSIONS/SIGNIFICANCE This present study indicated that intestinal protozoan infections are still a public health problem in Yemen, with Giardia and Entamoeba infections being most common. Statistical analysis indicated that low personal hygiene and contact with animals were important predictors for intestinal protozoan infections. As highlighted in this study, in order to effectively reduce these infections, a multi-sectoral effort is needed. Preventive measures should include good hygienic practices, good animal husbandry practices, heightened provision of educational health programs, health services in all governorates including rural areas. Furthermore, it is also essential to find radical solutions to the recent water crises in Yemen.
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Affiliation(s)
- Naelah A. Alyousefi
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohammed A. K. Mahdy
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Parasitology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Rohela Mahmud
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yvonne A. L. Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Bener A, Ehlayel MS, Abdulrahman HM. Exclusive breast feeding and prevention of diarrheal diseases: a study in Qatar. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2011. [DOI: 10.1590/s1519-38292011000100009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: to explore the relationships between breast feeding and diarrhea and to assess the effect of exclusive breast feeding (EBF) on reducing the risk of diarrhea in Qatar. METHODS: this is a cross sectional survey carried out at the Well baby clinics and Pediatric clinics in the 11 Primary Health Care Centers and Hamad General Hospital, Hamad Medical Corporation, in Qatar. A multistage sampling design was used and a representative sample of 1500 Qatari infants and preschool children with an age range of 0-3 years and mothers agedbetween 18 to 47 years were surveyed during the period from October 2006 to September 2008 in Qatar. Out of the 1500 mothers, 1278 agreed to participate in this study, with a response rate of 85.2%. Questionnaires were administered to women who were attending Primary Health Care (PHC) Centers for child immunization. Data about the child gathered included date of birth, gender, birth order, consanguinity, socio-economic conditions, age of mother, level of education of mother, occupation, mode of breast feeding, sterilization of bottle and incident of diarrhea during the interview. Univariate statistical methods were performed for statistical analysis. RESULTS: of the 1278 infants studied, more than half (59.3%) were exclusively breastfed, and the mean duration was11.4 (SD=6.7). The risk for presenting diarrhea was higher in formula fed (48.7%) and partiallybreastfed children (37.3%) when compared to EBF(32.5%). CONCLUSION: EBF plays an important role in reducing the incidence and severity of infantile diarrhea.
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Affiliation(s)
- Abdulbari Bener
- Hamad Medical Corporation and Weill Cornell Medical College, Qatar
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Giardia intestinalis genotypes: Risk factors and correlation with clinical symptoms. Acta Trop 2009; 112:67-70. [PMID: 19560431 DOI: 10.1016/j.actatropica.2009.06.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 05/22/2009] [Accepted: 06/22/2009] [Indexed: 11/20/2022]
Abstract
This study was conducted to identify genotypes related risk factors of Giardia intestinalis in an Orang Asli (aboriginal) community in Pahang, Malaysia. Stool samples were collected from 321 individuals aged between 2 and 76 years old, of whom 160 were males and 161 were females. Faecal samples were processed with trichrome staining technique for the primary identification of G. intestinalis. Molecular identification was carried out by the amplification of a partial SSU rRNA gene using nested PCR. PCR products were purified and genotyped. 42 samples successfully amplified from the 76 positive faecal samples, only 1 was Assemblage A, the rest were Assemblage B. Risk analysis based on the detected genotypes of Giardia using univariate analysis and logistic regression identified three significant risk factors of giardiasis caused by assemblage B which included children </=12 years (OR=13.56, 95% CI=1.79-102.64, p=0.012), females (OR=2.52, 95% CI=1.11-5.75, p=0.027) and eating fresh fruits (OR=7.78, 95% CI=1.01-60.00, p=0.049). Assemblage B infection was significantly correlated with clinical symptoms of giardiasis (OR=2.4, 95% CI=1.13-5.12, p=0.019). Females infected with Assemblage B were at higher risk of manifesting gastroenteritis signs and symptoms (OR=3.9, 95% CI=1.50-10.31, p=0.004). It has been concluded that giardiasis is still a public health problem in Orang Asli community and most commonly caused by assemblage B. The dynamic of transmission is most probably anthroponotic which is human to human either directly or indirectly through contaminated food. This route of transmission should be considered in the control strategy of the disease. Mass treatment together with health education could be the most practical intervention for reducing the infection. Those at high risk should receive more attention from public health authorities.
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Mohammed Mahdy A, Lim Y, Surin J, Wan K, Al-Mekhlafi MH. Risk factors for endemic giardiasis: highlighting the possible association of contaminated water and food. Trans R Soc Trop Med Hyg 2008; 102:465-70. [DOI: 10.1016/j.trstmh.2008.02.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 02/06/2008] [Accepted: 02/06/2008] [Indexed: 11/26/2022] Open
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Metwally AM, Saad A, Ibrahim NA, Emam HM, El-Etreby LA. Monitoring progress of the role of integration of environmental health education with water and sanitation services in changing community behaviours. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2007; 17:61-74. [PMID: 17365081 DOI: 10.1080/09603120600937856] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The health benefits of clean water, improved sanitation and better hygiene are now more recognized than ever before. The objective of the present study focused on monitoring the progress of behavioural changes towards appropriate behaviours related to water, environment and sanitation (WES). This was achieved through assessing the baseline community behaviours towards WES, exploring to what extent community hygienic behaviours had changed towards desirable and sustainable behaviours, through monitoring progress. The expected behavioural changes are results of an integrated package; safe water supply, sanitation, and hygiene education interventions produced by governmental and non-governmental organizations. The monitoring progress consisted of three household surveys that were administered over three years in four Egyptian districts within three Governorates; Fayoum, Beni Suef, and El-Menia. Behavioural changes were detected through special observation checklist indicators. These indicators were 7, 6, and 9 indicators each for personal hygienic behaviours, proper handling of drinking water, and proper use and maintenance of simple constructed sanitary latrines. The results from the baseline to mid-term and final surveys suggested improvement in the majority of the household behaviours towards the desirable behaviours. The proportions of the householders who practiced desirable behaviours were not to the same levels in the four districts. The results provide support to the concept that integrated interventions can produce a significant sustainable improvement in health promotion.
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Affiliation(s)
- Ammal M Metwally
- Community Medicine Research, National Research Center, Giza, Egypt
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Chompook P, Todd J, Wheeler JG, von Seidlein L, Clemens J, Chaicumpa W. Risk factors for shigellosis in Thailand. Int J Infect Dis 2006; 10:425-33. [PMID: 16997593 DOI: 10.1016/j.ijid.2006.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 05/06/2006] [Accepted: 05/10/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To assess the potential risk factors for shigellosis including housefly density. METHODS A matched case-control study to investigate potential risk factors for shigellosis was conducted in a semi-urban area, Kaengkhoi District, Saraburi Province, central Thailand. Shigella cases were ascertained from a two-year population-based surveillance study detecting diarrhea and shigellosis in the area. The study evaluated a wide range of exposures, which were assessed by odds ratios (OR) adjusted for proxy markers of socioeconomic status: family income, and type of residence, using conditional logistic regression analysis. RESULTS Hygiene behaviors such as regular hand washing (p<0.05), a clean environment surrounding the household (p<0.001), and the availability of water to flush the toilet (p=0.08) were associated with a reduced risk for shigellosis in the multivariate model. In contrast factors indicating a lower than average socioeconomic status, such as having to rent instead of owning one's housing (p<0.001) and a low family income (p<0.01) were associated with an increased risk for shigellosis. For children, breastfeeding showed a strong protective effect in reducing the risk of shigellosis (p<0.01). Prior to adjustment for environmental factors, fly density in the kitchen area was associated with an increased risk of shigellosis (p<0.01). CONCLUSIONS We found a correlation between socioeconomic status and the risk for shigellosis. To reduce shigellosis in this setting, we recommend interventions focused on three aspects: improved water supply and sanitation (especially latrines and garbage disposal) including fly control, health education on hand washing, and the promotion of breastfeeding.
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Affiliation(s)
- Pornthip Chompook
- Bureau of General Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.
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Wright J, Gundry S, Conroy R. Household drinking water in developing countries: a systematic review of microbiological contamination between source and point-of-use. Trop Med Int Health 2004; 9:106-17. [PMID: 14728614 DOI: 10.1046/j.1365-3156.2003.01160.x] [Citation(s) in RCA: 305] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the extent and causes of microbiological contamination of household drinking water between source and point-of-use in developing countries. METHODS A systematic meta-analysis of 57 studies measuring bacteria counts for source water and stored water in the home to assess how contamination varied between settings. RESULTS The bacteriological quality of drinking water significantly declines after collection in many settings. The extent of contamination after water collection varies considerably between settings, but is proportionately greater where faecal and total coliform counts in source water are low. CONCLUSIONS Policies that aim to improve water quality through source improvements may be compromised by post-collection contamination. Safer household water storage and treatment is recommended to prevent this, together with point-of-use water quality monitoring.
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Affiliation(s)
- Jim Wright
- Water and Environmental Management Research Centre, University of Bristol, Bristol, UK.
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Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. THE LANCET. INFECTIOUS DISEASES 2003; 3:275-81. [PMID: 12726975 DOI: 10.1016/s1473-3099(03)00606-6] [Citation(s) in RCA: 547] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We set out to determine the impact of washing hands with soap on the risk of diarrhoeal diseases in the community with a systematic review with random effects meta-analysis. Our data sources were studies linking handwashing with diarrhoeal diseases. Seven intervention studies, six case-control, two cross-sectional, and two cohort studies were located from electronic databases, hand searching, and the authors' collections. The pooled relative risk of diarrhoeal disease associated with not washing hands from the intervention trials was 1.88 (95% CI 1.31-2.68), implying that handwashing could reduce diarrhoea risk by 47%. When all studies, when only those of high quality, and when only those studies specifically mentioning soap were pooled, risk reduction ranged from 42-44%. The risks of severe intestinal infections and of shigellosis were associated with reductions of 48% and 59%, respectively. In the absence of adequate mortality studies, we extrapolate the potential number of diarrhoea deaths that could be averted by handwashing at about a million (1.1 million, lower estimate 0.5 million, upper estimate 1.4 million). Results may be affected by the poor quality of many of the studies and may be inflated by publication bias. On current evidence, washing hands with soap can reduce the risk of diarrhoeal diseases by 42-47% and interventions to promote handwashing might save a million lives. More and better-designed trials are needed to measure the impact of washing hands on diarrhoea and acute respiratory infections in developing countries.
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Olsen AR. Regulatory action criteria for filth and other extraneous materials. III. Review of flies and foodborne enteric disease. Regul Toxicol Pharmacol 1998; 28:199-211. [PMID: 10049791 DOI: 10.1006/rtph.1998.1271] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Forty-seven species of flies have been reliably associated with filthy conditions that might allow the spread of foodborne pathogens. These are categorized as "filth flies." Of that 47, only 21 species represent a potential threat to human health as scientifically proven causative agents of foodborne myiasis or as carriers of enteropathogenic Escherichia coli, Salmonella, Shigella, and other foodborne pathogens. These 21 species are categorized as "disease-causing flies" based on strict scientific criteria. The criteria are association with E. coli, Salmonella, AND Shigella; synanthropy; endophily; communicative behavior; attraction to both excrement and food products; and recognition by authorities as a potential health hazard. Within Hazard Analysis and Critical Control Point and other U.S. Food and Drug Administration regulatory frameworks, disease-causing flies are contributing factors to the spread of foodborne disease that require preventive and corrective actions as appropriate under Sanitation Standard Operating Procedures, Good Manufacturing Practices, or pest control programs.
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Affiliation(s)
- A R Olsen
- Microanalytical Branch, HFS-315, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, 200 C Street, Southwest, Washington, DC, 20204, USA
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Abstract
In this paper we review the literature in regard to possible relationships between breast feeding and diarrhoea or gastroenteritis. We show that in the developed as well as the developing world, there is consistent evidence of a protective effect of exclusive breast feeding in the first 4-6 months of life. The odds ratios were generally in excess of 3.0 for non-breast milk feeds. The relationship was not consistent for rotavirus infections but was consistently strong for non-viral pathogens. There are a number of indicators that suggest biological plausibility, in both the developing and developed world. The triple indicators of consistency and strength of the epidemiological associations, together with biological plausibility are major arguments for believing that there is a causal sequence involved.
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Affiliation(s)
- J Golding
- Unit of Paediatric and Perinatal Epidemiology, University of Bristol, UK
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