Personal Hygiene Practices among Urban Homeless Persons in Boston, MA

Knowledge and practices related to louse- and flea-borne diseases among staff providing services to people experiencing homelessness in the United States

BACKGROUND AND AIMS

Louse-borne Bartonella quintana infection and flea-borne murine typhus are two potentially serious vector-borne diseases that have led to periodic outbreaks among people experiencing homelessness in the United States. Little is known about louse- and flea-borne disease awareness and prevention among staff who provide services to the population. We surveyed staff in seven US states to identify gaps in knowledge and prevention practices for these diseases.

METHODS AND RESULTS

Surveys were administered to 333 staff at 89 homeless shelters and outreach teams in California, Colorado, Georgia, Maryland, Minnesota, New York and Washington from August 2022 to April 2023. Most participants (>68%) agreed that body lice and fleas are a problem for people experiencing homelessness. About half were aware that diseases could be transmitted by these vectors; however, most could not accurately identify which diseases. Less than a quarter of staff could describe an appropriate protocol for managing body lice or fleas. Misconceptions included that clients must isolate or be denied services until they are medically cleared.

CONCLUSIONS

Our findings reveal significant knowledge gaps among staff who provide services to people experiencing homelessness in the prevention and control of louse- and flea-borne diseases. This demonstrates an urgent need for staff training to both reduce disease and prevent unnecessary restrictions on services and housing.

WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region

BACKGROUND

Water, sanitation, and hygiene (WaSH) insecurity increases the risk of water-related diseases. However, limited research has been conducted on psychosocial distress as it relates to WaSH insecurity, especially among people who inject drugs (PWID). We examined the relationship between WaSH insecurity and related anxiety among PWID living in different housing conditions along the US-Mexico border region.

METHODS

From 2020-2021, a cross-sectional study was conducted among 585 people who injected drugs within the last month in Tijuana (N = 202), San Diego (N = 182), and in both Tijuana and San Diego (N = 201). Participants underwent interviewer-administered surveys related to WaSH access, substance use, and generalized anxiety disorder (GAD-7). Quasi-Poisson regressions were used to assess associations between WaSH insecurity and anxiety in the prior 6-months.

RESULTS

Participants were 75% male, 42% were unhoused and 91% experienced WaSH insecurity in the prior 6-months. After adjusting for housing status, gender, and age, lack of access to basic drinking water (Adj RR: 1.28; 95% CI: 1.02-1.58), sanitation (Adj RR:1.28; 95% CI: 1.07-1.55), and a daily bath/shower (Adj RR: 1.38; 95% CI: 1.15-1.66) were associated with mild-severe anxiety. The number of WaSH insecurities was independently associated with a 20% increased risk of experiencing anxiety per every additional insecurity experienced (Adj RR: 1.20; CI: 1.12-1.27). We also found a significant interaction between gender and housing status (p = 0.003), indicating that among people experiencing sheltered/unsheltered homelessness, women had a higher risk of mild-severe anxiety compared to men (Adj RR: 1.55; 95% CI: 1.27-1.89). At the same time, among women, those who are unhoused have 37% increased risk of anxiety than those who live in stable housing conditions (Adj RR: 1.37; 95% CI: 1.01-1.89).

CONCLUSION

The lack of specific WaSH services, particularly lack of drinking water, toilets, and daily showers were associated with higher levels of anxiety among PWID in the Tijuana-San Diego border region. Women experiencing homelessness were especially vulnerable. WaSH interventions that provide safe, 24-h access may help to reduce anxiety and health risks associated with WaSH insecurity.

Invisible struggles: WASH insecurity and implications of extreme weather among urban homeless in high-income countries - A systematic scoping review

This paper aims to provide a deeper understanding of the water-, sanitation- and hygiene (WASH)-related insecurities that people experiencing homelessness in urban areas of high-income countries (HIC) are facing, and how these insecurities are further complicated during extreme weather events. While limited recent research has looked into WASH among people experiencing homelessness in HICs, and while some work has considering the implications of climate change on WASH and health, the nexus of WASH, extreme weather events and homelessness in HICs have not been studied thus far. We conducted the first systematic scoping review of peer-reviewed literature on this nexus, which is understudied and marked by complexity, involving a range of systems and forms of impact. A total of 50 publications were included in our analysis. We found that public facilities like drinking water fountains, toilets, handwashing facilities, and showers are scarce, frequently unavailable, often pose safety and cleanliness issues, and access to non-public facilities may be cost-prohibitive for homeless populations. Consequently, people experiencing homelessness, including those sleeping rough, in encampments, or shelters, are often forced to limit drinking water consumption, forego healthy hygiene behaviours, and resort to open urination and defecation, all of which carry health risks. Extreme weather events, like heatwaves, extreme cold, heavy rain and flooding exacerbate challenges for people experiencing homelessness, further complicating their access to WASH, and reducing the ability of service providers to deliver extra relief, creating a dual WASH and health burden. Our review highlights that the Human Right to Water and Sanitation is not met for people experiencing homelessness in urban areas of high-income countries, with women emerging as one of the most vulnerable subgroups. It reveals that the impact of certain WASH issues (e.g. drinking water) on homeless populations are better understood than others (e.g. waste), and, similarly, the effects of certain extreme weather events (e.g. heatwaves) on the health and WASH conditions of people experiencing homelessness are better understood than others (e.g. flooding). Data gaps and the lack of information on limited WASH access and health circumstances of people experiencing homelessness, further minimize their representation and consequently impose obstacles to improve their situation. Based on our analysis, we established a framework which operationalizes the nexus of WASH, extreme weather events and homelessness. This framework improves our understanding of the underlying complexities at the intersection of these three issues and provides a foundation for enhanced preparedness and health-oriented planning.

Association of Housing Status With Types of Operations and Postoperative Health Care Utilization

OBJECTIVE

To analyze the association between housing status and the nature of surgical care provided, health care utilization, and operational outcomes.

BACKGROUND

Unhoused patients have worse outcomes and higher health care utilization across multiple clinical domains. However, little has been published describing the burden of surgical disease in unhoused patients.

METHODS

We conducted a retrospective cohort study of 111,267 operations from 2013 to 2022 with housing status documented at a single, tertiary care institution. We conducted unadjusted bivariate and multivariate analyses adjusting for sociodemographic and clinical characteristics.

RESULTS

A total of 998 operations (0.8%) were performed for unhoused patients, with a higher proportion of emergent operations than housed patients (56% vs 22%). In unadjusted analysis, unhoused patients had longer length of stay (18.7 vs 8.7 days), higher readmissions (9.5% vs 7.5%), higher in-hospital (2.9% vs 1.8%) and 1-year mortality (10.1% vs 8.2%), more in-hospital reoperations (34.6% vs 15.9%), and higher utilization of social work, physical therapy, and occupational therapy services. After adjusting for age, sex, comorbidities, insurance status, and indication for operation, as well as stratifying by emergent versus elective operation, these differences went away for emergent operations.

CONCLUSIONS

In this retrospective cohort analysis, unhoused patients more commonly underwent emergent operations than their housed counterparts and had more complex hospitalizations on an unadjusted basis that largely disappeared after adjustment for patient and operative characteristics. These findings suggest issues with upstream access to surgical care that, when unaddressed, may predispose this vulnerable population to more complex hospitalizations and worse longer term outcomes.

Survey of bed bug infestations in homeless shelters in southern France

Bed bug has become a major public health pest worldwide. Infestation may result in numerous negative health effects. Homeless shelters are one of the most habitats that can be infested with bed bugs, a few studies have focused on bed bug infestations in these settings. We conducted a survey of infestations of bed bugs in a homeless shelter in southern France, using an innovative seven-level scale (0-6) to assess the degree of infestation, MALDI TOF-MS to identify bed bugs, and a biomolecular tool to detect bacteria. Bed bug infestations were documented in 13% (9/68) of investigated rooms. A total of 184 bed bugs were collected and morphologically identified as Cimex lectularius. MALDI TOF-MS analysis allowed us to obtain high-quality MS spectra for all 184 specimens, to correctly identify all specimens, and included 178/184 (97%) Log Score Values higher than 1.8. Among the bacteria tested, Wolbachia sp. DNA was found in 149/184 (81%) of the bed bugs, and one sample was positive for Coxiella burnetii, the agent of Q fever. Our study is the first of its kind that offers new perspectives for increasing public awareness of the conditions in homeless shelters.

Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California

BACKGROUND

Access to water and sanitation is a basic human right; however, in many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. Limited knowledge exists about the coping strategies unhoused people use to access WaSH services. This study, therefore, examines WaSH access among unhoused communities in Los Angeles, California, a city with the second-highest count of unhoused people across the nation.

METHODS

We conducted a cross-sectional study using a snowball sampling technique with 263 unhoused people living in Skid Row, Los Angeles. We calculated frequencies and used multivariable models to describe (1) how unhoused communities cope and gain access to WaSH services in different places, and (2) what individual-level factors contribute to unhoused people's ability to access WaSH services.

RESULTS

Our findings reveal that access to WaSH services for unhoused communities in Los Angeles is most difficult at night. Reduced access to overnight sanitation resulted in 19% of the sample population using buckets inside their tents and 28% openly defecating in public spaces. Bottled water and public taps are the primary drinking water source, but 6% of the sample reported obtaining water from fire hydrants, and 50% of the population stores water for night use. Unhoused people also had limited access to water and soap for hand hygiene throughout the day, with 17% of the sample relying on hand sanitizer to clean their hands. Shower and laundry access were among the most limited services available, and reduced people's ability to maintain body hygiene practices and limited employment opportunities. Our regression models suggest that WaSH access is not homogenous among the unhoused. Community differences exist; the odds of having difficulty accessing sanitation services is two times greater for those living outside of Skid Row (Adj OR: 2.52; 95% CI: 1.08-6.37) and three times greater for people who have been unhoused for more than six years compared to people who have been unhoused for less than a year (Adj OR: 3.26; 95% CI: 1.36-8.07).

CONCLUSION

Overall, this study suggests a need for more permanent, 24-h access to WaSH services for unhoused communities living in Skid Row, including toilets, drinking water, water and soap for hand hygiene, showers, and laundry services.

Integrated approach to cardiovascular disease in people experiencing homelessness: a qualitative study

BACKGROUND

Homelessness is associated with an increased risk of cardiovascular disease (CVD), beyond impact of socioeconomic status. CVD is preventable and treatable, though barriers to interventions exist for people experiencing homelessness. Those with lived experience of homelessness and health professionals with relevant expertise can help to understand and address these barriers.

OBJECTIVES

To understand, and make recommendations to improve, CVD care in homeless populations through lived and professional expertise.

METHOD

Four focus groups were conducted in March-July 2019. Three groups included people currently or previously experiencing homelessness, each attended by a cardiologist (AB), a health services researcher (PB) and an 'expert by experience' (SB) who coordinated participants. One group included multidisciplinary health and social care professionals in and around London to explore solutions.

PARTICIPANTS

The three groups included 16 men and 9 women, aged 20-60 years, of whom 24 were homeless and currently living in hostels, and 1 rough sleeper. At least 14 discussed sleeping rough at some point.

RESULTS

Participants were aware of CVD risks and relevance of healthy habits but identified barriers to prevention and health access, starting with disorientation affecting planning and self-care, lack of facilities for food, hygiene and exercise, and experiences of discrimination.

CONCLUSIONS

CVD care for those experiencing homelessness should account for fundamental problems of the environment, be codesigned with service users and cover key principles: flexibility, public and staff education, integration of support and advocacy for health service rights.

Mpox Case Reports in an Urban Homeless Population and a Proof of Concept for a Street-Based Mobile Mpox Vaccination Clinic

Mpox is a new public health outbreak that particularly threatens the homeless population. Street Medicine Phoenix (SMP) is a student-led interprofessional volunteer organization that provides medical care and other essential services to individuals experiencing homelessness in Phoenix, Arizona. In addition to core services such as wound care; health screenings (blood pressure and blood glucose.); vision screenings; HIV testing; naloxone education and distribution; flu, COVID-19, and Hepatitis A vaccinations; and community resource referrals, SMP began offering mpox education and vaccination at outreach events. During an outreach event shortly after the onset of the mpox outbreak, SMP identified 2 suspected mpox cases. Accordingly, SMP has partnered with the Maricopa County Public Health Department to set up mobile mpox vaccination clinics on the streets outside of Phoenix Arizona's largest homeless shelter. We share the details of these 2 cases along with our early efforts vaccinating individuals experiencing homelessness for mpox via our mobile vaccination clinic. Our experiences demonstrate the importance of community agencies providing direct outreach to underserved populations where they are at, particularly the homeless population, to address public health concerns such as emerging disease outbreaks like mpox. In addition, these cases highlight the potential significant impact that street medicine programs can have on their respective homeless communities in the context of infectious disease mitigation and emphasize the importance of partnerships with local health departments.

'You feel how you look': Exploring the impacts of unmet water, sanitation, and hygiene needs among rural people experiencing homelessness and their intersection with drug use

Existing literature attests to water, sanitation, and hygiene (WASH) inequities among people experiencing homelessness (PEH) in the United States, but there is a dearth of research on such issues in rural areas. Homelessness is an emerging public health concern in rural areas where homelessness is on the rise, infectious disease outbreaks are becoming increasingly common, and PEH face unique WASH-related challenges compared to their urban counterparts. We conducted an exploratory study to understand the impacts of unmet WASH needs among rural PEH and their intersection with drug use through in-depth interviews (n = 10). Eligible participants were 18 years or older, lived in one of five Central Appalachian counties, and had experienced homelessness in the previous six months. Using thematic analysis, we identified factors that inhibit WASH access, and adverse health and well-being outcomes that result from unmet WASH needs. We also explore how WASH experiences compare among rural PEH who self-reported drug use to those who did not. Our findings revealed that factors at multiple levels inhibited WASH access, including stigma and place-based characteristics, which contributed to the adverse physical, mental, and emotional health of PEH. Comparisons between PEH who used drugs to those that did not revealed the intricate relationship between WASH, homelessness, and substance use in communities impacted by the opioid epidemic. Expanded WASH facilities that are safe and available with no prerequisites can address inadequate access among rural PEH and collaboration with harm reduction services may be advantageous to reach those who inject drugs.

Lonely, harassed and abandoned in society: the lived experiences of Iranian homeless youth

Introduction

Homelessness is increasing among young adults in large cities. According to the United Nations, there are more than one billion absolute or relative homeless people in the world. This study was conducted to explain the lived experiences of homeless youth in southeastern Iran.

Materials and methods

In this qualitative study, we recruited 13 participants in a big city, southeast Iran, in 2020. The participant was young homeless adults aged 18–29 years who were using homeless shelters provided by the municipality, sleeping in parks or on streets. Data were collected through in-depth and semi-structured interviews and three focus group discussions. Data were analyzed by conventional qualitative content analysis.

Results

The main category of “lonely, annoyed, and abandoned in society” and three subcategories of avoidance of/by society, comprehensive harassment, and lack of comprehensive support were extracted. The experiences of young homeless adults showed that they escaped from the community due to addiction, feeling like a burden to others, and social isolation, and not only have they been left without support in society, but they have also suffered from all kinds of physical and psychological harassments.

Conclusion

The lived experiences of homeless people show that in addition to appropriate facilities and living conditions, they require respect, reduced social stigma, discrimination, and favorable conditions for a return to life. Therefore, authorities should identify and settle their problems and needs.

Trends and age-related characteristics of substance use in the hospitalized homeless population

ABSTRACT

We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20-1.26], cocaine 2.55 [2.50-2.60], marijuana 1.43 [1.40-1.46], and heroin 1.57 [1.29-1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55-0.58] for other patients and 0.60 [0.50-0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81-6.90] and heroin 5.86 [2.08-16.52] in comparison with other hospitalized patients.Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.

Hand hygiene during the COVID-19 pandemic among people experiencing homelessness-Atlanta, Georgia, 2020

People experiencing homelessness are at risk for coronavirus disease 2019 (COVID-19) and may experience barriers to hand hygiene, a primary recommendation for COVID-19 prevention. We conducted in-depth interviews with 51 people experiencing sheltered and unsheltered homelessness in Atlanta, Georgia during May 2020 to August 2020 to (1) describe challenges and opportunities related to hand hygiene and (2) assess hand hygiene communication preferences. The primary hand hygiene barrier reported was limited access to facilities and supplies, which has disproportionately impacted people experiencing unsheltered homelessness. This lack of access has reportedly been exacerbated during COVID-19 by the closure of public facilities and businesses. Increased access to housing and employment were identified as long-term solutions to improving hand hygiene. Overall, participants expressed a preference for access to facilities and supplies over hand hygiene communication materials.

"Locked down outside": Perception of hazard and health resources in COVID-19 epidemic context among homeless people

While social inequality is widely recognised as being a risk factor for COVID-19 infection or serious forms of the disease, many questions still remain concerning the perception of hazard and protective measures by the most vulnerable populations. This mixed-methods study aimed (1) to describe the self-perceived health and protective measures linked to COVID-19 of homeless people in one of the largest and poorest cities in France, and (2) to assess which skills and resources they used to address the COVID-19 pandemic. The quantitative survey addressed these questions among a sample of 995 homeless people living either on the streets, in homeless shelters or in squats/slums, whereas the qualitative survey was constructed from 14 homeless interviewees. Both data collections were carried out between June and July 2020. Results showed that COVID-19 infection was clearly perceived by homeless people as a risk, but the experience of being homeless placed this risk among several others. Different practices of protection were observed according to the type of living place. Lockdown of the general population severely impacted the survival systems of the populations furthest from housing, with alarming rates of people without access to water or food. 77% of homeless participants reported that they encountered significant financial difficulties. All interviewees were particularly attentive to their health, with awareness and even a familiarity with the risks of infectious diseases long before the pandemic. Using a capability framework, our study showed a predominant lack of external health-related resources for homeless people, while internal health-related resources were more developed than expected. None of the places and lifestyles studied was favourable to health: collective shelters due to a greater restriction of people's choices, slums and street life due to a greater lack of basic resources.

The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population

People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered PEH (n = 246) in Nashville, TN, from August 2018–June 2019. Using multivariate fixed-effects linear regression models, we examined associations between biophysical and social environments and self-reported general health and emotional well-being. We found that study participants reported the lowest general health scores during winter months—Nashville’s coldest season. We also found a positive association between the number of nights participants spent indoors during the previous week and general health. Participants who spent even one night indoors during the past week had 1.8-point higher general health scores than participants who spent zero nights indoors (p < 0.01). Additionally, participants who experienced a conflict with a social contact in the past 30 days had lower emotional well-being scores than participants who experienced no conflict. Finally, women had worse general health and emotional well-being than men. Ecologically framed research about health and well-being among PEH is critically needed, especially as climate change threatens to increase the danger of many homeless environments.

An Assessment of Ambient Water Quality and Challenges with Access to Water and Sanitation Services for Individuals Experiencing Homelessness in Riverine Encampments

Individuals experiencing unsheltered homelessness face significant barriers to accessing water, sanitation, and hygiene services, but the risks associated with this lack of access and barriers to service provision have been largely understudied. We analyzed water samples upstream and downstream of three homeless encampments in the San Diego River watershed and interviewed service providers from public and nonprofit sectors to assess local perceptions about challenges and potential solutions for water and sanitation service provision in this context. Water upstream from encampments contained detectable levels of caffeine and sucralose. Escherichia coli concentrations downstream of the encampments were significantly greater than concentrations upstream, but there was no significant change in the concentrations of other pollutants, including caffeine and sucralose. The HF183 marker of Bacteroides was only detected in one sample upstream of an encampment and was not detected downstream. Overall, there was insufficient evidence to suggest that the encampments studied here were responsible for contributing pollution to the river. Nevertheless, the presence of caffeine, sucralose, and HF183 indicated that there are anthropogenic sources of contamination in the river during dry weather and potential risks associated with the use of this water by encampment residents. Interviews with service providers revealed perceptions that the provision of water and sanitation services for this population would be prohibitively expensive. Interviewees also reported perceptions that most riverbank residents avoided contact with service providers, which may present challenges for the provision of water and sanitation service unless trust is first built between service providers and residents of riverine encampments.

Water and Sanitation in Urban America, 2017-2019

Objectives. To estimate the population lacking at least basic water and sanitation access in the urban United States.Methods. We compared national estimates of water and sanitation access from the World Health Organization/United Nations Children's Fund Joint Monitoring Program with estimates from the US Department of Housing and Urban Development on homelessness and the American Community Survey on household water and sanitation facilities.Results. We estimated that at least 930 000 persons in US cities lacked sustained access to at least basic sanitation and 610 000 to at least basic water access, as defined by the United Nations.Conclusions. After accounting for those experiencing homelessness and substandard housing, our estimate of people lacking at least basic water equaled current estimates (n = 610 000)-without considering water quality-and greatly exceeded estimates of sanitation access (n = 28 000).Public Health Implications. Methods to estimate water and sanitation access in the United States should include people experiencing homelessness and other low-income groups, and specific policies are needed to reduce disparities in urban sanitation. We recommend similar estimation efforts for other high-income countries currently reported as having near universal sanitation access.

Barriers, beliefs, and practices regarding hygiene and vaccination among the homeless during a hepatitis A outbreak in Detroit, MI

Appropriate hygiene practices and vaccine acceptance are key factors impacting the health of homeless individuals. A recent outbreak of hepatitis A in Michigan, especially impacting Detroit, prompted us to investigate the practices and attitudes of Detroit's homeless population toward hygiene measures and vaccinations, as well as barriers to such resources. We developed a questionnaire as a means to collect our data, and participants were interviewed at shelters and soup kitchens. While the majority of participants adhered to healthy hygiene practices, approximately 89% reported barriers to accessing public showers. More than half the participants (64%) reported receiving their hepatitis A vaccine prior to the study, while 23% reported previously refusing or hesitating to receive vaccinations. Despite an overall favorable adherence to hygiene practices, substantial barriers are yet to be overcome. Moreover, active measures should be taken to establish higher levels of trust between providers and the homeless to encourage vaccine acceptance.

Intestinal parasitic infection among household contacts of primary cases, a comparative cross-sectional study

Background

Intestinal parasitic infection affects 3.5 billion people in the world and mostly affecting the low socio-economic groups. The objectives of this research works were to estimate the prevalence and determinants of intestinal parasitic infection among family members of known intestinal parasite infected patients.

Methods and materials

A comparative cross-sectional study design was implemented in the urban and rural settings of Mecha district. The data were collected from August 2017toMarch 2019 from intestinal parasite infected patient household members. Epi-info software was used to calculate the sample size, 4531 household members were estimated to be included. Data were collected using interview technique, and collecting stool samples from each household contact of intestinal parasite patients. Descriptive statistics were used to estimate the prevalence of intestinal parasites among known contacts of intestinal parasite patients/family members. Binary logistic regression was used to identify the determinant factors of intestinal parasitic infection among family members.

Results

The prevalence of intestinal parasite among household contacts of intestinal parasite-infected family members was 86.14% [95% CI: 86.14% - 87.15%]. Hookworm infection was the predominant type of infection (18.8%). Intestinal parasitic infection was associated with sex, environmental sanitation, overcrowding, personal hygiene, residence, substandard house, role in the household, source of light for the house, trimmed fingernails, family size, regular handwashing practice. Protozoa infection was associated with habit of ingesting raw vegetable, playing with domestic animals, water source and the presence of household water filtering materials.

Conclusion

High prevalence of intestinal parasitic infection was observed among household contacts of primary cases.

Self-Assessment of Hygiene Practices towards Predictive and Preventive Medicine Intervention: A Case Study of University Students in Ghana

INTRODUCTION

Personal hygiene is essential to the current paradigm shift towards predictive, preventive, and personalized medicine, which enables the prediction and prevention of infectious disease outbreaks.

OBJECTIVE

The aim of this paper was to evaluate the personal hygiene practices among university students aiming at providing a basis for preventive and predictive medical interventions and to make future efforts improve target interventions for young people.

METHODS

The study was conducted using a cross-sectional study. Validated instruments that related personal hygiene practices were used to obtain quantitative data from 412 tertiary students from seven universities in Accra, Ghana. The resulting data were analyzed with IBM-SPSS, version 23.

RESULTS

There were more female respondents (54.4%) in the study than male respondents (45.6%). Respondents between the age group of 19-24 years constituted majority (59.7%) of the respondents in the study. Respondents from urban areas exhibited good hygiene practice compared to those from urban residences. There was a significant association between residence and hygiene practice (χ 2=17.8, P≤0.001). We also observed that those respondents within the upper class in society had a poor hygiene practice, compared to the Lower Class and Middle Class respondents. Lack of education (63.1%) was observed as the main barrier to personal hygiene among the respondents. Future of the society depends on the health of its youth.

CONCLUSION

A significant number of students are not actively practicing good hygiene. There is a need for deployment of preventive medicine interventions targeted at young people. It calls for improvement in methods of hygiene education for young people in tertiary institutions and the inclusion of hygiene in school curricula.

Open Defecation Sites, Unmet Sanitation Needs, and Potential Sanitary Risks in Atlanta, Georgia, 2017-2018

OBJECTIVES

To survey the spatial distribution and enteric pathogen profile of discarded human feces in the city of Atlanta, Georgia.

METHODS

After defining priority search areas in central Atlanta, we conducted 5 searches of open defecation sites totaling 15 hours during the period from October 2017 to January 2018. We collected fresh stools for analysis via multiplex reverse-transcription polymerase chain reaction to identify presence of 15 common parasitic, bacterial, and viral enteric pathogens.

RESULTS

We identified and mapped 39 open defecation sites containing 118 presumptive human stools; 23% of the 26 collected fresh stools tested positive for 1 or more pathogens. An estimated 12% of stools were positive for enterotoxigenic Escherichia coli, 7.7% for Giardia spp., 3.8% for norovirus, and 3.8% for Salmonella spp. The majority (92%) of identified open defecation sites were within 400 meters of a shelter or soup kitchen.

CONCLUSIONS

Though this study was constrained by a small sample size, results suggest that open defecation in Atlanta is common and may pose risks to public health. Public Health Implications. Open defecation may pose health risks to people experiencing homelessness and the general public.