Evaluation of vegetables grown in dry mountainous regions for soil transmitted helminths contamination / Avaliação de vegetais para contaminação por helmintos transmitida pelo solo em quatro distritos da divisão de Malakand: noroeste do Paquistão

Infection caused by geo-helminth parasites are called geohelminthiasis are one of the global health problems. Vegetables eaten raw is the principal source of transmission of geo-helminth parasites. Pakistani people believe that eating raw vegetables are a significant source to get important vitamins and minerals. Based on the high incidence of pathogenic parasites and cultivating different vegetable types in the study areas, we conducted this study to evaluate the geo-helminth contamination of raw vegetables in northwest Khyber Pakhtunkhwa, Pakistan. This is a descriptive study comprised, 1942 samples of 25 various types of vegetables. The samples were examined in physiological saline solution using sedimentation and centrifugation methods. The findings were analyzed by Graph-Pad version 5. P value less than 0.05 (95% CI) was considered significant. Results showed that 16.5% (n=322) of all vegetables were contaminated with one or more type of geo-helminth parasites. Garlic was the highest (35%) and cauliflower the lowest (4%) contaminated samples respectively. Ascaris lumbricoides was the most common geo helminth found followed by hook worm species while Trichuris trichura was the least in all the vegetable samples. Leafy vegetables were highly contaminated 25.3% than vegetables with root parts 21.2% and fruity 9.09%. More than half of the contaminated vegetables were contaminated with single species of geo-helminth (P0.05) species of geo-helminth parasites. Education level of vendors and means of display were not significantly associated while types of vegetable used were significantly associated with the prevalence of parasites. The findings of this study provide evidence that consumption of raw [...].

As infecções causadas por parasitas geo-helmínticos são chamados de geohelmintíases e são um dos problemas de saúde globais. Os vegetais comidos crus são a principal fonte de transmissão dos parasitas geo-helmínticos. O povo paquistanês acredita que comer vegetais crus é uma fonte significativa para obter vitaminas e minerais importantes. Com base na alta incidência de parasitas patogênicos e no cultivo de diferentes tipos de vegetais nas áreas de estudo, conduzimos este estudo para avaliar a contaminação por geo-helmintos de vegetais crus no noroeste de Khyber Pakhtunkhwa, Paquistão. Trata-se de um estudo descritivo composto por 1942 amostras de 25 tipos diversos de vegetais. As amostras foram examinadas em solução salina fisiológica utilizando métodos de sedimentação e centrifugação. Os achados foram analisados pelo Graph-Pad versão 5. O valor de P menor que 0,05 (IC 95%) foi considerado significativo. Os resultados mostraram que 16,5% (n = 322) de todas as hortaliças estavam contaminadas com um ou mais tipos de parasitas geo-helmínticos. O alho foi a amostra mais contaminada (35%) e a couve-flor a menos (4%), respectivamente. Ascaris lumbricoides foi o geo-helmíntico mais comum encontrado, seguido por espécies de verme-anzol, enquanto Trichuris trichura foi o menos encontrado em todas as amostras de vegetais. Os vegetais folhosos foram altamente contaminados 25,3% do que os vegetais com partes de raiz 21,2% e frutados 9,09%. Mais da metade dos vegetais contaminados estavam contaminados com uma única espécie de geo-helmintos (P 0,05) espécies de parasitas geo-helmínticos. O nível de escolaridade dos vendedores e os meios de exibição não [...].

Effectiveness of Mass Media Campaigns to Improve Handwashing-Related Behavior, Knowledge, and Practices in Rural Bangladesh.

Water, sanitation, and handwashing interventions that use intensive interpersonal communication improve targeted behaviors, but are expensive at scale. Mass media is an alternative that could reach more people at lower cost but has rarely been rigorously evaluated. We assessed the effectiveness of a mass media campaign in improving handwashing knowledge and practices in rural Bangladesh. We conducted a cross-sectional assessment before the campaign among 8,947 households and again after 4 months of the campaign among 8,400 different households in the same areas. Trained enumerators conducted spot checks of water, sanitation, and hygiene facilities, and recorded reported knowledge and practices. We compared these outcomes after versus before the campaign using generalized linear models with robust standard errors. After the media campaign, caregivers were more likely to recall ≥ 3 messages regarding handwashing (prevalence ratio [PR] = 1.44, 1.34-1.55), sanitation (PR = 1.45, 1.35-1.55), and safe water (PR = 1.17, 1.08-1.26). After the campaign, the prevalence of using soap and water during handwashing demonstrations was higher among caregivers (PR = 1.15, 1.12-1.19) and children (PR = 1.31, 1.22-1.41). Hands were more commonly observed to be visibly clean among caregivers (PR = 1.14, 1.07-1.20) and children (PR = 1.13, 1.05-1.21). Soap and water was more commonly observed in handwashing stations near latrines (PR = 1.12, 1.06-1.19) and in cooking/eating places (PR = 1.09, 1.01-1.18). Our findings indicate improved handwashing knowledge and behaviors following a mass media campaign. This promising approach can be deployed to improve water, sanitation, and hygiene practices at scale and should be evaluated in other contexts.

Efetividade deliberativa em conselhos municipais de saneamento e de saúde: um estudo em Belo Horizonte-MG e em Belém-PA / Deliberative effectiveness in municipal sanitation and health councils: a study in Belo Horizonte-MG and in Belém-PA

Resumo A deliberação em conselhos municipais de saneamento e de saúde é objeto deste estudo, entendida como processo decisionístico e argumentativo, a partir das formulações de Rousseau, Habermas e Cohen. O objetivo proposto foi avaliar a efetividade da atuação deliberativa dos conselhos de Belo Horizonte (MG) e de Belém (PA). A avaliação abrangeu o estudo de variáveis definidoras do grau de institucionalização dos conselhos e reveladoras da dinâmica do processo deliberativo neles desenvolvido. Foram consultados o Regimento Interno de cada conselho e as atas e resoluções produzidas por eles no triênio 2012-2014. Os resultados revelaram que os quatro conselhos, no período e segundo os critérios de análise definidos, estão distantes do grau de efetividade deliberativa desejado, tendo em vista os propósitos do controle social em saneamento e em saúde, dispostos pela legislação específica de cada área. Mesmo com experiência mais larga, considerando seus anos de exercício pedagógico e democrático de participação, os conselhos de saúde não se mostraram mais efetivos que os neófitos conselhos de saneamento.

Abstract Deliberation in municipal councils of sanitation and health is the object of this study. Deliberation is understood as decision making and argumentative process, from the formulations of Rousseau, Habermas and Cohen. The proposed objective was to evaluate the effectiveness of the deliberative action of the councils of Belo Horizonte (MG) and Belém (PA). The evaluation included the study of variables defining the degree of institutionalization of the councils and revealing the dynamics of the deliberative process developed in them. The internal regulations of each council and the minutes and resolutions produced by them during the 2012-2014 triennium were consulted. The results showed that the four councils, in the period and according to the defined criteria of analysis, are far from the degree of deliberative effectiveness desired, considering the purposes of the social control in sanitation and in health, arranged by the specific legislation of each area. Even with broader experience, considering their years of participatory pedagogical exercise, health councils were no more effective than neophyte sanitation councils.

The Geshiyaro Project: a study protocol for developing a scalable model of interventions for moving towards the interruption of the transmission of soil-transmitted helminths and schistosome infections in the Wolaita zone of Ethiopia.

BACKGROUND: National deworming programmes rely almost exclusively on mass drug administration (MDA) to children to control morbidity caused by these parasitic infections. The provision of other interventions, consisting of preventive chemotherapy at high population level coverage together with water, sanitation and hygiene (WaSH) and changes in risk behaviour, should enable sustainable control of soil-transmitted helminths (STH) and schistosomiasis and ultimately interrupt transmission. METHODS/DESIGN: Two interventions will be implemented by the project: (i) community-wide biannual albendazole and annual praziquantel treatment with a target of 80-90% treatment coverage ("expanded MDA"); and (ii) provision of WaSH with behaviour change communication (BCC), within the Wolaita zone, Ethiopia. The project has three study arms: (i) expanded community-wide MDA, WaSH and BCC; (ii) expanded community-wide MDA only; and (iii) annual school-based MDA (the current National STH/schistosomiasis Control Programme). The impact of these interventions will be evaluated through prevalence mapping at baseline and endline (after four rounds of MDA), combined with annual longitudinal parasitological surveillance in defined cohorts of people to monitor trends in prevalence and reinfection throughout the project. Treatment coverage and individual compliance to treatment will be monitored by employing fingerprint biometric technology and barcoded identification cards at treatment. WaSH utilisation will be evaluated through school and household level observations and annual WaSH assessment survey. Complementary qualitative surveys will explore practices, cultural and social drivers of risk behaviours, uptake of WaSH and treatment, and assessing the impact of the BCC. DISCUSSION: The study has the potential to define an 'End Game' for STH and schistosomiasis programmes through provision of multiple interventions. Interrupting transmission of these infections would eliminate the need for long-term repeated MDA, lead to sustained health improvements in children and adults, thereby allowing health systems to focus on other disease control priorities.

O controle social em saneamento e em saúde: análise comparativa com base nos marcos legais federais brasileiros / Social control in the sectors of sanitation and health: a comparative analysis based on the Brazilian legal framework

Resumo A comparação entre os marcos legais federais brasileiros das áreas de saúde e de saneamento, sob a perspectiva do controle social, é o fio condutor deste trabalho, tendo em vista o pioneirismo da primeira e sua possível influência sobre a segunda. O esforço comparativo foi realizado a partir de seis critérios analíticos: mecanismos de controle social definidos; caráter conferido ao controle social; responsabilidade, recomendações e apoio para viabilizar o controle social; acesso à informação; controle sobre o uso dos recursos; controle da implementação das deliberações. Avaliaram-se possibilidades de o marco do saneamento se beneficiar das formulações no campo da saúde e lograr produzir práticas mais efetivas de controle social na condução dessa política pública. Os resultados revelam que, mesmo tendo recebido alguma influência da área de saúde, o marco do saneamento é mais restrito e tem menor potencialidade de produzir práticas mais efetivas, uma vez que apresenta: 1) mecanismos mais restritivos por não serem necessariamente deliberativos; 2) ausência de uma política de formação de conselheiros e de educação popular como incentivo e fortalecimento ao controle social; 3) ausência de mecanismos efetivos voltados para a fiscalização do uso dos recursos.

Abstract Comparison between federal Brazilian legal frameworks in the areas of health and sanitation, from the perspective of participation, is the thread of this work, considering the pioneering of health and its possible influence on sanitation. The comparative effort was made from six analytical criteria: defined social control mechanisms; character given to social control; responsibility, recommendations and support to enable social control; access to information; control over the use of resources; control of the implementation of the resolutions. It was evaluated if the sanitation framework have been helped by health formulations and if have achieved produce more effective practices of social control in the conduct of public policy. The results show that, although it has received some influence from the health area, the water and sanitation framework is more restricted and has less potential to produce more effective practices, since it presents: 1) more restrictive mechanisms because they are not necessarily deliberative; 2) lack of a policy of training counselors and popular education to incentive participation; 3) absence of effective mechanisms for monitoring the use of resources.

The environmental health nexuses within the Strategic Roadmap: regional work priorities for the WHO Eastern Mediterranean Region (Editorial).

The Eastern Mediterranean Region (EMR) is a diverse region in terms of income, development, health and environmental conditions. The environment and ecosystems are under serious pressures with adverse impacts on human health and well-being. Environmental Health (EH) is an area of growing importance for EMR, and environmental risk factors such as air, water and soil pollution, chemical exposures, climate change and radiation, contribute to more than 100 diseases and injuries, and environmental hazards are responsible for about 22% of the total burden of disease in the Region.

Application of a fluorescent marker with quantitative bioburden methods to assess cleanliness.

BACKGROUND: Improvement of environmental cleaning in hospitals has been shown to decrease in-hospital cross transmission of pathogens. Several objective methods, including aerobic colony counts (ACCs), the adenosine triphosphate (ATP) bioluminescence assay, and the fluorescent marker method have been developed to assess cleanliness. However, the standard interpretation of cleanliness using the fluorescent marker method remains uncertain. OBJECTIVE: To assess the fluorescent marker method as a tool for determining the effectiveness of hospital cleaning. DESIGN: A prospective survey study. SETTING: An academic medical center. METHODS: The same 10 high-touch surfaces were tested after each terminal cleaning using (1) the fluorescent marker method, (2) the ATP assay, and (3) the ACC method. Using the fluorescent marker method under study, surfaces were classified as totally clean, partially clean, or not clean. The ACC method was used as the standard for comparison. RESULTS: According to the fluorescent marker method, of the 830 high-touch surfaces, 321 surfaces (38.7%) were totally clean (TC group), 84 surfaces (10.1%) were partially clean (PC group), and 425 surfaces (51.2%) were not clean (NC group). The TC group had significantly lower ATP and ACC values (mean ± SD, 428.7 ± 1,180.0 relative light units [RLU] and 15.6 ± 77.3 colony forming units [CFU]/100 cm2) than the PC group (1,386.8 ± 2,434.0 RLU and 34.9 ± 87.2 CFU/100 cm2) and the NC group (1,132.9 ± 2,976.1 RLU and 46.8 ± 119.2 CFU/100 cm2). CONCLUSIONS: The fluorescent marker method provided a simple, reliable, and real-time assessment of environmental cleaning in hospitals. Our results indicate that only a surface determined to be totally clean using the fluorescent marker method could be considered clean.

A dimensão territorial do esgotamento sanitário: o caso do Recreio dos Bandeirantes, Rio de Janeiro, Brasil / The Territorial Dimension of Sewage Networks: the Case of Recreio dos Bandeirantes, Rio de Janeiro, Brazil

Resumo O crescimento das periferias de grandes cidades do Brasil vem ocorrendo sem que disponham de infraestrutura de saneamento adequada. Diferentes grupos sociais procuram superar estas deficiências, buscando alternativas locais de saneamento, individuais ou comunitárias, que se contrapõem ao modelo universal de redes de coleta de esgoto. A pesquisa foi desenvolvida no bairro do Recreio dos Bandeirantes, Rio de Janeiro, a fim de analisar o processo de instalação do sistema de esgotamento sanitário, sob uma abordagem territorial. Os dados permitiram a construção de esquemas territoriais relacionados a conflitos durante a implantação da estrutura de esgotamento sanitário neste bairro, onde convivem grupos populacionais de classe média e moradores de favelas, áreas de preservação ambiental, praias e atividades comerciais. Foi levantada a necessidade de contextualização das informações sobre saneamento, disponibilizadas pelo IBGE e pela companhia estadual de saneamento, que não refletiam estes conflitos ou a representação dos moradores sobre seus problemas de saneamento. A sobreposição das atribuições de gestão dos territórios deve, ainda, ser considerada como um dos fatores responsáveis por parte dos conflitos levantados no bairro. Novos estudos são sugeridos como complementação metodológica e atualização de dados.

ABSTRACT The urban suburbs of Brazilian cities have grown without an adequate sanitation infrastructure. Different social groups try to overcome these shortcomings seeking local sanitation alternatives at individual or community levels, contrasting with the universal model of sewage networks. This study was developed in the suburban neighborhood of Recreio dos Bandeirantes, Rio de Janeiro, Brazil, in order to analyze the installation process of the sewage system under a territorial approach. Data facilitated the construction of territorial schemes related to conflicts during the implementation of sewage networks in this neighborhood, where middle class groups and favela residents coexist with environmental preservation areas, beaches and commercial activities. This work revealed the need for contextualized sanitation information made available by the Brazilian Institute of Geography and Statistics (IBGE) and state sewage collection company, which conceal these conflicts or the representation of residents about their sanitation problems. Overlapping territorial managing functions should be considered as one of the factors responsible for the conflicts identified in the neighborhood. Further studies are suggested as methodological complementation and data update.

Prevalence of trachoma in 13 Local Government Areas of Taraba State, Nigeria.

PURPOSE: The purpose of these surveys was to determine the prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years and trichiasis prevalence in persons aged ≥15 years, in 13 Local Government Areas (LGAs) of Taraba State, Nigeria. METHODS: The surveys followed Global Trachoma Mapping Project (GTMP) protocols. Twenty-five households were selected from each of 25 clusters in each LGA, using two-stage cluster sampling providing probability of selection proportional to cluster size. Survey teams examined all the residents of selected households aged ≥1 year for the clinical signs TF, trachomatous inflammation-intense (TI) and trichiasis. RESULTS: The prevalence of TF in children aged 1-9 years in the 13 LGAs ranged from 0.0-5.0%; Ussa LGA had the highest prevalence of 5% (95%CI: 3.4-7.2). Trichiasis prevalence ranged from 0.0-0.8%; seven LGAs had trichiasis prevalences above the threshold for elimination. The backlog of trichiasis in the 13 LGAs (estimated combined population 1,959,375) was 3,185 people. There is need to perform surgery for at least 1,835 people to attain a trichiasis prevalence in each LGA of <0.2% in persons aged ≥15 years. In six of the 13 LGAs, 80% of households could access washing water within 1 km of the household, but only one LGA had >80% of households with access to improved latrines. CONCLUSION: One of 13 LGAs requires antibiotic mass drug administration for active trachoma. Community-based trichiasis surgery needs to be provided in seven LGAs. There is a need to increase household-level access to improved washing water and latrines across the State.

Impact Survey Results after SAFE Strategy Implementation in 15 Local Government Areas of Kebbi, Sokoto and Zamfara States, Nigeria.

PURPOSE: To determine prevalence of trachoma after interventions in 15 local government areas (LGAs) of Kebbi, Sokoto and Zamfara States, Nigeria. METHODS: A population-based impact survey was conducted in each LGA using Global Trachoma Mapping Project (GTMP) protocols. In each LGA, 25 villages were selected, except in Arewa LGA, where we selected 25 villages from each of four subunits to obtain finer-resolution prevalence information. Villages were selected with probability proportional to size. In each village, 25 households were enrolled and all consenting residents aged ≥1 year were examined by GTMP-certified graders for trachomatous inflammation-follicular (TF) and trachomatous trichiasis (TT). Information on sources of household water and types of sanitation facilities used was collected through questioning and direct observation. RESULTS: The number of households enrolled per LGA ranged from 623 (Kware and Tangaza) to 2488 (Arewa). There have been marked reductions in the prevalence of TF and TT since baseline surveys were conducted in all 15 LGAs. Eight of the 15 LGAs have attained TF prevalences <5% in children, while 10 LGAs have attained TT prevalences <0.2% in persons aged ≥15 years. Between 49% and 96% of households had access to water for hygiene purposes within 1 km of the household, while only 10-59% had access to improved sanitation facilities. CONCLUSION: Progress towards elimination of trachoma has been made in these 15 LGAs. Collaboration with water and sanitation agencies and community-based trichiasis surgery are still needed in order to eliminate trachoma by the year 2020.

Completing Baseline Mapping of Trachoma in Uganda: Results of 14 Population-Based Prevalence Surveys Conducted in 2014 and 2018.

PURPOSE: We aimed to estimate the prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years, trichiasis in adults aged ≥15 years, and water and sanitation (WASH) indicators in 12 suspected-endemic districts in Uganda. METHODS: Surveys were undertaken in 14 evaluation units (EUs) covering 12 districts. Districts were selected based on a desk review in 2014 (four districts) and trachoma rapid assessments in 2018 (eight districts). We calculated that 1,019 children aged 1-9 years were needed in each EU to estimate TF prevalence with acceptable precision and used three-stage cluster sampling to select 30 households in each of 28 (2014 surveys) or 24 (2018 surveys) villages. Participants living in selected households aged ≥1 year were examined for trachoma; thus enabling estimation of prevalences of TF in 1-9 year-olds and trichiasis in ≥15 year-olds. Household-level WASH access data were also collected. RESULTS: A total of 11,796 households were surveyed; 22,465 children aged 1-9 years and 24,652 people aged ≥15 years were examined. EU-level prevalence of TF ranged from 0.3% (95% confidence interval [CI] 0.1-0.7) to 3.9% (95% CI 2.1-5.8). EU-level trichiasis prevalence ranged from 0.01% (95% CI 0-0.11) to 0.81% (95% CI 0.35-1.50). Overall proportions of households with improved drinking water source, water source in yard or within 1km, and improved sanitation facilities were 88.1%, 23.0% and 23.9%, respectively. CONCLUSION: TF was not a public health problem in any of the 14 EUs surveyed: antibiotic mass drug administration is not required in these districts. However, in four EUs, trichiasis prevalence was ≥ 0.2%, so public health-level trichiasis surgery interventions are warranted. These findings will facilitate planning for elimination of trachoma in Uganda.

Hospitalizations due to diseases associated with poor sanitation in the public health care network of the metropolitan region of Porto Alegre, Rio Grande do Sul State, Brazil, 2010-2014. / Internações por doenças relacionadas ao saneamento ambiental inadequado na rede pública de saúde da região metropolitana de Porto Alegre, Rio Grande do Sul, 2010-2014.

OBJECTIVE: to describe the occurrence, characteristics and expenditures of hospitalizations due to diseases associated with poor sanitation funded by the Brazilian National Health System (SUS) among residents of the metropolitan region of Porto Alegre-RS, Brazil, from 2010 to 2014. METHODS: descriptive study with data from SUS Hospital Information System (SIH/SUS). RESULTS: out of 13,929 hospitalizations for diseases associated with poor sanitation, 93.7% were related to fecal-oral transmission diseases and 20.4% were children from 1 to 4 years of age (28.1 hospitalizations/10,000 inhabitants/year); hospital fatality rate was of 2.2%, fecal-oral transmission diseases were the main causes of death; intensive care unit (ICU) was used in 2.0% of hospitalizations; total expenditures on hospitalizations was around BRL6.1 million. CONCLUSION: diseases associated with poor sanitation are still an important issue in the metropolitan region of Porto Alegre-RS, although this region presents good development indicators.

Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda.

BACKGROUND: Praziquantel-based mass treatment is the main approach to controlling schistosomiasis mansoni in endemic areas. Interventions such as provision and use of safe water, minimising contact with infested water, disposal of stool in latrines and snail control provide key avenues to break the transmission cycle and can sustain the benefits of mass treatment in the long term. Efforts are also being made to develop a schistosomiasis vaccine which, if effective, might reduce the incidence of re-infection after treatment. However, any interventions deployed need to be acceptable to, and sustainable by, the target communities. METHODS: In this qualitative study, we investigated the perceptions of six Lake Victoria island communities of Koome, Uganda, about interventions to control Schistosoma mansoni infection and their willingness to participate in Schistosoma vaccine trials. Thirty-two in-depth interviews, 12 key informant interviews and 10 focus group discussions were conducted. Data were analysed using a thematic content approach. FINDINGS: Intestinal schistosomiasis was not regarded as a serious health problem because a mass treatment programme is in place. However, the communities lack safe water sources and latrines. Mass treatment with praziquantel, safe water supplies and use of toilets were deemed the most acceptable interventions by the participants. The communities are willing to participate in Schistosoma vaccine trials. CONCLUSION/SIGNIFICANCE: Knowledge of a community's perception about interventions to control schistosomiasis can be valuable to policy makers and programme implementers intending to set up interventions co-managed by the community members. In this study, the views of the Lake Victoria island communities of Koome are presented. This study also provides data to guide further work on alternative interventions such as Schistosoma vaccine trials in these communities.

Water, sanitation and hygiene infrastructure and quality in rural healthcare facilities in Rwanda.

BACKGROUND: WHO and UNICEF have proposed an action plan to achieve universal water, sanitation and hygiene (WASH) coverage in healthcare facilities (HCFs) by 2030. The WASH targets and indicators for HCFs include: an improved water source on the premises accessible to all users, basic sanitation facilities, a hand washing facility with soap and water at all sanitation facilities and patient care areas. To establish viable targets for WASH in HCFs, investigation beyond 'access' is needed to address the state of WASH infrastructure and service provision. Patient and caregiver use of WASH services is largely unaddressed in previous studies despite being critical for infection control. METHODS: The state of WASH services used by staff, patients and caregivers was assessed in 17 rural HCFs in Rwanda. Site selection was non-random and predicated upon piped water and power supply. Direct observation and semi-structured interviews assessed drinking water treatment, presence and condition of sanitation facilities, provision of soap and water, and WASH-related maintenance and record keeping. Samples were collected from water sources and treated drinking water containers and analyzed for total coliforms, E. coli, and chlorine residual. RESULTS: Drinking water treatment was reported at 15 of 17 sites. Three of 18 drinking water samples collected met the WHO guideline for free chlorine residual of >0.2 mg/l, 6 of 16 drinking water samples analyzed for total coliforms met the WHO guideline of <1 coliform/100 mL and 15 of 16 drinking water samples analyzed for E. coli met the WHO guideline of <1 E. coli/100 mL. HCF staff reported treating up to 20 L of drinking water per day. At all sites, 60% of water access points (160 of 267) were observed to be functional, 32% of hand washing locations (46 of 142) had water and soap and 44% of sanitary facilities (48 of 109) were in hygienic condition and accessible to patients. Regular maintenance of WASH infrastructure consisted of cleaning; no HCF had on-site capacity for performing repairs. Quarterly evaluations of HCFs for Rwanda's Performance Based Financing system included WASH indicators. CONCLUSIONS: All HCFs met national policies for water access, but WHO guidelines for environmental standards including water quality were not fully satisfied. Access to WASH services at the HCFs differed between staff and patients and caregivers.

Condições de saneamento e desigualdades de cor/raça no Brasil urbano: uma análise com foco na população indígena com base no Censo Demográfico de 2010 / Sanitation and racial inequality conditions in urban Brazil: an analysis focused on the indigenous population based on the 2010 Population Census

RESUMO: Objetivo: Os objetivos deste estudo foram analisar e descrever a presença da infraestrutura de saneamento básico nas áreas urbanas do Brasil, contrastando os perfis dos domicílios indígenas com os de não indígenas. Métodos: Trata-se de um estudo transversal com base nos microdados do Censo 2010. As análises foram baseadas em estatísticas descritivas (prevalências) e na construção de modelos de regressão logística múltipla (ajustados por covariáveis socioeconômicas e demográficas). Estimaram-se as razões de chance para a associação entre as variáveis explicativas (covariáveis) e de desfecho (abastecimento de água, esgotamento sanitário, coleta de lixo e saneamento adequado). O nível de significância estatística estabelecido foi de 5%. Resultados: Entre os serviços analisados, o esgotamento sanitário mostrou-se o mais precário. Em relação à cor ou raça, os domicílios com responsáveis indígenas apresentaram as menores frequências de presença de infraestrutura sanitária no Brasil Urbano. Os resultados das regressões ajustadas mostraram que, em geral, os domicílios indígenas se encontram em desvantagem quando comparados aos de outras categorias de cor ou raça, especialmente quanto à presença do serviço de coleta de lixo. Essas desigualdades foram de maior magnitude nas regiões Sul e Centro-Oeste. Conclusão: As análises deste estudo não somente confirmam o perfil de precárias condições de infraestrutura de saneamento básico dos domicílios indígenas em área urbana, como também evidenciam a persistência de iniquidades associadas à cor ou raça no país.

ABSTRACT: Objective: The aims of this study were to analyze and describe the presence and infrastructure of basic sanitation in the urban areas of Brazil, contrasting indigenous with non-indigenous households. Methods: A cross-sectional study based on microdata from the 2010 Census was conducted. The analyses were based on descriptive statistics (prevalence) and the construction of multiple logistic regression models (adjusted by socioeconomic and demographic covariates). The odds ratios were estimated for the association between the explanatory variables (covariates) and the outcome variables (water supply, sewage, garbage collection, and adequate sanitation). The statistical significance level established was 5%. Results: Among the analyzed services, sewage proved to be the most precarious. Regarding race or color, indigenous households presented the lowest rate of sanitary infrastructure in Urban Brazil. The adjusted regression showed that, in general, indigenous households were at a disadvantage when compared to other categories of race or color, especially in terms of the presence of garbage collection services. These inequalities were much more pronounced in the South and Southeastern regions. Conclusion: The analyses of this study not only confirm the profile of poor conditions and infrastructure of the basic sanitation of indigenous households in urban areas, but also demonstrate the persistence of inequalities associated with race or color in the country.

Prevalence of and Risk Factors for Trachoma in Southern Nations, Nationalities, and Peoples' Region, Ethiopia: Results of 40 Population-Based Prevalence Surveys Carried Out with the Global Trachoma Mapping Project.

PURPOSE: We sought to estimate the prevalence of trachoma at sufficiently fine resolution to allow elimination interventions to begin, where required, in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. METHODS: We carried out cross-sectional population-based surveys in 14 rural zones. A 2-stage cluster randomized sampling technique was used. A total of 40 evaluation units (EUs) covering 110 districts ("woredas") were surveyed from February 2013 to May 2014 as part of the Global Trachoma Mapping Project (GTMP), using the standardized GTMP training package and methodology. RESULTS: A total of 30,187 households were visited in 1047 kebeles (clusters). A total of 131,926 people were enumerated, with 121,397 (92.0%) consenting to examination. Of these, 65,903 (54.3%) were female. In 38 EUs (108 woredas), TF prevalence was above the 10% threshold at which the World Health Organization recommends mass drug administration with azithromycin annually for at least 3 years. The region-level age- and sex-adjusted trichiasis prevalence was 1.5%, with the highest prevalence of 6.1% found in Cheha woreda in Gurage zone. The region-level age-adjusted TF prevalence was 25.9%. The highest TF prevalence found was 48.5% in Amaro and Burji woredas. In children aged 1-9 years, TF was associated with being a younger child, living at an altitude <2500m, living in an area where the annual mean temperature was >15°C, and the use of open defecation by household members. CONCLUSION: Active trachoma and trichiasis are significant public health problems in SNNPR, requiring full implementation of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement).

Prevalence of Trachoma in Bauchi State, Nigeria: Results of 20 Local Government Area-Level Surveys.

PURPOSE: To determine the prevalence of trachomatous inflammation - follicular (TF) and trichiasis in each of the 20 local government areas (LGAs) of Bauchi State, Nigeria. METHODS: We undertook a population-based prevalence survey in each LGA in Bauchi State, employing the Global Trachoma Mapping Project methodology. We used a 2-stage, systematic and quasi-random sampling strategy. Using probability proportional to size, we selected 25 clusters, in each of which 25 households were selected by random walk. All residents of selected households 1 year and older were examined for TF, trachomatous inflammation - intense, and trichiasis, using the World Health Organization simplified grading scheme. RESULTS: Only two LGAs in Bauchi State had TF prevalences in 1-9-year-olds over 5%, with none having TF prevalences of 10% or greater. Only one LGA had a trichiasis prevalence in adults below the elimination threshold; all the others had trichiasis at levels suggestive of public health significance. In all 20 LGAs, more than 60% of households were within 1 km of an improved source of water for hygiene. CONCLUSION: Efforts need to be made in Bauchi State to provide trichiasis surgery in order to avert trachomatous blindness. Water supplies needs to be sustained and good personal hygiene practices assured so that elimination of trachoma as a public health problem will be achieved and sustained.

Prevalence of Trachoma in Katsina State, Nigeria: Results of 34 District-Level Surveys.

PURPOSE: To determine the local government area (LGA)-level prevalence of trachoma in all 34 LGAs of Katsina State. METHODS: A population-based prevalence survey was conducted in each LGA of Katsina State, using the Global Trachoma Mapping Project methodology. We used a 3-stage cluster random sampling strategy to select 25 households from each of 25 clusters. We examined all residents of selected households aged 1 year and older for the clinical signs of trachomatous inflammation-follicular (TF), trachomatous inflammation-intense and trichiasis, using the World Health Organization (WHO) simplified grading scheme. RESULTS: We examined 129,281 persons. Six LGAs had a TF prevalence ≥10%, and another six LGAs had a TF prevalence between 5% and 9.9%; all 12 require mass drug administration with azithromycin plus other interventions. The prevalence of trichiasis was ≥1.0% in 13 LGAs, and there is a need to perform trichiasis surgery in over 26,000 persons to reach targets set by the WHO for elimination of trichiasis. CONCLUSION: The prevalence of TF is generally low in Katsina state, but urgent steps must be taken to implement the full SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvement) in at least 12 LGAs while also stepping up efforts to provide community-based trichiasis surgery throughout the whole state, in order to make trachoma elimination by 2020 a reality.

Hand washing behavior and associated factors in Vietnam based on the Multiple Indicator Cluster Survey, 2010-2011.

BACKGROUND: Handwashing is a cost-effective way of preventing communicable diseases such as respiratory and food-borne illnesses. However, handwashing rates are low in developing countries. Target 7C of the seventh Millennium Development Goals was to increase by half the proportion of people with sustainable access to safe drinking water and basic sanitation by 2015. Studies have found that better access to improved water sources and sanitation is associated with higher rates of handwashing. OBJECTIVE: Our goal was to describe handwashing behaviour and identify the associated factors in Vietnamese households. DESIGN: Data from 12,000 households participating in the Vietnam Multiple Indicator Cluster Survey 2011 were used. The survey used a multistage sampling method to randomly select 100 clusters and 20 households per cluster. Self-administered questionnaires were used to collect data from a household representative. Demographic variables, the presence of a specific place for handwashing, soap and water, access to improved sanitation, and access to improved water sources were tested for association with handwashing behaviour in logistic regression. RESULTS: Almost 98% of households had a specific place for handwashing, and 85% had cleansing materials and water at such a place. The prevalence of handwashing in the sample was almost 85%. Educational level, ethnicity of the household head, and household wealth were factors associated with handwashing practice (p<0.05). Those having access to an improved sanitation facility were more likely to practise handwashing [odds ratio (OR)=1.69, 95% confidence interval (CI): 1.37-2.09, p<0.001], as were those with access to improved water sources (OR=1.74, 95% CI: 1.37-2.21, p<0.001). CONCLUSIONS: Households with low education, low wealth, belonging to ethnic minorities, and with low access to improved sanitation facilities and water sources should be targeted for interventions implementing handwashing practice. In addition, the availability of soap and water at handwashing sites should be increased and practical teaching programs should be deployed in order to increase handwashing rates.

Aranãs do médio Jequitinhonha: aspectos socioeconômicos, demográficos e sanitários de uma população indígena desaldeada / The Aranãs in mid-Jequitinhonha: socioeconomic, demographic and sanitary aspects of a landless indigenous population

Resumo A deficiência de dados para subsidiar a análise das condições epidemiológicas e ambientais em que vivem os povos indígenas no Brasil constitui desafio para a elaboração de políticas públicas específicas. O déficit informacional é ainda maior para os grupos “desaldeados”. Diante desse cenário, julgou-se relevante caracterizar uma população indígena desaldeada, privilegiando as dimensões demográfica, socioeconômica e sanitária. Buscou-se identificar diferenças internas ao grupo e analisar os dados levantados para essa população comparando-os aos de outras etnias. Informações foram obtidas a partir da realização de inquérito domiciliar. Os resultados evidenciaram semelhanças com aqueles revelados pelo Censo 2010 para os indígenas brasileiros, sobretudo para os domiciliados fora das terras indígenas. Foram identificadas assimetrias dentro do grupo, principalmente de ordem sanitária, que sugeriram relação com a localização do domicílio. Aponta-se para a necessidade de intervenções prioritárias voltadas para os Aranã residentes no meio rural, recaindo na antiga discussão sobre as disparidades urbano-rurais, também aplicada às populações não indígenas. Em adição, sugere-se que o IBGE precisa aprimorar a investigação do contingente populacional indígena desaldeado.

Abstract The lack of epidemiological and environmental data on Brazilian indigenous populations is a challenge for the elaboration of public policy. This lack of data is more acute for “landless” indigenous groups. From this perspective, it was considered relevant to describe the Aranã, a landless indigenous group living in Minas Gerais, focusing on the demographic, socioeconomic and sanitary dimensions. A household survey was conducted. The data collected were analyzed and compared with those from other national ethnic groups. The results revealed similarities between these findings and those from the 2010 Census related to the native indigenous population, especially those not living on indigenous lands or reservations. Asymmetric results were identified within the households, mainly sanitary disparities, which suggested a relation with the location. This result indicates the need for priority intervention for the Aranã living in rural areas, bringing to light the age-old discussion about rural and urban disparities. In addition, we suggest that the Brazilian Institute of Geography and Statistics (IBGE), responsible for the 2010 census, should refine its assessment methods concerning landless indigenous groups.