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Pesu H, Mbabazi J, Mutumba R, Savolainen O, Olsen MF, Mølgaard C, Michaelsen KF, Ritz C, Filteau S, Briend A, Mupere E, Friis H, Grenov B. Correlates of Plasma Citrulline, a Potential Marker of Enterocyte Mass, among Children with Stunting: A Cross-Sectional Study in Uganda. J Nutr 2024; 154:765-776. [PMID: 38135004 DOI: 10.1016/j.tjnut.2023.12.027] [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] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Environmental enteric dysfunction (EED) is associated with stunting. Citrulline, produced in mature enterocytes, may be a valuable biomarker of small intestinal enterocyte mass in the context of EED. OBJECTIVES We aimed to explore the correlates of plasma citrulline (p-cit) in children with stunting. METHODS In a cross-sectional study using baseline data from the community-based MAGNUS (milk affecting growth, cognition and the gut in child stunting) trial (ISRCTN13093195), we explored potential correlates of p-cit in Ugandan children with stunting aged 12-59 mo. Using linear regression in univariate and multivariate models, we explored associations with socioeconomics, diet, micronutrient status, and water, sanitation, and hygiene characteristics. The influence of covariates age, fasting, and systemic inflammation were also explored. RESULTS In 750 children, the mean ± standard deviation age was 32.0 ± 11.7 mo, and height-for-age z-score was -3.02 ± 0.74. P-cit, available for 730 children, differed according to time fasted and was 20.7 ± 8.9, 22.3 ± 10.6 and 24.2 ± 13.1 μmol/L if fasted <2, 2-5 and >5 h, respectively. Positive correlates of p-cit were age [0.07; 95% confidence interval (CI): 0.001, 0.15 μmol/L] and log10 serum insulin-like growth factor-1 (8.88; 95% CI: 5.09, 12.67 μmol/L). With adjustment for systemic inflammation, the association with serum insulin-like growth factor-1 reduced (4.98; 95% CI: 0.94, 9.03 μmol/L). Negative correlates of p-cit included food insecurity, wet season (-3.12; 95% CI: -4.97, -1.26 μmol/L), serum C-reactive protein (-0.15; 95% CI: -0.20, -0.10 μmol/L), serum α1-acid glycoprotein (-5.34; 95% CI: -6.98, -3.70 μmol/L) and anemia (-1.95; 95% CI: -3.72, -0.18 μmol/L). Among the negatively correlated water, sanitation, and hygiene characteristics was lack of soap for handwashing (-2.53; 95% CI: -4.82, -0.25 μmol/L). Many associations attenuated with adjustment for inflammation. CONCLUSIONS Many of the correlates of p-cit are characteristic of populations with a high EED prevalence. Systemic inflammation is strongly associated with p-cit and is implicated in EED and stunting. Adjustment for systemic inflammation attenuates many associations, reflecting either confounding, mediation, or both. This study highlights the complex interplay between p-cit and systemic inflammation.
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Affiliation(s)
- Hannah Pesu
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Joseph Mbabazi
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rolland Mutumba
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Otto Savolainen
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden; Faculty of Health Sciences, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Mette F Olsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Suzanne Filteau
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - André Briend
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark; Tampere Centre for Child Health Research, Tampere University, Tampere, Finland
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Benedikte Grenov
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.
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Stoll V, Edwin N, Dahal K, Barnes JA, Pfautsch M, Maharjan L, Blavo C. Health Issues Among Nepalese Youth: A Literature Review. Cureus 2023; 15:e45108. [PMID: 37842493 PMCID: PMC10569343 DOI: 10.7759/cureus.45108] [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] [Received: 07/30/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Nepal is one of the world's least-developed countries. Nepalese children are often vulnerable to a lack of resources which leads to suboptimal levels of health in turn. This review article aims to identify health issues and inequities faced by school-aged children greater than five years old in Nepal. A comprehensive search of the literature was conducted in PubMed and Global Health databases to gather relevant studies. Inclusion and exclusion criteria were applied to select appropriate articles, and 35 full-length articles were reviewed in-depth. The literature supports the association between inadequate resource distribution among Nepalese children and poorer health outcomes compared to youth in developed countries. The key health issues of Nepalese youth identified in the literature consist of diarrheal illness, stunted growth, dental caries, visual impairment, poor mental health, and low health literacy. This review article aims to identify key health issues affecting Nepalese youth as well as propose interventions that can lead to an enhanced quality of life in this population.
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Affiliation(s)
- Veenah Stoll
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Naomi Edwin
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Kripa Dahal
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - John A Barnes
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Miranda Pfautsch
- Department of Global Health, International Health Initiatives, Inc., Clearwater, USA
| | - Lahana Maharjan
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, NPL
| | - Cyril Blavo
- Department of Public Health, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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Pooseesod K, Umezaki M, Phetrak A, Phuanukoonnon S. Corrigendum: Handwashing among caregivers of young children in a protracted and complex refugee and immigration context: a mixed methods study on the Thai-Myanmar border. Front Public Health 2023; 11:1279605. [PMID: 37711252 PMCID: PMC10497953 DOI: 10.3389/fpubh.2023.1279605] [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] [Received: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2023.1099831.].
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Affiliation(s)
- Kasama Pooseesod
- Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Masahiro Umezaki
- Department of Human Ecology, Graduate School of Medical Sciences, University of Tokyo, Tokyo, Japan
| | - Athit Phetrak
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Thailand
| | - Suparat Phuanukoonnon
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Thailand
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Pooseesod K, Umezaki M, Phetrak A, Phuanukoonnon S. Handwashing among caregivers of young children in a protracted and complex refugee and immigration context: a mixed methods study on the Thai-Myanmar border. Front Public Health 2023; 11:1099831. [PMID: 37583886 PMCID: PMC10423810 DOI: 10.3389/fpubh.2023.1099831] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Protracted refugee situations create complex contexts that present significant health risks for young children. Effective hand hygiene practices by caregivers can reduce respiratory infections and diarrhoeal disease, the two largest contributors to mortality among children between 1 month and 5 years of age. This study documented handwashing patterns and access to water, sanitation and hygiene (WASH) infrastructure among caregivers of young children living along the Thai-Myanmar border, one of the world's most protracted and complex refugee and immigration contexts. It also examined the association between handwashing and socio-demographic variables and captured participants' explanations for when and how hands are washed. The study broadened the scope of previous research by also including the large number of caregivers living outside formal camps. Methods Caregivers of children attending 11 preschools in Tak province, Thailand participated in a mixed-methods cross-sectional study. Quantitative questionnaire data (n = 384) were supplemented by a thematic analysis of data from in-depth interviews (n = 9). Results Fewer than half the caregivers reported routinely washing their hands before preparing meals or after using the latrine/toilet. Fewer than one-in-five routinely used soap in these situations. Interviewees explained that handwashing was only necessary when a substance could be felt or seen, in which case wiping with a cloth or a rinsing with water were sufficient to clean hands. However, their explanations also suggested some potential avenues for culturally appropriate and feasible interventions to improve hand hygiene. Conclusion The results confirmed previous research on the multi-dimensional barriers to good hand hygiene in protracted refugee situations and other low-resource settings. Additional investment to overcome shortages in the infrastructure necessary to support good hand hygiene and creative means of drawing on and developing human capital will be necessary to realize the potential hand hygiene holds for reducing ill-health and mortality among young children living in these contexts.
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Affiliation(s)
- Kasama Pooseesod
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Thailand
| | - Masahiro Umezaki
- Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Athit Phetrak
- Department of Human Ecology, Graduate School of Medical Sciences, University of Tokyo, Tokyo, Japan
| | - Suparat Phuanukoonnon
- Department of Human Ecology, Graduate School of Medical Sciences, University of Tokyo, Tokyo, Japan
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Mutonhodza B, Dembedza MP, Lark MR, Joy EJM, Manzeke-Kangara MG, Njovo H, Nyadzayo TK, Kalimbira AA, Bailey EH, Broadley MR, Matsungo TM, Chopera P. Anemia in children aged 6-59 months was significantly associated with maternal anemia status in rural Zimbabwe. Food Sci Nutr 2023; 11:1232-1246. [PMID: 36911837 PMCID: PMC10003031 DOI: 10.1002/fsn3.3157] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/26/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022] Open
Abstract
Globally, anemia is a public health problem affecting mostly women of reproductive age (WRA, n = 452) and children aged 6-59 months (n = 452) from low- and lower-middle-income countries. This cross-sectional study assessed the prevalence and determinants of anemia in WRA and children aged 6-59 months in rural Zimbabwe. The venous blood sample was measured for hemoglobin utilizing a HemoCue machine. Anthropometric indices were assessed and classified based on World Health Organization standards. Socioeconomic characteristics were assessed. The median (±inter quartile range (IQR)) age of WRA was 29 ± 12 years and that for children was 29 ± 14 months. The prevalence of anemia was 29.6% and 17.9% in children and WRA, respectively, while the median (±IQR) hemoglobin levels were 13.4 ± 1.8 and 11.7 ± 1.5 g/dl among women and children, respectively. Multiple logistic regression analysis was used to assess determinants of anemia. Anemia in children was significantly associated with maternal anemia (odds ratio (OR) = 2.02; 95% CI 1.21-3.37; p = .007) and being a boy (OR = 0.63; 95% CI 0.41-0.95; p = .029), while anemia in WRA was significantly associated with the use of unimproved dug wells as a source of drinking water (OR = 0.36; 95% CI 0.20-0.66; p = .001) and lack of agricultural land ownership (OR = 0.51; 95% CI 0.31-0.85; p = .009). Anemia is a public health problem in the study setting. The positive association between maternal and child anemia reflects the possibility of cross-generational anemia. Therefore, interventions that focus on improving preconceptual and maternal nutritional status may help to reduce anemia in low-income settings.
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Affiliation(s)
- Beaula Mutonhodza
- Department of Nutrition, Dietetics and Food Sciences University of Zimbabwe Harare Zimbabwe
| | - Mavis P Dembedza
- Department of Nutrition, Dietetics and Food Sciences University of Zimbabwe Harare Zimbabwe
| | - Murray R Lark
- School of Biosciences, Sutton Bonington Campus University of Nottingham Loughborough, Leicestershire UK
| | - Edward J M Joy
- London School for Hygiene & Tropical Medicine London UK.,Rothamsted Research Harpenden UK
| | | | - Handrea Njovo
- National Nutrition Unit Ministry of Health and Child Care of Zimbabwe Harare Zimbabwe
| | - Tasiana K Nyadzayo
- National Nutrition Unit Ministry of Health and Child Care of Zimbabwe Harare Zimbabwe
| | - Alexander A Kalimbira
- Department of Human Nutrition and Health Lilongwe University of Agriculture and Natural Resources Lilongwe Malawi
| | - Elizabeth H Bailey
- School of Biosciences, Sutton Bonington Campus University of Nottingham Loughborough, Leicestershire UK
| | - Martin R Broadley
- School of Biosciences, Sutton Bonington Campus University of Nottingham Loughborough, Leicestershire UK.,Rothamsted Research Harpenden UK
| | - Tonderayi M Matsungo
- Department of Nutrition, Dietetics and Food Sciences University of Zimbabwe Harare Zimbabwe
| | - Prosper Chopera
- Department of Nutrition, Dietetics and Food Sciences University of Zimbabwe Harare Zimbabwe
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Gaybor J, Harcourt W. Seeing the colour red: Menstruation in global body politics. Glob Public Health 2021; 17:2388-2400. [PMID: 34941466 DOI: 10.1080/17441692.2021.2016886] [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: 10/19/2022]
Abstract
In this article, we set out how menstrual activism is emerging as a novel strand in global feminist health demands that challenge the norms and practices which condone and institutionalise gender inequalities. Menstruation has moved from being understood principally as a biological function, invisible in the public sphere, to a vibrant form of global body politics with a flourishing set of diverse practices. We examine how menstruation has been brought to global attention in two ways: one through a global development discourse that promotes menstrual health by improving hygiene and the sanitary infrastructure in the Global South; and two through the upswell of feminist groups involved in menstrual activism around the world. The article is a contribution to moving closer towards productive alliances between these two strands as together they contribute to important changes in menstrual health and sexual rights.
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Affiliation(s)
- Jacqueline Gaybor
- International Institute of Social Studies of Erasmus University Rotterdam, The Hague, Netherlands
| | - Wendy Harcourt
- International Institute of Social Studies of Erasmus University Rotterdam, The Hague, Netherlands
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Gold-Watts A, Aamodt G, Gandhimathi S, Sudha R, Bastien S. Corrigendum: Understanding Adolescents' Perceptions of Diarrhea: A Formative Research Study of a Visual Scale to Measure Self-Reported Diarrhea in Low-Resource Settings. Front Public Health 2021; 9:780587. [PMID: 34692634 PMCID: PMC8531743 DOI: 10.3389/fpubh.2021.780587] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2021.561367.].
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Affiliation(s)
- Anise Gold-Watts
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - Geir Aamodt
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | | | - Rajamani Sudha
- Department of Obstetrics and Gynecology Nursing, Sri Narayani College and School of Nursing, Vellore, India
| | - Sheri Bastien
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Meyer DD, Hill C, McCain K, Smith JA, Bessong PO, Rogawski McQuade ET, Wright NC. Embedding Usage Sensors in Point-of-Use Water Treatment Devices: Sensor Design and Application in Limpopo, South Africa. Environ Sci Technol 2021; 55:8955-8964. [PMID: 34133882 PMCID: PMC9207768 DOI: 10.1021/acs.est.0c08683] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Health benefits from point-of-use (POU) water treatment devices come only with consistent use. Embedded sensors can measure the consistency of POU-device use and can provide insights about improving it. We demonstrate both potentials with data from SmartSpouts: accelerometer-based sensors embedded in spigot handles that record the duration and timing of use. In the laboratory, most sensor readings correlated well (>0.98) with manually timed water withdrawals. In the field, SmartSpouts measured >60,000 water withdrawals across 232 households in Limpopo, South Africa. Sensors proved critical to understanding consistent use; surveys overestimated it by 53 percentage points. Sensor data showed when households use POU devices (evening peaks and delayed weekend routines) and user preferences (safe storage over filters). We demonstrate analytically and with data that (i) consistent use (e.g., 7 continuous days) is extremely sensitive to single-day use prevalence and (ii) use prevalence affects the performance of contact-time-based POU devices, exemplified with silver tablets. Deployed SmartSpouts had limitations, including memory overflows and confounding device relocation with water withdrawal. Nevertheless, SmartSpouts provided useful and objective data on the prevalence of single-day and consistent use. Considerably less expensive than alternatives, SmartSpouts enable an order of magnitude increase in how many POU-device sensors can be deployed.
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Affiliation(s)
- David D Meyer
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Courtney Hill
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - Kelly McCain
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - James A Smith
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - Pascal O Bessong
- University of Virginia, Charlottesville, Virginia 22904, United States
- University of Venda, Thohoyandou 0950, Limpopo, South Africa
| | | | - Natasha C Wright
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
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Gold-Watts A, Aamodt G, Gandhimathi S, Sudha R, Bastien S. Understanding Adolescents' Perceptions of Diarrhea: A Formative Research Study of a Visual Scale to Measure Self-Reported Diarrhea in Low-Resource Settings. Front Public Health 2021; 9:561367. [PMID: 34113594 PMCID: PMC8185169 DOI: 10.3389/fpubh.2021.561367] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Although water, sanitation, and hygiene interventions are effective in reducing diarrhea, there are methodological issues regarding the research tools used to evaluate their health impact. Moreover, there is limited research on individuals' subjective interpretations of diarrheal illness which may introduce further limitations in relying on self-reported data. Therefore, we conducted a study that aims to understand adolescents' perceptions of diarrheal illness in rural Tamil Nadu, India. Next, we wish to explore the acceptability of the Bristol Stool Form Scale to assess self-reported diarrhea in water, sanitation, and hygiene interventions involving adolescent participants in low-resource settings. Materials and Methods: The study was conducted as part of the formative research phase in the cultural adaptation of Project SHINE, a school-based educational water, sanitation, and hygiene intervention in Thirumalaikodi, Tamil Nadu, India. A convergent parallel mixed-methods study design with a purposive sampling strategy was used. Qualitative data included 10 in-depth interviews with student participants aged 13–14. Quantitative data were collected through interviewer-administered face-to-face surveys (n = 14) and one-week stool diaries (n = 14). Each data set was analyzed separately and compiled during the interpretation of the findings. Results: Across all data sets, diarrhea was reported to be perceived as unhealthy and an irregular occurrence among participants. Participants also reported diarrheal-taboos, local methods to cure or control diarrhea, and discussed how diarrheal illness can lead to absenteeism or withdrawal from school and social activities. Moreover, participants were able to understand and answer questions about their stool using the Bristol Stool Form Scale, suggesting that is an acceptable tool. Discussion: Visual tools demonstrate promise in improving self-reported diarrheal illness among adolescents in low-resource settings in India. However, until we address diarrhea-related taboos it will be difficult to address methodological issues in the assessment and reporting of diarrheal illness among adolescents.
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Affiliation(s)
- Anise Gold-Watts
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - Geir Aamodt
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | | | - Rajamani Sudha
- Department of Obstetrics and Gynecology Nursing, Sri Narayani College and School of Nursing, Vellore, India
| | - Sheri Bastien
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Okoyo C, Medley G, Mwandawiro C, Onyango N. Modeling the Interruption of the Transmission of Soil-Transmitted Helminths Infections in Kenya: Modeling Deworming, Water, and Sanitation Impacts. Front Public Health 2021; 9:637866. [PMID: 33842421 PMCID: PMC8024473 DOI: 10.3389/fpubh.2021.637866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Kenya, just like other countries with endemic soil-transmitted helminths (STH), has conducted regular mass drug administration (MDA) program for the last 5 years among school aged children as a way to reduce STH infections burden in the country. However, the point of interruption of transmission of these infections still remains unclear. In this study, we developed and analyzed an age structured mathematical model to predict the elimination period (i.e., time taken to interrupt STH transmission) of these infections in Kenya. The study utilized a deterministic age structured model of the STH population dynamics under a regular treatment program. The model was applied to three main age groups: pre-school age children (2-4 years), school age children (5-14 years), and adult populations (≥15 years) and compared the impact of two interventions on worm burden and elimination period. The model-simulated results were compared with the 5 year field data from the Kenyan deworming program for all the three types of STH (Ascaris lumbricoides, Trichuris trichiura, and hookworm). The model demonstrated that the reduction of worm burden and elimination period depended heavily on four parameter groups; drug efficacy, number of treatment rounds, MDA and water, sanitation and hygiene (WASH) coverage. The analysis showed that for STH infections to be eliminated using MDA alone in a short time period, 3-monthly MDA plan is desired. However, complementation of MDA with WASH at an optimal (95%) coverage level was most effective. These results are important to the Kenyan STH control program as it will guide the recently launched Breaking Transmission Strategy.
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Affiliation(s)
- Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
- School of Mathematics, University of Nairobi, Nairobi, Kenya
| | - Graham Medley
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nelson Onyango
- School of Mathematics, University of Nairobi, Nairobi, Kenya
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Anderson DM, Cronk R, Fejfar D, Pak E, Cawley M, Bartram J. Safe Healthcare Facilities: A Systematic Review on the Costs of Establishing and Maintaining Environmental Health in Facilities in Low- and Middle-Income Countries. Int J Environ Res Public Health 2021; 18:817. [PMID: 33477905 PMCID: PMC7833392 DOI: 10.3390/ijerph18020817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/21/2023]
Abstract
A hygienic environment is essential to provide quality patient care and prevent healthcare-acquired infections. Understanding costs is important to budget for service delivery, but costs evidence for environmental health services (EHS) in healthcare facilities (HCFs) is lacking. We present the first systematic review to evaluate the costs of establishing, operating, and maintaining EHS in HCFs in low- and middle-income countries (LMICs). We systematically searched for studies costing water, sanitation, hygiene, cleaning, waste management, personal protective equipment, vector control, laundry, and lighting in LMICs. Our search yielded 36 studies that reported costs for 51 EHS. There were 3 studies that reported costs for water, 3 for sanitation, 4 for hygiene, 13 for waste management, 16 for cleaning, 2 for personal protective equipment, 10 for laundry, and none for lighting or vector control. Quality of evidence was low. Reported costs were rarely representative of the total costs of EHS provision. Unit costs were infrequently reported. This review identifies opportunities to improve costing research through efforts to categorize and disaggregate EHS costs, greater dissemination of existing unpublished data, improvements to indicators to monitor EHS demand and quality necessary to contextualize costs, and development of frameworks to define EHS needs and essential inputs to guide future costing.
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Affiliation(s)
- Darcy M. Anderson
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (D.F.); (E.P.); (J.B.)
| | - Ryan Cronk
- ICF International, Durham, NC 27713, USA;
| | - Donald Fejfar
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (D.F.); (E.P.); (J.B.)
| | - Emily Pak
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (D.F.); (E.P.); (J.B.)
| | - Michelle Cawley
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Jamie Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (D.F.); (E.P.); (J.B.)
- School of Civil Engineering, University of Leeds, Leeds LS2 9JT, UK
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Smith CD, Jackson K, Peters H, Herrera Lima S. Lack of Safe Drinking Water for Lake Chapala Basin Communities in Mexico Inhibits Progress toward Sustainable Development Goals 3 and 6. Int J Environ Res Public Health 2020; 17:E8328. [PMID: 33187103 DOI: 10.3390/ijerph17228328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/29/2020] [Accepted: 11/08/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Access to safe, affordable and accessible drinking water is a human right and foundational to the third and sixth World Health Organization's Sustainable Development Goals (SDGs). Unsafe drinking water is a risk factor for chronic and enteric diseases. Both chronic kidney disease (CKD) and diarrheal disease are highly prevalent in the Lake Chapala basin, Jalisco, Mexico, suggesting disparities in factors leading to successful achievement of these two SDGs. METHODS This study aimed to assess progress towards SDG three and six in the Lake Chapala basin. Qualitative, quantitative, and geospatial data were collected between May and August of 2019 from three towns within the municipalities of Poncitlán and Chapala. RESULTS Ninety-nine households participated in this study. Water sampling analyses determined 81.18% of samples from water jugs (garrafones) and 70.05% of samples from tap water were contaminated with total coliform bacteria, often including E. coli. Additionally, 32% of garrafón samples and 61.9% of tap water samples had detectable levels of arsenic. Approximately 97.94% of respondents stated that they believe clean water is a human right, but 78.57% feel the Mexican government does not do enough to make this a reality. CONCLUSIONS This mixed methods approach highlights water quality as a serious issue in communities around Lake Chapala, and demonstrates inadequate drinking water as a key hazard, potentially perpetuating the high disease burden of both CKD and enteric disease in the region.
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Mathur A, Baghel D, Jaat J, Diwan V, Pathak A. Community-Based Participatory Research and Drug Utilization Research to Improve Childhood Diarrhea Case Management in Ujjain, India: A Cross-Sectional Survey. Int J Environ Res Public Health 2019; 16:ijerph16091646. [PMID: 31083579 PMCID: PMC6539114 DOI: 10.3390/ijerph16091646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 11/22/2022]
Abstract
Childhood diarrhea continues to be a major cause of under-five (U-5) mortality globally and in India. In this study, 1571 U-5 children residing in nine rural villages and four urban slums in Ujjain, India were included with the objective to use community participation and drug utilization research to improve diarrheal case management. The mean age was 2.08 years, with 297 (19%), children living in high diarrheal index households. Most mothers (70%) considered stale food, teething (62%), and hot weather (55%) as causes of diarrhea. Water, sanitation, and hygiene (WASH)-related characteristics revealed that most (93%) households had toilets, but only 23% of the children used them. The study identified ineffective household water treatment by filtration through cloth by most (93%) households and dumping of household waste on the streets (89%). The results revealed low community awareness of correct causes of diarrhea (poor hand hygiene, 21%; littering around the household, 15%) and of correct diarrhea treatment (oral rehydration solution (ORS) and zinc use, 29% and 11%, respectively) and a high antibiotic prescription rate by healthcare providers (83%). Based on the results of the present study, context-specific house-to-house interventions will be designed and implemented.
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Affiliation(s)
- Aditya Mathur
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain 456006, India.
| | - Devendra Baghel
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain 456006, India.
| | - Jitendra Jaat
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain 456006, India.
| | - Vishal Diwan
- Global Health-Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
- Department of Public Health & Environment, R. D. Gardi Medical College, Ujjain 456006, India.
| | - Ashish Pathak
- Department of Pediatrics, R. D. Gardi Medical College, Ujjain 456006, India.
- Global Health-Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
- Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, SE-751 85 Uppsala, Sweden.
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