Eliminating Trachoma in Africa: The Importance of Environmental Interventions

Subsequent to the failure of the World Health Organisation (WHO) of achieving their target to eliminate trachoma by the year 2020, the most effective strategy in eliminating trachoma must be re-examined to accomplish the new target of eradication by the year 2030. Whilst antibiotic therapy is a core foundation of this elimination strategy, another important factor is the state of the environmental conditions in trachoma endemic countries. This manuscript aimed to identify the impact of environmental improvement strategies on the prevalence of trachoma and the significance of environmental improvement alongside the use of antibiotic treatment to achieve trachoma elimination. Two independent literature searches were conducted up until the 5th of July 2021. Two main databases were used to carry out these literature searches, namely, Ovid EMBASE and Ovid MEDLINE. All of the relevant references were found using MeSH and free text terms. Key terms used were 'trachoma', 'water', 'sanitation', 'hygiene' and 'environmental Improvement'. The exclusion criteria included non-African-based studies, review papers, protocols and case reports. A total of 17 studies were included for this review. Living within a close range of a water source was significantly associated with reduced risk of trachoma infection. Water obtained from piped water sources was associated with the lowest rates of active trachoma. Studies on facial cleanliness evidenced a strong association with reduced prevalence of trachoma. Whilst the provision of latrine facilities found was significantly associated with reduced prevalence of trachoma, there was no significant difference between the use of private latrine facilities over communal latrine facilities. The use of repeated scheduled antibiotic treatments over single-use antibiotic distribution had a greater impact both short term and long term on the prevalence rates of trachoma. Nonetheless, prevalence rates increased again following the commencement of treatment. Mass antibiotic treatment has been proven to have a greater impact on lowering the prevalence of trachoma initially, but this impact is not sustainable due to the rise in prevalence rates following the completion of treatment. A holistic approach, therefore, must be implemented with evidence showing that an emphasis on longer-term environmental methods should be implemented to compliment antibiotic distribution. Prioritisation of specific interventional measures should be tailored according to local epidemiology; nonetheless, these measures form the backbone of a trachoma elimination strategy to eliminate trachoma by the year 2030.

The Socioeconomic Factors of Street Food Vending in Developing Countries and Its Implications for Public Health: A Systematic Review

The sale of ready-to-eat (RTE) street food represents an important source of income in many developing countries. However, these foods are frequently implicated in outbreaks of gastrointestinal diseases. Street food vendors face several constraints that hamper improvement in the microbiological quality of their products. The aim of this review was to update knowledge about the main causes of foodborne illnesses in developing countries, including the growing concern with the microbial transmission of antibiotic resistance. Following PRISMA guidelines, this systematic review was conducted on original articles published from January 2010 to July 2023. The search was carried out using Scopus, PubMed, Web of Science, Food Science and Technology Abstracts (FSTA), the International Information System for Agricultural Sciences and Technology (AGRIS), as well as isolated searches of relevant articles from Google Scholar. The initial search identified 915 articles, 50 of which were included in this systematic review. The results indicate that, in the majority of the 15 countries examined, women constitute the predominant segment of street food vendors, representing more than 55% of the total number of these vendors. In 11 countries, street food vendors under the age of 18 were identified. Most vendors had a low level of education and, consequently, were unaware of good hygiene practices when handling food. The combination of factors such as poor hygiene practices on the part of food handlers and the lack of facilities, namely, the absence of available potable water, were frequently listed as the main causes of food contamination. Enterobacteriaceae such as Escherichia coli (61.9%), Salmonella (30.1%), and Shigella spp. (9.5%), as well as Staphylococcus aureus (30.1%) and Listeria monocytogenes (14.3%), were the most common pathogens found in RTE street foods. In 22 studies from 13 developing countries, 59% (13/22) reported high multidrug resistance in Enterobacteriaceae (40% to 86.4% in E. coli, 16.7 to 70% in Salmonella, and 31 to 76.4% in S. aureus). To address the challenges faced by street vendors and improve their economic activities, it is necessary for government entities, consumers, and vendors to work together collaboratively.

Does Fecal-Oral Transmission of SARS-CoV-2 Due to Low Sanitation Conditions Contribute to Low Mortality Rates From COVID-19

BACKGROUND

 The novel coronavirus disease 2019 (COVID-19) is a global pandemic generated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary infection site is mucosal surfaces, mainly the lungs and the intestine, where epithelial cells can be infected. COVID-19 has spread throughout the world, causing millions of deaths and hundreds of millions of confirmed infections. Despite the global spread of SARS-CoV-2, there are extreme differences between countries in mortality rates and confirmed infections.

METHODS

 Pearson correlations and a t-test were performed on data from 137 countries in order to test the correlation between number of deaths from diarrheal diseases (pre-COVID-19 pandemic data) as a marker for countries' sanitation level, and the number of confirmed COVID-19 cases and deaths per million.

RESULTS

 It was found that countries' prevalence of confirmed COVID-19 cases and deaths per million are statistically correlated with their sanitation level.

CONCLUSIONS

 The hypothesis proposed in this article is that the low mortality rates from COVID-19 in countries where the level of sanitation is low are due to fecal-oral infection of the population by SARS-CoV-2, rather than infection of the respiratory system. This hypothesis is supported by the protective effect of the low sanitation level presented in this work and the fact that lung infection by SARS-CoV-2 can cause severe pathology, while infection in the intestine generally causes minor or no symptoms.

[Rural environmental sanitation in the central, southern and northern regions of Shaanxi Province in 2018]

OBJECTIVE

To understand the rural sanitary conditions in different geographical areas of Shaanxi Province.

METHODS

According to the stratified random sampling method, 30 agriculture-related counties were selected(The central area includes 13 counties in Xi'an, Tongchuan, Weinan, Xianyang and Baoji cities. The southern area includes 10 counties in Hanzhong, Ankang, Shangluo cities. The northern area includes 7 counties in Yulin, Yan'an cities. ). Five townships were selected randomly in each county(excluding Chengguan Town), and 4 administrative villages were selected randomly in each township as survey villages, which were collected the soil samples for testing lead, cadmium and chromium in each subject village, and 5 households were randomly selected in each villages as survey households. The data was obtained through data reading, interviews, on-site observations, and laboratory testing, etc. The detection of soil lead and cadmium was carried out according to the Measurement of Soil Quality Lead and Cadmium by Graphite Furnace Atomic Absorption Spectrophotometry(GB/T 17141-1997), and the detection of chromium was carried out according to the Determination of Total Chromium in Soil by Flame Atomic Absorption Spectrometry(HJ 491). The data was statistically analyzed and evaluated according to the central, southern and northern regions.

RESULTS

The population coverage of rural centralized water supply in the three regions(central、southern and northern area) was 92. 86%, 75. 49% and 70. 41%, respectively. The penetration rate of sanitary toilets was 28. 18%, 45. 38% and 9. 90%, respectively. The proportion of villages where domestic garbage was randomly stacked was 0. 38%, 4. 00% and 32. 86%, respectively. The proportion of villages where domestic sewage was randomly discharged was 30. 38%, 40. 00% and 60. 00%, respectively. The heavy metals exceeding the standard in the soil were mainly cadmium. The over-standard rates were 4. 62%, 21. 50% and 0. 71%, respectively. The three regional differences of the above result were statistically significant(χ~2=57 676. 74, 18 143. 94, 124. 86, 33. 15 and 54. 12, P<0. 01).

CONCLUSION

There was still some decentralized water supply population in the province. The coverage rate of the centralized water supply population and the proportion of drinking water after complete treatment projects were both higher in the central area than in the southern area and northern area. Sanitation toilets have a low penetration rate in the province, which was higher in the southern area than in the central area and the northern area. The domestic garbage was randomly discarded, and domestic sewage was randomly discharged, which was more in the northern area than in the central area and the southern area. Soil cadmium pollution was relatively heavy, mainly in the southern area.

Urban sanitation in Nigeria: the past, current and future status of access, policies and institutions

Though rated among the largest economies in sub-Saharan Africa, Nigeria is currently grappling with enormous socio-economic challenges such as high poverty rate, power and water supply shortages, large-scale unemployment ratio, economic recession and underperforming agricultural sector. Judging by the scale of urgent political and economic importance, urban sanitation definitely ranks low among the government's priorities. No wonder political slogans and manifestos of political parties feature provision of water supply while sanitation is conspicuously usually omitted. This is suggestive of the opinion that having not critically understood the status, challenges and opportunities associated with sanitation in the country's urban areas might be partly responsible for this. Thus, the current work presents a detailed review of the past, current and future status of urban sanitation in Nigeria in terms of access coverage, policies, institutions and future challenges and opportunities. The past status was difficult to evaluate because of the absence of data and unclear definitions of the term 'sanitation'. The current status shows among other findings that water supply issues receive domineering attention than sanitation, mainly due to merging together of discussions, policies and implementation of the two issues together. In cases where sanitation crops up in the agenda, rural areas are favored more than the urban areas. This pattern is also common in the literature. But the future of urban sanitation in Nigeria is double-edged depending on actions or inactions of the government and other stakeholders. The study further makes recommendations for - balanced and sustainable urban development planning, restructuring of land and housing policies and creation of enabling market environment that could trigger a viable sanitation industry - as the way forward.

Common Gastrointestinal Symptoms and Associated Factors Among Under-5 Children in Rural Dembiya, Northwest Ethiopia: A Community-Based Cross-Sectional Study

BACKGROUND

Gastrointestinal (GI) symptoms such as abdominal discomfort, abdominal cramp, nausea, vomiting, gas in the GI tract, changes in bowel habits (e.g. diarrhea), or heartburn are common in the community. However, these symptoms may be misinterpreted and their impact and significance misunderstood, especially in the rural communities. This study was, therefore, conducted to assess common GI symptoms among children in rural Dembiya, northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted in May 2017 among 225 randomly selected under-5 children. We primarily used mothers' report to assess GI symptoms. Health professionals also diagnosed for some symptoms. Direct stool examination technique was used to identify parasitic infections. Bacteriological analysis of drinking water was done to determine the quality of drinking water. Food safety, environmental sanitation, and hygiene condition of children were assessed using observation checklists. Multivariable binary logistic regression analysis was employed to identify factors associated with GI symptoms on the basis of adjusted odds ratio (OR) with 95% confidence interval (CI) and P < .05.

RESULTS

The current study depicted that 139 of 225(61.8%) of the children had GI symptoms. Abdominal discomfort (137 of 139 [98.7%]), abdominal cramp (125 of 139 [89.9%]), and diarrhea (118 of 139 [84.9%]) were the highest GI symptoms reported. GI symptoms were significantly associated with childhood intestinal parasitic infections (OR = 13.69, 95% CI = 3.31-56.59), unclipped and unclean finger nails (OR = 2.28, 95% CI = 1.02-5.10), inadequate living environment sanitation (OR = 2.37, 95% CI = 1.08-5.18), unclean living houses (OR = 9.06, 95% CI = 2.60-31.54), and owning livestock (OR = 4.68, 95% CI = 1.82, 12.03).

CONCLUSION

The prevalence of GI symptoms among under-5 children in rural Dembiya, northwest Ethiopia, was found to be high. GI symptoms were significantly associated with childhood intestinal parasitic infections, hand hygiene condition of children, and sanitation condition of the living environment. Therefore, preventing intestinal parasitic infections, improving hand hygiene condition, and promoting environmental sanitation will have overriding contributions to prevent symptoms among children in rural Dembiya.

Exposure-response relationship of neighbourhood sanitation and children's diarrhoea

OBJECTIVES

To assess the association of neighbourhood sanitation coverage with under-five children's diarrhoeal morbidity and to evaluate its exposure-response relationship.

METHODS

We used the Demographic and Health Surveys (DHS) of 29 developing countries in sub-Saharan Africa and South Asia, conducted between 2010 and 2014. The primary outcome was two-week incidence of diarrhoea in children under 5 years of age (N = 269014). We conducted three-level logistic regression analyses and applied cubic splines to assess the trend between neighbourhood-level coverage of improved household sanitation and diarrhoeal morbidity.

RESULTS

A significant association between neighbourhood-level coverage of improved household sanitation and diarrhoeal morbidity (OR [95% CI] = 0.68 [0.62-0.76]) was found. Exposure-relationship analyses results showed improved sanitation coverage threshold at 0.6. We found marginal degree of association (OR [95% CI] = 0.82 [0.77-0.87]) below the threshold, which, beyond the threshold, sharply increased to OR of 0.44 (95% CI: 0.29-0.67) at sanitation coverage of 1 (i.e. neighbourhood-wide use of improved household sanitation). Similar exposure-response trends were identified for urban and rural subgroups.

CONCLUSIONS

Our findings suggest that neighbourhood sanitation plays a key role in reducing diarrhoeal diseases and that increase in sanitation coverage may only have minimal impact on diarrhoeal illness, unless sufficiently high coverage is achieved.

Epidemiological investigation of the jaundice outbreak in lalkuan, nainital district, uttarakhand

BACKGROUND

In March 2013, cases of acute hepatitis were reported from Lalkuan, Nainital district. We investigated the outbreak to identify the source of infection and to facilitate control measures.

OBJECTIVES

To study the distribution of hepatitis cases, to find the source of infection, and to initiate the control measures in the affected area.

MATERIALS AND METHODS

WE DEFINED A CASE OF ACUTE HEPATITIS AS THOSE CASES THAT HAD JAUNDICE WITH AT LEAST ONE OF THE FOLLOWING SYMPTOMS: Dark urine, fever, pain in abdomen, vomiting, and loss of appetite in the affected area between January and March 2013. Door-to-door survey was carried out. Thirteen blood samples were randomly collected from jaundice cases for immunoglobulin M (IgM) antibody for hepatitis A virus (HAV) and hepatitis E virus (HEV). Water samples were collected to test residual chlorine.

RESULTS

Total 2,785 individuals were surveyed; of which 240 were suffering from acute viral hepatitis (attack rate (AR) = 8.61%). Out of 13 serum samples, 10 were found positive for HEV IgM antibodies and three cases had IgM antibodies for both HAV and HEV, which confirmed a hepatitis E outbreak. The difference in attack rate of hepatitis of both the sexes was statistically significant (P < 0.001). The attack rate was significantly higher in age groups >12 years of age (P < 0.001). Environmental investigation also confirmed the sewage contamination of drinking water in the distribution system. The attack rate was much higher (29.4%) among those who were exposed to the leaking pipeline than the nonexposed (χ(2) = 574.26, P < 0.01).

CONCLUSION

HEV was confirmed as the major etiological agent in this outbreak that was transmitted by contaminated drinking water. The recognition of early warning signals, timely investigation, and application of specific control measures can contain the outbreak.

Health and environmental sanitation in India: Issues for prioritizing control strategies

Environmental sanitation is a major public health issue in India. Recent interventional studies on environmental sanitation in India highlighted the importance of prioritizing control strategies. Research related to the appropriate cost-effective intervention strategies and their implementation in Indian context is a big challenge. This paper discusses various intervention strategies related to environmental sanitation in India and emphasizes to prioritize it according to the need of country.

Environmental Sanitation Crisis: More than just a health issue

THE GLOBAL ENVIRONMENTAL SANITATION CRISIS CANNOT BE DENIED: well over a century after the sanitary revolution in 19th century Europe, 40% of the world's population still lacks access to improved sanitation. Important lessons from the past must be applied today if the crisis is to be averted. Sanitation has suffered from a lack of prioritization for as long as it has remained the poor relation to water supply. The International Year of Sanitation 2008 provides an opportunity to separate the two and give sanitation the emphasis it requires. The economic argument for sanitation must be articulated and non-health incentives for improved sanitation exploited. Environmental sanitation results in a multitude of socio-economic benefits and can contribute positively to all the Millennium Development Goals. Community-led bottom-up approaches, rather than supply-led or technology-driven approaches, are most effective in increasing and sustaining access to sanitation but need to be implemented at scale. Targeted strategies for urban and school sanitation are also required. Evidence-based advocacy can help develop the political will that is now needed to ensure sufficient public sector investment, leadership, legislation and regulation to ensure that the fundamental human right of access to sanitation is realized.