Практическое руководство по оптимизации малых источников питьевого водоснабжения: план обеспечения безопасности воды в сельских сообществах

Подход, предполагающий разработку и реализацию плана обеспечения безопасности воды (ПОБВ), рекомендован в Руководстве ВОЗ по обеспечению качества питьевой воды как наиболее действенный способ, позволяющий бесперебойно снабжать потребителей безопасной питьевой водой. Проблемы и трудности, связанные со снабжением питьевой водой населения сельских районов и малых городов, вызывают серьезную озабоченность во всем мире, однако подход к решению этих проблем, в основе которого лежит ПОБВ, доказал свою эффективность в маломасштабных системах водоснабжения. В нем четко подчеркивается важность профилактики заболеваний, передающихся через воду, и оказывается поддержка сообществам в решении повседневных проблем, связанных с обеспечением надежного и безопасного водоснабжения. В этом втором, обновленном издании документа ВОЗ «План обеспечения безопасности воды: практическое руководство по повышению безопасности питьевой воды в небольших местных сообществах» содержится пошаговое введение в подход ПОБВ и включен ряд готовых к использованию шаблонов, чтобы помочь специалистам, занимающимся водоснабжением в сельской местности, разработать и внедрить свои собственные ПОБВ.

Seroprevalence of anti-hepatitis A virus antibody in Iraq

Background: Hepatitis A virus infection is widespread in Iraq, therefore, assessing its seroprevalence is important for infection control at the community level. Aims: To determine hepatitis A virus seroprevalence in a representative sample in Duhok Governorate, northern Iraq; evaluate changes in the epidemiological pattern; and assess factors associated with its seropositivity. Methods: This cross-sectional study was conducted from July 2020 to November 2021. Random cluster sampling was used to select participants aged 5–74 years. Hepatitis A virus immunoglobulin G (IgG) was determined among the participants and demographic data were collected on sex, residency (urban or rural), age, history of jaundice, number of family members (≤ five or > five), and sources of drinking water. Results: A total of 1052 participants (625 males and 427 females) were enrolled. The overall seroprevalence of hepatitis A virus IgG was 68.3%: 24.4% in ages 5–10 years; 38.3% in ages 11–15; 86.9% in ages 16–20; 85.4% in ages 21–30; 95.3% in ages 31–40; and 89.2% in ages > 40 years. Factors significantly associated with hepatitis A virus IgG positivity were rural residence, male sex and family size greater than five (all P < 0.01). Conclusion: Hepatitis A virus seroprevalence in Iraq has been declining since the past decade, indicating intermediate-to-low endemicity of hepatitis A virus. However, people are still many susceptible, indicating the need for hepatitis A virus vaccination in the country.

A field guide to improving small drinking-water supplies: water safety planning for rural communities

The WHO Guidelines for drinking-water quality recommend the water safety plan (WSP) approach as the most effective way of ensuring continuous provision of safe drinking-water. The challenges related to drinking-water supply in rural areas and small towns are of notable concern globally, but the WSP approach has been proven to work effectively in small-scale water supplies. It clearly emphasizes the importance of preventing waterborne disease, and supports communities in dealing with the everyday challenges of maintaining a reliable and safe water supply. This second, updated edition of WHO’s Water safety plan: a field guide to improving drinking-water safety in small communities provides a step-by-step introduction to the WSP approach and includes a range of ready-to-use templates to assist those involved in rural water supply with developing and implementing their own WSPs

Impact of household food insecurity on maternal mental health in Egypt

Background: Food insecurity leads to disturbed eating patterns, hunger or poor nutrition and is strongly correlated with poor mental health. Aims: To determine the impact of household food insecurity on maternal mental health in a rural population in Egypt. Methods: This community-based cross-sectional study was conducted in Qulubba Village in Minia Governorate. We interviewed 497 mothers with at least one child, using the Household Food Insecurity Access Scale and Hopkins Symptom Check List-25. Results: Nearly 70% of women resided in food-insecure households. Symptoms of anxiety and depression were significantly more common among food-insecure mothers. By logistic regression analysis, household food insecurity, socioeconomic status, husband working abroad, and number of children were significant predictors of maternal distress. Mothers with severe food insecurity were approximately 13 times more likely to experience mental distress than were food secure mothers. Conclusions: Household food insecurity was associated with an increased likelihood of poor maternal mental health. The study highlights the need for policies to decrease poverty and programmes for screening and addressing food insecurity. Integrating mental health into programmes addressing food insecurity and providing counselling are recommended.

Women’s agency in Egypt: construction and validation of a multidimensional scale in rural Minya

Background: Measurement of women’s agency in specific sociocultural conditions, particularly in Middle Eastern settings, has received limited attention, making its usefulness as an outcome or predictor of gender equality unclear. Aims: This study aimed to construct and validate a multidimensional and context-specific scale of women’s agency in rural Minya, Egypt. Methods: Using data from 608 ever-married women in 2012, confirmatory and exploratory factor analysis were used to construct a scale measuring women’s agency in rural Minya. The scale was validated through exploratory structural equation models. Results: The 21-item model consisted of three factors (decision-making, freedom of movement and gender role attitudes), each corresponding to a previously-theorized domain of women’s agency. The three factors were positively correlated, supporting women’s agency as a multidimensional, context-specific construct. The strongest correlation was between decision-making and freedom of movement (0.410), and then between freedom of movement and gender attitudes (0.307); the weakest correlation was between decision-making and gender attitudes (0.211). Although we hypothesized that each domain would be positively associated with age, only decision-making was significantly and positively associated with women’s age. Conclusion: Similarities between the items used here and a study at the national level in Egypt suggest these indicators could be used in various Egyptian settings to monitor progress on the United Nations Sustainable Development Goal 5 on empowering women and girls, and to assess the effect of policies and programmes. Future research should build on the findings to identify the best observable indicators of women’s agency in Egypt and elsewhere.

Assessment of undernutrition using Composite Index of Anthropo-metric Failure among children aged < 5 years in rural Yemen

Background: Impaired nutritional status is a major health problem affecting young children in developing countries that has a significant impact on child morbidity and mortality.Aims: This study aimed to assess the prevalence of undernutrition among children aged < 5 years, using conventional indices and the Composite Index of Anthropometric Failure (CIAF), and then comparing their estimated results.Methods: A community-based cross-sectional study was conducted and information was collected through house-to-house visits using precoded structured records. We analysed data from 1292 children aged 6–59 months, from Ahwar and Al-Mahfed rural districts in Abyan Governate, South Yemen, with reference to the 2006 World Health Organization growth standards. Results: CIAF identified undernutrition in 70.1% of children, while conventional anthropometric indices revealed 38.5% stunting, 39.9% wasting, and 55.1% underweight. Compared with conventional indices, CIAF aggregate recognized 31.6%, 30.2% and 15% more undernourished children than stunting, wasting and underweight separately. According to CIAF, 21% had a single anthropometric failure and 49.2% exhibited multiple failures. Stunting Index, Wasting Index and Under-weight Index were 0.55, 0.57 and 0.79, respectively. Conclusions: CIAF gives a better estimate of undernutrition than currently used conventional indices; identifies more children with multiple anthropometric failures; and reflects a wider view of the extent and pattern of undernutrition of children living in communities with limited resource settings.

Contexte : L’altération de l’état nutritionnel est un grave problème de santé qui touche les jeunes enfants dans les pays à faible revenu et qui a un impact significatif sur la morbidité et la mortalité infantiles.Objectifs : La présente étude visait à évaluer la prévalence de la dénutrition chez les enfants de moins de 5 ans en utilisant les indices classiques et l’indice composite d’insuffisance anthropométrique, puis en comparant leurs résultats estimés. Méthodes : Une étude communautaire transversale a été réalisée et des informations ont été recueillies au moyen d’un document structuré précodé lors de visites porte-à-porte. Nous avons analysé les données relatives à 1292 enfants âgés entre 6 et 59 mois des districts ruraux d’Ahwar et d’Al-Mahfed, dans le gouvernorat d’Abyan (sud du Yémen), par rapport aux normes de croissance publiées en 2006 par l’OMS. Résultats : D’après l’indice composite d’insuffisance anthropométrique, 70 % des enfants souffraient de dénutrition. Selon les indices anthropométriques classiques, les prévalences du retard de croissance, de l’émaciation et du déficit pondéral étaient de 38,5 %, 39,9 % et 55,1 % respectivement. L’indice composite susmentionné, qui fournit un chiffre agrégé, a ainsi identifié 31,5 %, 30,1 % et 14,9 % d’enfants dénutris en plus que les mesures du retard de croissance, de l’émaciation et du déficit pondéral prises séparément. D’après cet indice composite, 21 % des enfants présentaient une seule insuffisance anthropométrique et 49,2 % présentaient des insuffisances multiples. Les indices de retard de croissance, d’émaciation et de déficit pondéral obtenus étaient, respectivement, de 0,55, 0,57 et 0,79. Conclusions : L’indice composite d’insuffisance anthropométrique donne un meilleur aperçu de la dénutrition que les indices classiques actuellement utilisés. Il identifie en outre plus d’enfants souffrant d’insuffisances anthropométriques multiples et brosse un tableau plus complet de l’ampleur et de la nature du problème de la dénutrition des enfants vivant dans des communautés où les ressources sont limitées.

Satisfaction levels with family physician services: a pilot national health programme in the Islamic Republic of Iran

Family physicians in the Islamic Republic of Iran have been providing health and medical services to residents from rural areas since 2005, and from 2011 these services have been delivered to urban residents in Fars and Mazandaran provinces. This study was conducted in 2014 to measure the rate of user satisfaction with services provided by family physicians to the rural and urban population of the second most populated county in Fars province [Marvdasht county, population > 330 000]. In urban and rural areas, 1650 houses [825 in rural and 825 in urban areas] were selected, of which 1561 houses were inhabited [2908 individuals in urban and 3062 individuals in rural areas] and an interview-administered doorstep questionnaire was completed. Overall satisfaction rate was 59.2%: 54.5% for urban areas and 63.2% for rural areas. This study suggests that satisfaction is higher among rural residents and that better quality services from family physicians are needed in both rural and urban communities

En République islamique d'Iran, les médecins de famille fournissent des services médico-sanitaires aux habitants des zones rurales depuis 2005. Depuis 2011, les habitants urbains des provinces de Fars et Mazandaran bénéficient également de ces prestations de service. La présente étude a été menée en 2014 afin de mesurer le taux de satisfaction des bénéficiaires des services fournis par des médecins de famille aux populations urbaines et rurales du deuxième département le plus peuplé de la province de Fars, à savoir Marvdasht, qui regroupe une population de plus de 330 000 habitants. Dans les zones urbaines et rurales, 1650 maisons [825 en zone rurale et 825 en zone urbaine] ont été sélectionnées, parmi lesquelles 1561 étaient habitées [2908 individus en zone urbaine et 3062 en zone rurale], et un questionnaire a été rempli sur la base d'entretiens [pas de porte] Le taux de satisfaction global était de 59,2%, avec 54,5% pour les zones urbaines et 63,2% pour les zones rurales. Cette étude suggère que la satisfaction est plus élevée parmi les habitants ruraux, et qu'il est nécessaire d'améliorer la qualité des services fournis par les médecins de famille dans les communautés rurales comme urbaines

Plan de gestion de la sécurité sanitaire de l’eau : guide pratique pour l’amélioration de la sécurité sanitaire de l’eau potable dans les petites communautés

Selon les Directives de qualité pour l’eau de boisson de l’OMS, la mise en place d’un plan de gestion de la sécurité sanitaire de l’eau (PGSSE) constitue l’approche la plus efficace en vue d’assurer une alimentation continue en eau potable. Même si l’alimentation en eau potable dans les zones rurales et les petites villes ne cesse de poser d’importants problèmes dans l’ensemble de la Région européenne de l’OMS, l’approche PGSSE s’est révélée efficace pour les systèmes d'approvisionnement en eau à petite échelle. Le présent guide pratique vise à faciliter la mise en oeuvre du PGSSE dans les petites communautés en fournissant de courtes explications sur ce processus et des modèles pratiques utilisables sur le terrain.

План обеспечения безопасности воды: практическое руководство по повышению безопасности питьевой воды в небольших местных общинах

Подход, предполагающий разработку и реализацию “Плана обеспечения безопасности воды” (ПОБВ),рекомендован в Руководстве ВОЗ по обеспечению качества питьевой воды как наиболее действенныйспособ, позволяющий бесперебойно снабжать потребителей безопасной питьевой водой. Проблемыи трудности, связанные со снабжением питьевой водой населения сельских районов и малых городов,вызывают серьезную озабоченность во всем Европейском регионе ВОЗ, однако подход к решениюэтих проблем, в основе которого лежит ПОБВ, доказал свою эффективность в маломасштабныхсистемах водоснабжения. Предлагаемое практическое руководство, в котором содержатся краткиепояснения процесса разработки и осуществления ПОБВ и готовые к практическому использованиюформы документов для использования в реальных условиях, предназначено для того, чтобы помочьвнедрить методику и принципы ПОБВ в небольших общинах.

Water safety plan: a field guide to improving drinking-water safety in small communities

The WHO Guidelines for drinking-water quality recommend the water safety plan (WSP) approach as the most effective way of ensuring continuous provision of safe drinking-water. The challenges related to drinking-water supply in rural areas and small towns are of notable concern across the entire WHO European Region, but the WSP approach has been proven to work effectively in small-scale water supplies. This field guide aims to support WSP implementation in small communities by providing brief explanations of the WSP process and practical templates for field use.

Diabetes in rural Pondicherry, India: a population-based study of the incidence and risk factors

Background: For India, the ‘diabetes capital’ of the world, it is essential to knowthe incidence of type 2 diabetes mellitus (T2DM) and its key determinants. Astwo thirds of Indians live in rural areas, a study was undertaken to assess theincidence and risk factors of T2DM in rural Pondicherry, India.Methods: In a population-based cohort study initiated in 2007, a sample of 1223adults > 25 years of age from two villages of Pondicherry were selected using clusterrandom sampling. Data on risk factor exposure were collected using a structuredquestionnaire, anthropometric tests and fasting blood glucose assessment. Duringhouse visits, 1223 of 1403 invited subjects participated. Of these, 71 (5.8%) werefound to have diabetes. In 2010–2011, 85% of the non-diabetics (979/1152) werefollowed up using the same protocol. We calculated the risk of T2DM per annumstandardized by age and sex. Population estimates of the risk factors associatedwith T2DM were analysed using the Generalized Estimating Equation model andthe Population Attributable Risk (PAR) for T2DM calculated.Results: During 2937 person-years (PY) of follow-up, 63 new cases of T2DMoccurred, giving an incidence rate of 21.5/1000 PY. Almost one third (31.7%)of cases occurred in people aged below 40 years. The incidence was doubleamong males (28.7/1000 PY; 95% confidence interval (CI): 21.0–38.7) comparedwith females (14.6/1000 PY; 95% CI: 9.4–21.7). Applying these rates to ruralpopulations, it is estimated that each year 8.7 million people develop T2DM inrural India. Nearly half of the T2DM incidence was attributed to overweight/obesityand alcohol usage.Conclusion: T2DM incidence was 2% per year in adults in rural Pondicherry,India, with the rate increasing twice as fast in men. Increasing age, obesity, alcoholuse and a family history of T2DM independently predicted the development ofdiabetes. As half of T2DM incidence was attributed to overweight/obesity andalcohol use, health promotion interventions focusing on maintaining an optimalweight and decreasing

Factors affecting defaulting from DOTS therapy under the national programme of tuberculosis control in Alexandria, Egypt

This unmatched case-control study aimed to identify factors affecting default from therapy under the national programme of TB control in Alexandria, Egypt. Record reviews and structured interviews were made with 57defaulters and 187 randomly selected controls. Univariate analysis showed 13 out of 54 factors investigated were significantly associated with defaulting and/ after stepwise logistic regression, 5 factors remained in the model: younger age [adjusted OR= 0.16], rural area of residence [OR= 12.9], long waiting times [OR=5.81], poor physician-patient communication [OR= 3.06] and fear of information leakage [OR =3.62]. Reasons cited by defaulters included long distance to the clinic, unsuitable clinic times and long waiting times. The main factors associated with defaulting from the national programme of TB control In Alexandria, Egypt were service-related factors, which are amenable to Improvement

Barriers affecting utilization of family planning services among rural Egyptian women

Access to family planning [FP], quality of care and exploring barriers to utilization of services are key factors in the adoption and continuation of contraception in Egypt. We conducted this study to explore the barriers affecting utilization of FP as well as the characteristics of women who discontinue using FP and nonusers of the FP services. A descriptive cross-sectional research design was used. A multistage random selection of 8 family health centres in Menufia Governorate, Egypt was done. We selected a purposive sample of 500 married, rural women of reproductive age who fulfilled the required criteria [109 non-users, 391 discontinued]. Cognitive barriers were cited by more than 55% of the participants in both groups and cultural barriers by 40% of both groups. Barriers related to the method were cited by 35.8% of the women who had discontinued, and demographic barriers by 39.4% of the non-users

Lead exposure among the general population of Duhok governorate, Kurdistan region, Iraq

This study was carried out to establish baseline data on lead exposure in a sample of the general population from Duhok governorate, Iraq in 2011. A cross-sectional study was made of blood lead levels of 820 individuals and of dust and of air lead levels in urban, suburban and rural residential areas. Mean blood lead [BPb] value in the overall sample was 7.3 [SD 2.8] microg/dL, range 1.6-17.0 microg/dL; significant differences were found with respect to age, area of residence, altitude and distance from a gasoline generator. The prevalence of toxic levels of lead [BPb > 10 microg/dL] was 22.8% overall and 2.4% in children. People living in suburban areas [39.7%] and < 50 m from a gasoline generator [93.1%] were exposed to high environmental lead levels. A linear relationship was found between BPb and air lead levels [r= 0.8]. While lead exposure does not constitute a great health problem for adults in our community, 2.4% of the children had toxic lead levels and measures to reduce exposure to environmental heavy metals should be considered

Home-related injuries among children: knowledge, attitudes and practice about first aid among rural mothers

Injuries to children arising from home accidents are an increasing community health concern. The aim of this cross-sectional study in Qalubeya governorate, Egypt was to measure the incidence and types of home injuries affecting rural children aged up to 12 years and to assess their mothers' knowledge, attitudes and practices [KAP] about first aid and its associated factors. An interview questionnaire was completed by 1450 rural mothers. The incidence of home injuries in the previous 4 weeks was 38.3% [57.5% were boys]. Cut wounds, falls and fractures, burns, poisoning and foreign body aspiration were the common forms of home injuries. Mothers answered an average of 11.0 [SD 5.3] out of 29 KAP questions correctly. Younger age of mother, higher level of education, higher socioeconomic status, being in paid employment, source of knowledge about first aid and having attended a training course on first aid were significant predictors of better KAP among mothers

Rural poverty and health systems in the WHO European Region

Globally, poverty tends to have a rural face. In disadvantaged rural areas, the drivers of poverty are also the drivers of ill health. The health system, a determinant of health, is often not sufficiently equipped in rural areas to respond to the needs of the population, contributing to rural−urban health inequities. This short analysis of rural poverty and health systems in the WHO European Region is divided into four main sections: rural poverty in the Region; selected social determinants of health in disadvantaged rural areas; differences in health system performance and health between rural and urban areas; and the implications for health systems. This briefing is a follow-up to key European resolutions, charters and communications on how to reduce health inequities.

Patient satisfaction with mobile clinic services in a remote rural area of Saudi Arabia

Mobile clinics have been established in Saudi Arabia to facilitate the equitable delivery of primary health care services in remote and rural areas. A descriptive cross-sectional study was conducted to investigate the perceived quality of services provided to villages in the Al-Laith region. The majority of the 176 clients interviewed were satisfied with the working hours and health staff. However, 35.8% viewed the location as unsatisfactory and 20.5% were dissatisfied with the clinic schedule. Overall satisfaction was very high, although the mobile clinics were not viewed as substitutes for primary health care centres. Public awareness of the service needs to be improved and better access and quality of services are important for optimal service provision

Burden of smoking in Moroccan rural areas

The aim of this study was to estimate the prevalence and characteristics of current smoking among rural Moroccans. The population study included 3438 individuals aged 15 years and above from both sexes. The crude prevalence of current smoking [currently smoked and had smoked > 100 cigarettes in lifetime] was 16.9% in the adolescent and adult rural population: 31.0% among men and 1.1% among women. The majority of smokers [74.4% of men and 68.8% of women] began smoking before age 20 years. Multiple logistic regression analysis showed that age, sex, marital status, occupation and region of residence were the strongest determinants of current smoking. These results showed a high prevalence of smoking among males in the rural population of Morocco

Fever prevalence and management among three rural communities in the North West Zone, Somalia

Between March and August 2008 we undertook 2 cross-sectional surveys among 1375 residents of 3 randomly selected villages in the district of Gebiley in the North-West Zone, Somalia. We investigated for the presence of malaria infection and the period prevalence of self-reported fever 14 days prior to both surveys. All blood samples examined were negative for both species of Plasmodium. The period prevalence of 14-day fevers was 4.8% in March and 0.6% in August; the majority of fevers [84.4%] were associated with other symptoms including cough, running nose and sore throat; 48/64 cases had resolved by the day of interview [mean duration 5.4 days]. Only 18 [37.5%] fever cases were managed at a formal health care facility: 7 within 24 hours and 10 within 24-72 hours of onset. None of the fevers were investigated for malaria; they were treated with antibiotics, antipyretics and vitamins