Experiences of children's self-wetting (including urinary incontinence) in Cox's Bazar's Rohingya refugee camps, Bangladesh.

Self-wetting is the leakage of urine, either due to the medical condition of urinary incontinence (UI), or because a person does not want to, or cannot, access a toileting facility in time. This study explored the attitudes towards self-wetting and experiences of children (aged five to 11), their caregivers, community leaders and humanitarian practitioners in the Rohingya refugee camps in Cox's Bazar, Bangladesh. We particularly focused on how water, sanitation and hygiene (WASH) and protection interventions might assist in improving these experiences. We purposively selected participants from two camps where our partner organisation works. We conducted Key Informant Interviews (KIIs) with community leaders and camp officials, Story Book (SB) sessions with Rohingya children and in-depth Interviews (IDIs) with caregivers of children who participated in the SB sessions, as well as surveying communal toilets. Self-wetting by children was common and resulted in them feeling embarrassed, upset and uncomfortable, and frightened to use the toilet at night; many children also indicated that they would be punished by their caregivers for self-wetting. Key informants indicated that caregivers have difficulty handling children's self-wetting due to a limited amount of clothing, pillows, and blankets, and difficulty cleaning these items. It was evident that the available toilets are often not appropriate and/or accessible for children. Children in the Rohingya camps appear to self-wet due to both the medical condition of UI and because the sanitation facilities are inappropriate. They are teased by their peers and punished by their caregivers. Although WASH and protection practitioners are unable to drastically alter camp conditions or treat UI, the lives of children who self-wet in these camps could likely be improved by increasing awareness on self-wetting to decrease stigma and ease the concerns of caregivers, increasing the number of child-friendly toilets and increasing the provision of continence management materials.

Understanding children's experiences of self-wetting in humanitarian contexts: An evaluation of the Story Book methodology.

Little is known about how children in humanitarian contexts experience self-wetting. Children can wet themselves due to having the medical condition of urinary incontinence (the involuntary leakage of urine), or due to them not wanting to or not being able to use the toilet facilities available (social or functional incontinence). Self-wetting is a global public health challenge: the physical health of children can suffer; they can miss out on educational and social opportunities; they may face increased protection risks; and the emotional effect on daily life can be significantly negative. The Story Book methodology was developed to facilitate conversations with children aged five to eleven in humanitarian contexts (specifically refugee settlements in Adjumani District, Uganda; and refugee camps in Cox's Bazar, Bangladesh) about self-wetting to understand how humanitarian professionals can best meet the needs of children that wet themselves. This paper has evaluated how far the Story Book methodology meets the specific requirements of conducting research a) in a humanitarian context; b) with young children; and c) on a personal and highly sensitive topic. Data has been used from Story Book sessions held with children in Adjumani District and Cox's Bazar, and from semi-structured interviews held with adults known to have participated in the planning and/or facilitation of the sessions. The evaluation found that although the Story Book methodology provided deep insights into how children in humanitarian contexts experience self-wetting, it was not always implemented as designed; it is not practical to implement in humanitarian settings; and it was not acceptable to all participants and facilitators as a research tool. Changes have been recommended to improve the methodology as a research tool to better understand how children experience personal health issues, but even with such changes the methodology will remain better suited to non-humanitarian contexts.

Effect of Turning Frequency on the Survival of Fecal Indicator Microorganisms during Aerobic Composting of Fecal Sludge with Sawdust.

The study investigated the effect of turning frequency on survival of fecal indicator pathogens (E. coli, Enterococcus spp., Salmonella spp. and helminth eggs) during fecal sludge (FS) co-composting with sawdust. Dewatered FS was mixed with sawdust and composted on a pilot scale using different turning frequencies-i.e., 3 days (3TF), 7 days (7TF), and 14 days (14TF). Composting piles were monitored weekly for survival of fecal indicator microorganisms and evolution of selected physical and chemical characteristics for 14 weeks. Our results show that turning frequency has a statistically significant (p < 0.05) effect on pathogen inactivation in FS compost. The 3TF piles exhibited shorter pathogen inactivation periods (8 weeks) than 7TF and 14TF piles (10 weeks). Temperature-time was found to be the major factor responsible for the survival of pathogens in FS composting piles, followed by indigenous microbial activities and toxic by-products (monitored as NH4+-N). Our study findings suggest that even at low composting temperatures, the high turning frequency can enhance pathogen inactivation. This is a significant finding for composting activities in some rural areas where suitable organic solid waste for co-composting with FS to attain the recommended high thermophilic conditions could be greatly lacking.

Recycling of Faecal Sludge: Nitrogen, Carbon and Organic Matter Transformation during Co-Composting of Faecal Sludge with Different Bulking Agents.

This study investigated the effect of locally available bulking agents on the faecal sludge (FS) composting process and quality of the final FS compost. Dewatered FS was mixed with sawdust, coffee husk and brewery waste, and composted on a pilot scale. The evolution of physical and chemical characteristics of the composting materials was monitored weekly. Results indicate that bulking agents have a statistically significant effect (p < 0.0001) on the evolution of composting temperatures, pH, electrical conductivity, nitrogen forms, organic matter mineralisation, total organic carbon, maturity indices, quality of the final compost and composting periods during FS composting. Our results suggest reliable maturity indices for mature and stable FS compost. From the resource recovery perspective, this study suggests sawdust as a suitable bulking agent for co-composting with FS-as it significantly reduced the organic matter losses and nitrogen losses (to 2.2%), and improved the plant growth index, thus improving the agronomic values of the final compost as a soil conditioner. FS co-composting can be considered a sustainable and decentralised treatment option for FS and other organic wastes in the rural and peri-urban communities, especially, where there is a strong practice of reusing organic waste in agriculture.

Economic cost analysis of low-cost sanitation technology options in informal settlement areas (case study: Soweto, Johannesburg).

In Urban Africa, water and sanitation utility companies are facing a huge backlog of sanitation provision in the informal settlement areas. In order to clear this backlog, new investment is required. However, to select appropriate sanitation technologies, lifecycle costs need to be assessed. The aim of this research was to establish lifecycle costs for appropriate sanitation technologies in informal settlement areas. Three sanitation options were compared: simplified sewerage, urine diversion dry toilet (UDDT) and Ventilated Improved Pit (VIP) latrine. Three scenarios for simplified sewerage were considered; gravity flow into existing conventional sewers with treatment; new-build with pumping and treatment; and new-build gravity flow with treatment. The study revealed that simplified sewerage is the cheapest option for Soweto informal settlement, even when the costs of pumping and treatment are included. Gravity simplified sewerage with treatment is cheaper than the UDDT system and VIP latrine at all population densities above 158 and 172 persons/ha, respectively. The total annual cost per household of simplified sewerage and treatment was US$142 compared to US$156 and US$144 for UDDT and VIP latrine respectively. The costs of simplified sewerage could be recovered through a monthly household surcharge and cross-subsidy summing US$5.3 The study concluded that simplified sewerage system was the first choice for Soweto informal settlement areas, given the current population density.

Erratum for "Aberrantly Expressed Genes in HaCaT Keratinocytes Chronically Exposed to Arsenic Trioxide".

[This corrects the article on p. 7 in vol. 6, PMID: 21461292.].

Aberrantly Expressed Genes in HaCaT Keratinocytes Chronically Exposed to Arsenic Trioxide.

Inorganic arsenic is a known environmental toxicant and carcinogen of global public health concern. Arsenic is genotoxic and cytotoxic to human keratinocytes. However, the biological pathways perturbed in keratinocytes by low chronic dose inorganic arsenic are not completely understood. The objective of the investigation was to discover the mechanism of arsenic carcinogenicity in human epidermal keratinocytes. We hypothesize that a combined strategy of DNA microarray, qRT-PCR and gene function annotation will identify aberrantly expressed genes in HaCaT keratinocyte cell line after chronic treatment with arsenic trioxide. Microarray data analysis identified 14 up-regulated genes and 21 down-regulated genes in response to arsenic trioxide. The expression of 4 up-regulated genes and 1 down-regulated gene were confirmed by qRT-PCR. The up-regulated genes were AKR1C3 (Aldo-Keto Reductase family 1, member C3), IGFL1 (Insulin Growth Factor-Like family member 1), IL1R2 (Interleukin 1 Receptor, type 2), and TNFSF18 (Tumor Necrosis Factor [ligand] SuperFamily, member 18) and down-regulated gene was RGS2 (Regulator of G-protein Signaling 2). The observed over expression of TNFSF18 (167 fold) coupled with moderate expression of IGFL1 (3.1 fold), IL1R2 (5.9 fold) and AKR1C3 (9.2 fold) with a decreased RGS2 (2.0 fold) suggests that chronic arsenic exposure could produce sustained levels of TNF with modulation by an IL-1 analogue resulting in chronic immunologic insult. A concomitant decrease in growth inhibiting gene (RGS2) and increase in AKR1C3 may contribute to chronic inflammation leading to metaplasia, which may eventually lead to carcinogenicity in the skin keratinocytes. Also, increased expression of IGFL1 may trigger cancer development and progression in HaCaT keratinocytes.

Cytotoxicity patterns of arsenic trioxide exposure on HaCaT keratinocytes.

BACKGROUND: Arsenic is a ubiquitous environmental toxicant, and abnormalities of the skin are the most common outcomes of long-term, low-dose, chronic arsenic exposure. If the balance between keratinocyte proliferation, differentiation, and death is perturbed, pathologic changes of the epidermis may result, including psoriasis, atopic dermatitis, and certain forms of ichthyosis. Therefore, research investigations using in vitro human epidermal cells could help elucidate cellular and molecular processes in keratinocytes affected by arsenic. Data from such investigations could also provide the basis for developing cosmetic intervention for skin diseases caused by arsenic. METHODS: The viability of HaCaT keratinocyte cultures with or without prior exposure to low-dose arsenic trioxide was compared for varying concentrations of arsenic trioxide over a time course of 14 days because in untreated control cultures, approximately 2 weeks is required to complete cell differentiation. Long-term cultures were established by culturing HaCaT cells on collagen IV, and cells were subsequently exposed to 0 parts per million (ppm), 1 ppm, 5 ppm, 7.5 ppm, 10 ppm, and 15 ppm of arsenic trioxide. The percentages of viable cells as well as DNA damage after exposure were determined on Day 2, Day 5, Day 8, and Day 14. RESULTS: Using both statistical and visual analytics approaches for data analysis, we have observed a biphasic response at a 5 ppm dose with cell viability peaking on Day 8 in both chronic and acute exposures. Further, a low dose of 1 ppm arsenic trioxide enhanced HaCaT keratinocyte proliferation, whereas doses above 7.5 ppm inhibited growth. CONCLUSION: The time course profiling of arsenic trioxide cytotoxicity using long-term HaCaT keratinocyte cultures presents an approach to modeling the human epidermal cellular responses to varying doses of arsenic trioxide treatment or exposure. A low dose of arsenic trioxide appears to aid cell growth but concomitantly disrupts the DNA transcription process.

Candidate single nucleotide polymorphism markers for arsenic responsiveness of protein targets.

Arsenic is a toxic metalloid that causes skin cancer and binds to cysteine residues-a property that could be used to infer arsenic responsiveness of a target protein. Non-synonymous Single Nucleotide Polymorphisms (nsSNPs) result in amino acid substitutions and may alter arsenic binding with cysteine residues. Thus, the objective of this investigation was to identify and analyze nsSNPs that lead to substitutions to or from cysteine residues as an indication of increased or decreased arsenic responsiveness. We hypothesize that integration of data on molecular impacts of nsSNPs and arsenic-gene relationships will identify nsSNPs that could serve as arsenic responsiveness markers. We have analyzed functional and structural impacts data for 5,811 nsSNPs linked to 1,224 arsenic-annotated genes. In addition to the identified candidate nsSNPs for increased or reduced arsenic responsiveness, we observed i) a nsSNP that results in the breakage of a disulfide bond, as candidate marker for reduced arsenic responsiveness of KLK7, a secreted serine protease participate in normal shedding of the skin; and ii) 6 pairs of vicinal cysteines in KLK7 protein that could be binding sites for arsenic. In summary, our analysis identified non-synonymous SNPs that could be used to evaluate responsiveness of a protein target to arsenic. In particular, an epidermal expressed serine protease with crucial function in normal skin physiology was prioritized on the basis of abundance of vicinal cysteines for further research on arsenic-induced keratinocyte carcinogenesis.