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Tareke AA, Jemal SS, Yemane GD, Zakaria HF, Shiferaw EW, Ngabonzima A. Spatial disparity and associated factors of diarrhea among under-five children in Rwanda: a multilevel logistic regression analysis. BMC Pediatr 2024; 24:266. [PMID: 38658869 PMCID: PMC11040746 DOI: 10.1186/s12887-024-04748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Diarrhea, defined as three or more loose stool per day, is a major cause of child mortality. Exploring its spatial distribution, prevalence, and influencing factors is crucial for public health decision and targeted interventions. This study aimed to investigate these aspects using 2019 Rwanda demographic health survey data. METHOD A total 7,978 (weighted) under-five children were included in this study. Spatial clustering (hotspots areas) were mapped using ArcGIS and SaTscan software. A multilevel logistic regression model was fitted to assessed factors associated with diarrhea, reporting significance at p < 0.05 and a 95% confidence interval. RESULTS diarrheal diseases in Rwanda showed a clustered spatial pattern (Moran's I = 0.126, p = 0.001), with the primary cluster in west and north provinces. Under-five diarrhea prevalence was 14.3% (95% CI: 13.55, 15.08). Factors increasing likelihood included maternal age 15-34 years, child age 7-24 months, while full immunization was protective (aOR = 0.74, 95% CI: 0.56, 0.98). CONCLUSION Spatial clustering of diarrheal diseases is found in west and north provinces of Rwanda. Being born to a young mother, being a child aged 7-24 months, being fully immunized, being born to a low-educated mother and belonging to a community having low level education are factors associated with diarrheal diseases in Rwanda. Developing interventional plans based on identified clusters and approaching children based on their immunization status, maternal education and age could be cost-effective in reducing diarrheal diseases in Rwanda. Location based intervention could allow for the efficient allocation of resources by focusing on areas with higher prevalence and need.
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Affiliation(s)
- Abiyu Abadi Tareke
- West Gondar Zonal Health Department, Amref Health Africa, Gondar, Ethiopia.
| | - Sebwedin Surur Jemal
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Getahun Dejene Yemane
- Department of Statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Hamdi Fekredin Zakaria
- Department of Epidemiology and Biostatistics, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Enyew Woretaw Shiferaw
- Department of Maternal and Child Health (MCH), West Gondar Zonal Health Department, Gondar, Ethiopia
| | - Anaclet Ngabonzima
- John Snow, Inc.(JSI) Research & Training Institute, Inc, Washington, DC, USA
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Colston JM, Chernyavskiy P, Gardner L, Nong M, Fang B, Houpt E, Swarup S, Badr H, Zaitchik B, Lakshmi V, Kosek M. The Planetary Child Health & Enterics Observatory (Plan-EO): a protocol for an interdisciplinary research initiative and web-based dashboard for mapping enteric infectious diseases and their risk factors and interventions in LMICs. Res Sq 2024:rs.3.rs-2640564. [PMID: 36993232 PMCID: PMC10055683 DOI: 10.21203/rs.3.rs-2640564/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Background Diarrhea remains a leading cause of childhood illness throughout the world that is increasing due to climate change and is caused by various species of ecologically sensitive pathogens. The emerging Planetary Health movement emphasizes the interdependence of human health with natural systems, and much of its focus has been on infectious diseases and their interactions with environmental and human processes. Meanwhile, the era of big data has engendered a public appetite for interactive web-based dashboards for infectious diseases. However, enteric infectious diseases have been largely overlooked by these developments. Methods The Planetary Child Health and Enterics Observatory (Plan-EO) is a new initiative that builds on existing partnerships between epidemiologists, climatologists, bioinformaticians, and hydrologists as well as investigators in numerous low- and middle-income countries. Its objective is to provide the research and stakeholder community with an evidence base for the geographical targeting of enteropathogen-specific child health interventions such as novel vaccines. The initiative will produce, curate, and disseminate spatial data products relating to the distribution of enteric pathogens and their environmental and sociodemographic determinants. Discussion As climate change accelerates there is an urgent need for etiology-specific estimates of diarrheal disease burden at high spatiotemporal resolution. Plan-EO aims to address key challenges and knowledge gaps by making rigorously obtained, generalizable disease burden estimates freely available and accessible to the research and stakeholder communities. Pre-processed environmental and EO-derived spatial data products will be housed, continually updated, and made publicly available to the research and stakeholder communities both within the webpage itself and for download. These inputs can then be used to identify and target priority populations living in transmission hotspots and for decision-making, scenario-planning, and disease burden projection. Study registration PROSPERO protocol #CRD42023384709.
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Affiliation(s)
| | | | | | - Malena Nong
- University of Virginia College of Arts & Sciences
| | | | - Eric Houpt
- University of Virginia School of Medicine
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Colston JM, Chernyavskiy P, Gardner L, Nong M, Fang B, Houpt E, Swarup S, Badr H, Zaitchik B, Lakshmi V, Kosek M. The Planetary Child Health & Enterics Observatory (Plan-EO): a protocol for an interdisciplinary research initiative and web-based dashboard for mapping enteric infectious diseases and their risk factors and interventions in LMICs. Res Sq 2024:rs.3.rs-2640564. [PMID: 36993232 PMCID: PMC10055683 DOI: 10.21203/rs.3.rs-2640564/v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Diarrhea remains a leading cause of childhood illness throughout the world that is increasing due to climate change and is caused by various species of ecologically sensitive pathogens. The emerging Planetary Health movement emphasizes the interdependence of human health with natural systems, and much of its focus has been on infectious diseases and their interactions with environmental and human processes. Meanwhile, the era of big data has engendered a public appetite for interactive web-based dashboards for infectious diseases. However, enteric infectious diseases have been largely overlooked by these developments. Methods The Planetary Child Health and Enterics Observatory (Plan-EO) is a new initiative that builds on existing partnerships between epidemiologists, climatologists, bioinformaticians, and hydrologists as well as investigators in numerous low- and middle-income countries. Its objective is to provide the research and stakeholder community with an evidence base for the geographical targeting of enteropathogen-specific child health interventions such as novel vaccines. The initiative will produce, curate, and disseminate spatial data products relating to the distribution of enteric pathogens and their environmental and sociodemographic determinants. Discussion As climate change accelerates there is an urgent need for etiology-specific estimates of diarrheal disease burden at high spatiotemporal resolution. Plan-EO aims to address key challenges and knowledge gaps by making rigorously obtained, generalizable disease burden estimates freely available and accessible to the research and stakeholder communities. Pre-processed environmental and EO-derived spatial data products will be housed, continually updated, and made publicly available to the research and stakeholder communities both within the webpage itself and for download. These inputs can then be used to identify and target priority populations living in transmission hotspots and for decision-making, scenario-planning, and disease burden projection. Study registration PROSPERO protocol #CRD42023384709.
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Affiliation(s)
| | | | | | - Malena Nong
- University of Virginia College of Arts & Sciences
| | | | - Eric Houpt
- University of Virginia School of Medicine
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Ritter PI, Sanchez RA. The effects of an epidemic on prenatal investments, childhood mortality and health of surviving children. J Popul Econ 2022; 36:505-544. [PMID: 35378850 PMCID: PMC8968331 DOI: 10.1007/s00148-022-00886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
The potential death toll from an epidemic is larger than the number of deaths directly associated with the infection. In this study, we find that prenatal exposure to a cholera epidemic in Peru increased childhood mortality and that surviving children were more likely to be underweight and to suffer from diarrhea. We further find that a significant part of this mortality happened during the first day of life, and that prenatal exposure to cholera decreased prenatal care and institutional deliveries, suggesting that the mortality and possibly other longer-term effects were partially driven by a reduction in prenatal investments.
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Nengminza Sangma RV, Rasania SK, Prasuna JG, Das R, Jais M. Seasonal variation of diarrheal diseases and drinking water quality in resettlement colony in Delhi, India: A community-based cross-sectional study. Indian J Public Health 2022; 65:387-390. [PMID: 34975084 DOI: 10.4103/ijph.ijph_1214_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Seasonal variation plays an important role in the occurrence of diarrheal diseases and distinct seasonal occurrence of diarrheal diseases, with bacterial diarrhea occurring more during the warm seasons and viral diarrhea occurring during the drier cool months, has been observed due to seasonal variation. Time-series cross-sectional study was conducted from January to December 2018 among 553 under-five children to assess seasonal variation of diarrheal diseases and its association with the drinking water quality in a resettlement colony of Delhi. The prevalence of diarrhea was 40.7% and was highest during the rainy season (67.6%). Majority of the water samples were found to be unsatisfactory for human consumption during the rainy and summer seasons. Significant and moderate relationship was found between the seasonal variation and occurrence of diarrhea (r = 0.728, P < 0.05) and most probable number count (r = 0.50, P < 0.05), respectively. Understanding the environmental factors that influences the occurrence of diarrheal diseases is warranted.
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Affiliation(s)
| | - S K Rasania
- Director Professor and Head, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - J G Prasuna
- Director Professor, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Ranjan Das
- Director Professor, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Manoj Jais
- Director Professor, Department of Microbiology, Lady Hardinge Medical College, New Delhi, India
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Brander RL, Pavlinac PB, Walson JL, John-Stewart GC, Weaver MR, Faruque ASG, Zaidi AKM, Sur D, Sow SO, Hossain MJ, Alonso PL, Breiman RF, Nasrin D, Nataro JP, Levine MM, Kotloff KL. Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study. BMC Med 2019; 17:214. [PMID: 31767012 PMCID: PMC6878715 DOI: 10.1186/s12916-019-1441-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/08/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD. METHODS Using data from the Global Enteric Multicenter Study of children 0-23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A clinical prediction tool was developed using backward elimination of potential variables, and Akaike Information Criterion to select the best fit model. RESULTS Of the 5902 included children, mean age was 10 months and 43.2% were female. Over the 50-90-day follow-up period, 24.2% of children had severe linear growth faltering and the mean ΔLAZ over follow-up was - 0.17 (standard deviation [SD] 0.54). After adjustment for age, baseline LAZ, and site, several factors were associated with decline in LAZ: young age, acute malnutrition, hospitalization at presentation, non-dysenteric diarrhea, unimproved sanitation, lower wealth, fever, co-morbidity, or an IMCI danger sign. Compared to children 12-23 months old, those 0-6 months were more likely to experience severe linear growth faltering (adjusted prevalence ratio [aPR] 1.97 [95% CI 1.70, 2.28]), as were children 6-12 months of age (aPR 1.72 [95% CI 1.51, 1.95]). A prediction model that included age, wasting, stunting, presentation with fever, and presentation with an IMCI danger sign had an area under the ROC (AUC) of 0.67 (95% CI 0.64, 0.69). Risk scores ranged from 0 to 37, and a cut-off of 21 maximized sensitivity (60.7%) and specificity (63.5%). CONCLUSION Younger age, acute malnutrition, MSD severity, and sociodemographic factors were associated with short-term linear growth deterioration following MSD. Data routinely obtained at MSD may be useful to predict children at risk for growth deterioration who would benefit from interventions.
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Affiliation(s)
- Rebecca L Brander
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | | | - Judd L Walson
- Department of Epidemiology, Global Health, Pediatrics, Medicine, Childhood Acute Illness and Nutrition Network, University of Washington, Seattle, WA, USA
| | - Grace C John-Stewart
- Department of Epidemiology, Global Health, Pediatrics, Medicine, University of Washington, Seattle, WA, USA
| | - Marcia R Weaver
- Department of Global Health, Health Services, Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Abu S G Faruque
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Anita K M Zaidi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Present Address: Enteric and Diarrheal Diseases Program, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India.,Present Address: Translational Health Science and Technology Institute, Faridabad, India
| | - Samba O Sow
- Centre pour le Développement des Vaccines, Bamako, Mali
| | - M Jahangir Hossain
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Pedro L Alonso
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique.,Present Address: Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Robert F Breiman
- Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya.,Present Address: Global Health Institute Emory University, Atlanta, GA, USA
| | - Dilruba Nasrin
- Center for Vaccine Development, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James P Nataro
- Center for Vaccine Development, Department of Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,Present Address: Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Myron M Levine
- Center for Vaccine Development and Global Health, Department of Pediatrics and Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, Department of Pediatrics and Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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7
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Porter CK, Gutierrez RL, Kotloff KL. Clinical endpoints for efficacy studies. Vaccine 2019; 37:4814-22. [PMID: 30981626 DOI: 10.1016/j.vaccine.2019.03.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/19/2019] [Accepted: 03/21/2019] [Indexed: 12/21/2022]
Abstract
Well-established, validated and clinically meaningful primary and secondary endpoints are critical in advancing vaccines through proof of principal studies, licensure and pre-qualification. To that end, the field of vaccine development for Shigella, enterotoxigenic Escherichia coli (ETEC) as well as other enteric pathogens would benefit greatly from a focused review of clinical endpoints and the use of common endpoints across the field to enable study-to-study comparisons as well as comparative assessments between vaccine candidates. A workshop was conducted to review clinical endpoints from controlled human challenge studies, field studies in naïve adult travelers and pediatric studies in low-middle income countries and to develop a consensus on clinical endpoints for future vaccine trials. Following sequential presentations on different study designs (CHIM, travelers' efficacy and pediatric efficacy), workshop participants broke into three simultaneous workgroups focused on those study designs to discuss a number of topics key to clinical endpoints specific to each study design. Previously utilized endpoints were reviewed with an eye towards potentially novel endpoints for future studies and consideration of the disease parameters and spectrum of disease targeted for prevention. The strength of support among workshop participants for the use of various endpoints is summarized as are recommendations for additional endpoints to be considered in future studies. It is anticipated that this report will facilitate endpoint determination in future efficacy trials of vaccine candidates.
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8
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Liu Z, Ding G, Zhang Y, Lao J, Liu Y, Zhang J, Lu L, Liu Q, Jiang B. Identifying different types of flood-sensitive diarrheal diseases from 2006 to 2010 in Guangxi, China. Environ Res 2019; 170:359-365. [PMID: 30623882 DOI: 10.1016/j.envres.2018.12.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/09/2018] [Accepted: 12/29/2018] [Indexed: 05/13/2023]
Abstract
Floods may influence different types of diarrheal diseases and epidemiological studies of pathogen-specific diarrhea due to floods in China are still needed. In addition, few studies have been conducted to quantify the lag and cumulative risk of diarrheal disease due to floods in Guangxi, China. Our study aimed to identify different types of diarrheal diseases that were sensitive to floods and to quantify their lag and cumulative impact. A matched analysis based on time series data of floods and infectious disease from 2006 to 2010 was conducted in Guangxi, China. Each flood day was treated as an independent unit in our study. A simplified assumption that each day of the flood confers the same risk was adopted before analysis. Each flood day was matched to a non-flood day by city and time. Log-linear mixed-effects regression models were used to quantify the association between different types of diarrheal diseases and floods. Lag and cumulative effects were also calculated to get delayed and overall effects. A total of 45,131 diarrhea cases were notified in the study area over the study period. After controlling for the long-term trend, seasonality, and meteorological factors, floods caused a significantly increased risk of total diarrheal diseases. The RR was highest at lag 2 days (RR=1.24, 95% CI: 1.11-1.40). Floods caused a significantly increased risk in bacillary dysentery and in other infectious diarrhea, but not in typhoid fever and paratyphoid fever. Floods were significantly associated with total diarrheal diseases and other infectious diarrhea for both cumulative lag 0-7 and 0-14 days. Our study provides strong evidence of a positive association between floods and diarrheal diseases including bacillary dysentery and other infectious diarrhea in study area. Public health interventions should be taken to prevent a potential risk of these flood-sensitive diarrheal diseases according to the different lag period after floods.
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Affiliation(s)
- Zhidong Liu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong Province 250012, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province 250012, People's Republic of China
| | - Guoyong Ding
- Department of epidemiology, School of Public Health, Taishan Medical College, Taian, Shandong Province 271016, People's Republic of China
| | - Ying Zhang
- School of Public Health, China Studies Centre, The University of Sydney, New South Wales, Australia
| | - Jiahui Lao
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong Province 250012, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province 250012, People's Republic of China
| | - Yanyu Liu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong Province 250012, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province 250012, People's Republic of China
| | - Jing Zhang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong Province 250012, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province 250012, People's Republic of China
| | - Liang Lu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, China CDC, Beijing 102206, People's Republic of China
| | - Qiyong Liu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, China CDC, Beijing 102206, People's Republic of China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong Province 250012, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province 250012, People's Republic of China.
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Rowles LS, Alcalde R, Bogolasky F, Kum S, Diaz-Arriaga FA, Ayres C, Mikelonis AM, Toledo-Flores LJ, Alonso-Gutiérrez MG, Pérez-Flores ME, Lawler DF, Ward PM, Lopez-Cruz JY, Saleh NB. Perceived versus actual water quality: Community studies in rural Oaxaca, Mexico. Sci Total Environ 2018; 622-623:626-634. [PMID: 29223086 DOI: 10.1016/j.scitotenv.2017.11.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/15/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
Compromised water quality risks public health, which becomes particularly acute in economically marginalized communities. Although the majority of the clean-water-deprived population resides in Sub-Saharan Africa and Asia, a significant portion (32 million) lives in Meso- and Latin-America. Oaxaca is one of the marginalized southern states of Mexico, which has experienced high morbidity from infectious diseases and also has suffered from a high rate of infant mortality. However, there has been a paucity of reports on the status of water quality of culturally diverse rural Oaxaca. This study follows community-based participatory research methods to address the data gap by reporting on water quality (chemical and microbiological) and by exploring social realities and water use practices within and among communities. Surveys and water quality analyses were conducted on 73 households in three rural communities, which were selected based on the choice of water sources (i.e., river water, groundwater, and spring water). Statistically significant variations among communities were observed including the sanitation infrastructure (p-value 0.001), public perception on water quality (p-value 0.007), and actual microbiological quality of water (p-value 0.001). Results indicate a high prevalence of diarrheal diseases, a desire to improve water quality and reduce the cost of water, and a need for education on water quality and health in all the surveyed communities. The complexities among the three studied communities highlight the need for undertaking appropriate policies and water treatment solutions.
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Affiliation(s)
- Lewis Stetson Rowles
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX, USA
| | - Reinaldo Alcalde
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX, USA
| | - Francisca Bogolasky
- The Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, TX, USA
| | - Soyoon Kum
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX, USA
| | - Farith A Diaz-Arriaga
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX, USA
| | - Craig Ayres
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX, USA
| | | | | | - Manuel Gerardo Alonso-Gutiérrez
- Insituto Politécnico Nacional, Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional Unidad, Oaxaca, Mexico
| | - Maria Eufemia Pérez-Flores
- Insituto Politécnico Nacional, Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional Unidad, Oaxaca, Mexico
| | - Desmond F Lawler
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX, USA
| | - Peter M Ward
- The Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, TX, USA
| | - Juana Yolanda Lopez-Cruz
- Insituto Politécnico Nacional, Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional Unidad, Oaxaca, Mexico
| | - Navid B Saleh
- Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX, USA.
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Burden of diarrhea in the Eastern Mediterranean Region, 1990-2015: Findings from the Global Burden of Disease 2015 study. Int J Public Health 2018; 63:109-121. [PMID: 28776239 PMCID: PMC5973974 DOI: 10.1007/s00038-017-1008-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Diarrheal diseases (DD) are an important cause of disease burden, especially in children in low-income settings. DD can also impact children's potential livelihood through growth faltering, cognitive impairment, and other sequelae. METHODS As part of the Global Burden of Disease study, we estimated DD burden, and the burden attributable to specific risk factors and etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2015. We calculated disability-adjusted life-years (DALYs)-the sum of years of life lost and years lived with disability-for both sexes and all ages. RESULTS We estimate that over 103,692 diarrhea deaths occurred in the EMR in 2015 (95% uncertainty interval: 87,018-124,692), and the mortality rate was 16.0 deaths per 100,000 persons (95% UI: 13.4-19.2). The majority of these deaths occurred in children under 5 (63.3%) (65,670 deaths, 95% UI: 53,640-79,486). DALYs per 100,000 ranged from 304 (95% UI 228-400) in Kuwait to 38,900 (95% UI 25,900-54,300) in Somalia. CONCLUSIONS Our findings will guide evidence-based health policy decisions for interventions to achieve the ultimate goal of reducing the DD burden.
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Rull M, Masson S, Peyraud N, Simonelli M, Ventura A, Dorion C, Luquero FJ, Uzzeni F, Cigleneki I. The new WHO decision-making framework on vaccine use in acute humanitarian emergencies: MSF experience in Minkaman, South Sudan. Confl Health 2018; 12:11. [PMID: 29599819 PMCID: PMC5868060 DOI: 10.1186/s13031-018-0147-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction The main causes of death during population movements can be prevented by addressing the population's basic needs. In 2013, the World Health Organization (WHO) issued a framework for decision making to help prioritize vaccinations in acute humanitarian emergencies. This article describes MSF's experience of applying this framework in addition to addressing key population needs in a displacement setting in Minkaman, South Sudan. Case description Military clashes broke out in South Sudan in December 2013. By May 2014, Minkaman, a village in the Lakes State, hosted some 85,000 displaced people. MSF arrived in Minkaman on 28 December 2013 and immediately provided interventions to address the key humanitarian needs (health care, access to drinking water, measles vaccination). The WHO framework was used to identify priority vaccines: those preventing outbreaks (measles, polio, oral cholera vaccine, and vaccine against meningococcal meningitis A (MenAfrivac®)) and those reducing childhood morbidity and mortality (pentavalent vaccine that combines diphtheria, tetanus, whooping cough, hepatitis B, and Haemophilus influenzae type B; pneumococcal vaccine; and rotavirus vaccine). By mid-March, access to primary and secondary health care was ensured, including community health activities and the provision of safe water. Mass vaccination campaigns against measles, polio, cholera, and meningitis had been organized. Vaccination campaigns against the main deadly childhood diseases, however, were not in place owing to lack of authorization by the Ministry of Health (MoH). Conclusions The first field use of the new WHO framework for prioritizing vaccines in acute emergencies is described. Although MSF was unable to implement the full package of priority vaccines because authorization could not be obtained from the MoH, a series of mass vaccination campaigns against key epidemic-prone diseases was successfully implemented within a complex emergency context. Together with covering the population's basic needs, this might have contributed to reducing mortality levels below the emergency threshold and to the absence of epidemics. For the WHO framework to be used to its full potential it must not only be adapted for field use but, most importantly, national decision makers should be briefed on the framework and its practical implementation.
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Affiliation(s)
- Monica Rull
- 1Medecins Sans Frontieres Switzerland, Geneva, Switzerland
| | | | | | | | | | - Claire Dorion
- 1Medecins Sans Frontieres Switzerland, Geneva, Switzerland
| | | | | | - Iza Cigleneki
- 1Medecins Sans Frontieres Switzerland, Geneva, Switzerland
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Rosinger AY. Household water insecurity after a historic flood: Diarrhea and dehydration in the Bolivian Amazon. Soc Sci Med 2017; 197:192-202. [PMID: 29253721 DOI: 10.1016/j.socscimed.2017.12.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/29/2022]
Abstract
While 884 million people worldwide lack access to clean water, millions live in flood-prone regions. Unexpected flooding increases risk of diarrheal diseases and is expected to occur with increased frequency in the 21st century. Water insecurity is linked to mental distress in water scarce regions, yet this construct has not been examined closely among populations living in flood-prone regions. This paper examines how differences in water sources and lifestyle among Tsimane' forager-horticulturalists in lowland Bolivia are related to water insecurity after a historic flood in 2014, and in turn, how water insecurity is associated with diarrhea and dehydration. Pre-flood data come from qualitative interviews with 36 household heads, anthropometrics, participant observation, and water quality analysis between September 2013-January 2014 used to create a locally-adapted water insecurity questionnaire. Water insecurity was measured after the historic flood; no pre-flood water insecurity measures are available. Post-flood data were collected through surveys, water quality analysis, and health exams using near-exhaustive sampling in two villages, yielding 118 adults and 115 children (aged 2-12 years) in 62 households between March-April 2014. Overall, 89% of adults reported medium or high water insecurity. Only hand-pumps tested negative for pathogenic bacteria both pre- and post-flood. Tobit regressions suggest that hand-pumps (when available) and adult age were associated with lower water insecurity scores. Multiple logistic regressions suggest that adults with high water insecurity were more likely to report diarrhea than adults with low (Odds Ratio [OR] 9.2; 95% CI: 1.27-67.1). Children from households with medium (OR: 6.8; 95% CI: 1.41-32.5) or high (OR: 14.0; 95% CI: 2.40-81.5) water insecurity had significantly higher odds of dehydration than children in households with low water insecurity. Catastrophic flooding may systematically increase dimensions of household water insecurity. This research suggests an experience-based measure of water insecurity is associated with objective health outcomes.
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Affiliation(s)
- Asher Y Rosinger
- Department of Biobehavioral Health, The Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802, USA; Department of Anthropology, The Pennsylvania State University, 410 Carpenter Building, University Park, PA 16802, USA.
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Yao W, Yang C, Wen Y, Zhang W, Zhang X, Ma Q, Ji P, Hua Y, Wei Y. Treatment effects and mechanisms of Yujin Powder on rat model of large intestine dampness-heat syndrome. J Ethnopharmacol 2017; 202:265-280. [PMID: 28330724 DOI: 10.1016/j.jep.2017.03.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 03/14/2017] [Accepted: 03/18/2017] [Indexed: 06/06/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Yujin Powder (YJP), an old prescription, is one of the most classical prescription for treating the large intestine dampness-heat syndrome (LIDHS). However, its potential modern pharmacological mechanisms remain unclear. AIM OF THE STUDY The present study was designed to explore the essence of LIDHS and treatment mechanisms of the YJP on the LIDHS. METHODS The rat model of LIDHS was established by such complex factors as high-sugar and high-fat diet, improper diet, high temperature and humidity environment (HTHE), drinking and intraperitoneal injection of Escherichia coli., which imitated the inducing conditions of LIDHS. Then the clinical symptoms and signs, blood routine, blood biochemistry, whole blood viscosity (WBV), serum inflammatory cytokines levels and the histopathological changes of main organs were detected and observed, respectively. RESULTS The results showed that the clinical symptoms and signs of the model rats were consistent with the diagnostic criteria of LIDHS, moreover, there were obvious systemic inflammatory response and extensive congestion. And after treatment with YJP in different dosages, the clinical symptoms and signs of the rats with LIDHS were improved; the indexes of blood routine and blood biochemistry and inflammatory cytokines levels tended to be normal; the WBV decreased and histopathological changes of major organs were alleviated or returned to normal. There was an obvious dose-effect relationship, and the high dose of YJP (HD-YJP) had the best treatment effects. CONCLUSIONS These results suggested that in LIDHS, diarrhea was the major clinical manifestation; the large intestine was the main lesion area; mucosa injury, inflammation and congestion of the large intestine with systemic inflammatory response and congestion were the most typical pathological characteristics. Meanwhile, YJP exhibited the comprehensive effects of anti-diarrhea, anti-inflammation, lowering blood lipid, relieving blood stasis, repairing intestinal mucosa and regulation and protection of multiple organs on LIDHS. These findings provided not only important information for understanding the essence of LIDHS but also the theoretical basis for developing new-drugs for treating dampness-heat type of diarrheal diseases.
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Affiliation(s)
- Wanling Yao
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou 730070, PR China.
| | - Chaoxue Yang
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou 730070, PR China.
| | - Yanqiao Wen
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou 730070, PR China.
| | - Wangdong Zhang
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou 730070, PR China.
| | - Xiaosong Zhang
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou 730070, PR China.
| | - Qi Ma
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou 730070, PR China.
| | - Peng Ji
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou 730070, PR China.
| | - Yongli Hua
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou 730070, PR China.
| | - Yanming Wei
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou 730070, PR China.
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Mubarak MY, Wagner AL, Asami M, Carlson BF, Boulton ML. Hygienic practices and diarrheal illness among persons living in at-risk settings in Kabul, Afghanistan: a cross-sectional study. BMC Infect Dis 2016; 16:459. [PMID: 27576606 PMCID: PMC5006562 DOI: 10.1186/s12879-016-1789-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/18/2016] [Indexed: 11/12/2022] Open
Abstract
Background Sustained civil and military conflict, resulting in large numbers of internally displaced persons (IDP), in combination with rapid urbanization has strained public health and sanitation within cities in Afghanistan. In order to examine the association between preventive sanitary behaviors and diarrhea within two high risk settings located within Kabul, Afghanistan, this study aimed to evaluate the prevalence of hygienic practices and diarrheal illness in an IDP camp and an urban slum. Methods In this cross sectional study, a convenience sample of residents of an IDP camp and an urban slum in Kabul, Afghanistan, was used. Participants were asked to describe their hygienic practices and interviewers independently documented household sanitation. The knowledge and attitudes about and practice of hygienic activities to prevent diarrhea were compared between the two settings. Results Two hundred participants, 100 from each setting, were enrolled. Knowledge, attitudes, and practices regarding hygienic activities to prevent diarrhea were greater among the slum dwellers than the IDP. Fewer than half of participants washed their hands with soap before eating or after eating: 31 % of slum dwellers washed before eating compared to 11 % of IDPs (P = 0.0050), and 25 % of slum dwellers washed after defecating compared to 4 % of IDPs (P = 0.0020). The IDPs were more likely to share a latrine (P = 0.0144) and less likely to disinfect their latrine than slum dwellers. Diarrhea in the household within the past 3 months was more common in the IDP camp (54 %) than the slum (20 %) (P = 0.0020). Conclusions Even though certain sanitary and hygienic practices were more common among slum dwellers than IDPs, the lack of hygienic activities in both setting indicates that interventions to change behavior, like increasing the availability of soap and encouraging hand washing, are needed. Any initiative will have to be developed in the context of pervasive illiteracy among persons in both of these settings. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1789-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammad Yousuf Mubarak
- Department of Microbiology, Kabul Medical University, Jamal Mina, 3rd District, University Road, Kabul, Afghanistan
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
| | - Mari Asami
- Area on Water Management, Department of Environmental Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
| | - Bradley F Carlson
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Matthew L Boulton
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA
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