A novel theatre-based behaviour change approach for influencing community uptake of schistosomiasis control measures.

BACKGROUND: Appropriate behaviour change with regard to safe water contact practices will facilitate the elimination of schistosomiasis as a public health concern. Various approaches to effecting this change have been trialled in the field but with limited sustainable outcomes. Our case study assessed the effectiveness of a novel theatre-based behaviour change technique (BCT), in combination with cohort awareness raising and capacity training intervention workshops. METHODOLOGY: Our study was carried out in four rural communities in the Mwanza region of Tanzania and in the semi-urban town of Kemise, Ethiopia. We adapted the Risk, Attitude, Norms, Ability and Self-regulation (RANAS) framework and four phases using a mixed methods approach. Participatory project phase engagement and qualitative formative data were used to guide the design of an acceptable, holistic intervention. Initial baseline (BL) data were collected using quantitative questionnaire surveys with 804 participants in Tanzania and 617 in Ethiopia, followed by the theatre-based BCT and capacity training intervention workshops. A post-intervention (PI) survey was carried out after 6 months, with a participant return rate of 65% in Tanzania and 60% in Ethiopia. RESULTS: The intervention achieved a significant improvement in the knowledge of schistosomiasis transmission being associated with poorly managed sanitation and risky water contact. Participants in Tanzania increased their uptake of preventive chemotherapy (males: BL, 56%; PI, 73%, females: BL, 43%; PI, 50%). There was a significant increase in the selection of sanitation (Tanzania: BL, 13%; PI, 21%, Ethiopia: BL, 63%; PI, 90%), safe water and avoiding/minimising contact with infested waters as prevention methods in Tanzania and Ethiopia. Some of the participants in Tanzania followed on from the study by building their own latrines. CONCLUSIONS: This study showed that substantial positive behaviour changes in schistosomiasis control can be achieved using theatre-based BCT intervention and disease awareness training. With the appropriate sensitisation, education and stakeholder engagement approaches, community members were more open to minimising risk-associated contact with contaminated water sources and were mobilised to implement preventive measures.

Effect of a low-cost, behaviour-change intervention on latrine use and safe disposal of child faeces in rural Odisha, India: a cluster-randomised controlled trial.

BACKGROUND: Uptake of Government-promoted sanitation remains a challenge in India. We aimed to investigate a low-cost, theory-driven, behavioural intervention designed to increase latrine use and safe disposal of child faeces in India. METHODS: We did a cluster-randomised controlled trial between Jan 30, 2018, and Feb 18, 2019, in 66 rural villages in Puri, Odisha, India. Villages were eligible if not adjacent to another included village and not designated by the Government to be open-defecation free. All latrine-owning households in selected villages were eligible. We assigned 33 villages to the intervention via stratified randomisation. The intervention was required to meet a limit of US$20 per household and included a folk performance, transect walk, community meeting, recognition banners, community wall painting, mothers' meetings, household visits, and latrine repairs. Control villages received no intervention. Neither participants nor field assessors were masked to study group assignment. We estimated intervention effects on reported latrine use and safe disposal of child faeces 4 months after completion of the intervention delivery using a difference-in-differences analysis and stratified results by sex. This study is registered at ClinicalTrials.gov, NCT03274245. FINDINGS: We enrolled 3723 households (1807 [48·5%] in the intervention group and 1916 [51·5%] in the control group). Analysis included 14 181 individuals (6921 [48·8%] in the intervention group and 7260 [51·2%] in the control group). We found an increase of 6·4 percentage points (95% CI 2·0-10·7) in latrine use and an increase of 15·2 percentage points (7·9-22·5) in safe disposal of child faeces. No adverse events were reported. INTERPRETATION: A low-cost behavioural intervention achieved modest increases in latrine use and marked increases in safe disposal of child faeces in the short term but was unlikely to reduce exposure to faecal pathogens to a level necessary to achieve health gains. FUNDING: The Bill & Melinda Gates Foundation and International Initiative for Impact Evaluation.

Multi-intervention integrated deworming strategy for sustained control of soil-transmitted helminths infections: a case study in Jiangsu Province, China.

BACKGROUND: Soil-transmitted helminths (STH) infections still present a global health problem. Mass drug administration (MDA) is a widely applied strategy to reduce morbidity and mortality caused by STH. Yet, this approach has some shortcomings. In this study, we analyzed the impact of a multi-intervention integrated deworming approach including MDA, health education (HE), and environmental sanitation improvements (ESI) for sustained STH control in Jiangsu Province of China that was applied from 1989 to 2019. METHODS: Data, including infection rate of STH, medications used, coverage of the medication, non-hazardous lavatory rate, and household piped-water access rate in rural areas, and actions related to HE and ESI were collected (from archives) and analyzed in this retrospective descriptive study. Pearson's correlation analysis was applied to test correlations. RESULTS: There was a dramatic decline in the infection rate of STH from 1989 (59.32%) to 2019 (0.12%). From 1995 to 1999, MDA and HE were recommended in rural areas. A negative correlation was observed between infection rate and medication from 1994 to 1998 (r = - 0.882, P = 0.048). From 2000 to 2005, targeted MDA was given to high-risk populations with HE continuously promoting good sanitation behaviors. From 2006 to 2014, targeted MDA + HE and ESI were used to consolidate the control effect. ESI was strengthened from 2006, and a negative correlation was observed between the coverage rate of the non-hazardous lavatory and the infection rate from 2006 to 2019 (r = - 0.95, P < 0.001). The targeted MDA was interrupted in 2015, while continuous efforts like HE and ESI contributed in sustaining STH control. CONCLUSIONS: Multi-intervention integrated deworming strategy contributes to the reduction of STH infections. This approach is a valuable example of how different interventions can be integrated to promote durable STH control.

Molecular Viral Diagnosis and Sanitation of Yam Genetic Resources: Implications for Safe Yam Germplasm Exchange.

Yam (Dioscorea spp.) is an important crop in tropical and subtropical regions. Many viruses have been recently identified in yam, hampering genetic conservation and safe international exchanges of yam germplasm. We report on the implementation of reliable and cost-effective PCR-based detection tools targeting eight different yam-infecting viruses. Viral indexing of the in vitro yam collection maintained by the Biological Resources Center for Tropical Plants (BRC-TP) in Guadeloupe (French West Indies) unveiled a high prevalence of potyviruses, badnaviruses, Dioscorea mosaic associated virus (DMaV) and yam asymptomatic virus 1 (YaV1) and a high level of coinfections. Infected yam accessions were subjected to a combination of thermotherapy and meristem culture. Sanitation levels were monitored using PCR-based and high-throughput sequencing-based diagnosis, confirming the efficacy and reliability of PCR-based detection tools. Sanitation rates were highly variable depending on viruses. Sixteen accessions were successfully sanitized, paving the way to safe yam germplasm exchanges and the implementation of clean seed production programs worldwide.

Geographical variation in the association of child, maternal and household health interventions with under-five mortality in Burkina Faso.

BACKGROUND: Over the past 15 years, scaling up of cost effective interventions resulted in a remarkable decline of under-five mortality rates (U5MR) in sub-Saharan Africa. However, the reduction shows considerable heterogeneity. We estimated the association of child, maternal, and household interventions with U5MR in Burkina Faso at national and subnational levels and identified the regions with least effective interventions. METHODS: Data on health-related interventions and U5MR were extracted from the Burkina Faso Demographic and Health Survey (DHS) 2010. Bayesian geostatistical proportional hazards models with a Weibull baseline hazard were fitted on the mortality outcome. Spatially varying coefficients were considered to assess the geographical variation in the association of the health interventions with U5MR. The analyses were adjusted for child, maternal, and household characteristics, as well as climatic and environmental factors. FINDINGS: The average U5MR was as high as 128 per 1000 ranging from 81 (region of Centre-Est) to 223 (region of Sahel). At national level, DPT3 immunization and baby post-natal check within 24 hours after birth had the most important association with U5MR (hazard rates ratio (HRR) = 0.89, 95% Bayesian credible interval (BCI): 0.86-0.98 and HRR = 0.89, 95% BCI: 0.86-0.92, respectively). At sub-national level, the most effective interventions are the skilled birth attendance, and improved drinking water, followed by baby post-natal check within 24 hours after birth, vitamin A supplementation, antenatal care visit and all-antigens immunization (including BCG, Polio3, DPT3, and measles immunization). Centre-Est, Sahel, and Sud-Ouest were the regions with the highest number of effective interventions. There was no intervention that had a statistically important association with child survival in the region of Hauts Bassins. INTERPRETATION: The geographical variation in the magnitude and statistical importance of the association between health interventions and U5MR raises the need to deliver and reinforce health interventions at a more granular level. Priority interventions are DPT3 immunization, skilled birth attendance, baby post-natal visits in the regions of Sud-Ouest, Sahel, and Hauts Bassins, respectively. Our methodology could be applied to other national surveys, as it allows an incisive, data-driven and specific decision-making approach to optimize the allocation of health interventions at subnational level.

Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh.

Background: Anemia in young children is a global health problem. Risk factors include poor nutrient intake and poor water quality, sanitation, or hygiene. Objective: We evaluated the effects of water quality, sanitation, handwashing, and nutrition interventions on micronutrient status and anemia among children in rural Kenya and Bangladesh. Design: We nested substudies within 2 cluster-randomized controlled trials enrolling pregnant women and following their children for 2 y. These substudies included 4 groups: water, sanitation, and handwashing (WSH); nutrition (N), including lipid-based nutrient supplements (LNSs; ages 6-24 mo) and infant and young child feeding (IYCF) counseling; WSH+N; and control. Hemoglobin and micronutrient biomarkers were measured after 2 y of intervention and compared between groups using generalized linear models with robust SEs. Results: In Kenya, 699 children were assessed at a mean ± SD age of 22.1 ± 1.8 mo, and in Bangladesh 1470 participants were measured at a mean ± SD age of 28.0 ± 1.9 mo. The control group anemia prevalences were 48.8% in Kenya and 17.4% in Bangladesh. There was a lower prevalence of anemia in the 2 N intervention groups in both Kenya [N: 36.2%; prevalence ratio (PR): 0.74; 95% CI: 0.58, 0.94; WSH+N: 27.3%; PR: 0.56; 95% CI: 0.42, 0.75] and Bangladesh (N: 8.7%; PR: 0.50; 95% CI: 0.32, 0.78; WSH+N: 7.9%, PR: 0.46; 95% CI: 0.29, 0.73). In both trials, the 2 N groups also had significantly lower prevalences of iron deficiency, iron deficiency anemia, and low vitamin B-12 and, in Kenya, a lower prevalence of folate and vitamin A deficiencies. In Bangladesh, the WSH group had a lower prevalence of anemia (12.8%; PR: 0.74; 95% CI: 0.54, 1.00) than the control group, whereas in Kenya, the WSH+N group had a lower prevalence of anemia than did the N group (PR: 0.75; 95% CI: 0.53, 1.07), but this was not significant (P = 0.102). Conclusions: IYCF counseling with LNSs reduced the risks of anemia, iron deficiency, and low vitamin B-12. Effects on folate and vitamin A varied between studies. Improvements in WSH also reduced the risk of anemia in Bangladesh but did not provide added benefit over the nutrition-specific intervention. These trials were registered at clinicaltrials.gov as NCT01590095 (Bangladesh) and NCT01704105 (Kenya).

Prioritizing the Scale-Up of Evidence-Based Nutrition and Health Interventions to Accelerate Stunting Reduction in Ethiopia.

Despite some progress, stunting prevalence in many African countries including Ethiopia remains unacceptably high. This study aimed to identify key interventions that, if implemented at scale through the health sector in Ethiopia, can avert the highest number of stunting cases. Using the Lives Saved Tool (LiST), the number of stunting cases that would have been averted, if proven interventions were scaled-up to the highest wealth quintile or to an aspirational 90% coverage was considered. Stunting prevalence was highest among rural residents and households in the poorest wealth quintile. Coverage of breastfeeding promotion and vitamin A supplementation were relatively high (>50%), whereas interventions targeting women were limited in number and had particularly low coverage. Universal coverage (90%) of optimal complementary feeding, preventive zinc supplementation, and water connection in homes could have each averted 380,000-500,000 cases of stunting. Increasing coverage of water connection to homes to the level of the wealthiest quintile could have averted an estimated 168,000 cases of stunting. Increasing coverage of optimal complementary feeding, preventive zinc supplementation, and Water, Sanitation and Hygiene (WASH) services is critical. Innovations in program delivery and health systems governance are required to effectively reach women, remote areas, rural communities, and the poorest proportion of the population to accelerate stunting reduction.

A critical review on the application of the National Sanitation Foundation Water Quality Index.

Many studies have employed the National Sanitation Foundation Water Quality Index (NSFWQI) with non-original rather than originally defined parameters of the model, particularly when incorporating fecal coliform (FC), total solids, and total phosphates as inputs. For this reason, this study aimed to perform a critical review on the application of the NSFWQI to explore the amount of change that can be expected when users employed non-original parameters (such as orthophosphate and total dissolved solids/total suspended solids instead of total phosphorous and total solids, respectively), or different units (FC based on the maximum probable number (FC-MPN) rather than the colony forming unit (FC-CPU)). To demonstrate the influence of originally defined inputs on NSFWQI results, various scenarios were investigated. These scenarios were generated using different possible inputs to the NSFWQI, altering the FC, total solids, and total phosphorous parameters obtained from the monitoring stations of the Sefidroud River in Iran. Considerable differences were observed in the NSFWQI values when using orthophosphate and total suspended solids, instead of the originally defined data (i.e., total phosphorous and total solids), in the model (first scenario). In this case, the number of stations with "good" water quality increased from one to seven when compared with the first scenario results. In addition, unlike the results of the first scenario, none of the stations were classified as class IV (i.e., "bad" water quality status). However, the results of the implemented scenarios presented a more favorable water quality status than those obtained using the first scenario (except the second scenario which included FC-MPN rather than FC-CFU). Using total dissolved solids instead of total solids and FC-MPN rather than FC-CPU, resulted in fewer changes. In both cases, the average of the NSFWQI values in the river classed all stations as "medium" and "bad" water quality for the wet and dry seasons, respectively. Proper application of NSFWQI is important to provide high quality results for evaluation of water bodies, particularly when incorporating total solids and total phosphorous as inputs.

Universal health coverage in India: Newer innovations and the role of public health.

The realization of Universal Health Coverage requires adequate healthcare financing and human resources to provide financial protection to the economically disadvantaged population by covering their medicine, diagnostics, and service costs. Conventionally, inadequate public healthcare financing and the lack of skilled human resources are considered as the major barriers towards achieving UHC in India. To strengthen the Indian healthcare system, there has been significant increase budgetary allocation towards healthcare, a national health protection scheme targeting low-income households, upgrading of primary health-care and expansion of the health work-force. Nevertheless, an evolving paradigm for improving holistic health, sanitation, nutrition, gender equity, drug accessibility and affordability, innovative initiatives in national health programs for reduction of maternal deaths, tuberculosis and HIV burden and the utilization of information technology in healthcare provision of the underserved and the marginalized is gaining rapid acceleration. These represent a genuine innovation towards fulfillment of UHC goals for India.

The impact of water on health and ill-health in a sub-Saharan African wetland: Exploring both sides of the coin.

Wetlands are a source of water out of which humans derive their livelihoods in Sub-Saharan Africa. They are often over-utilized and expose humans to disease-causing infectious agents. This calls for an evaluation of the role of water, sanitation and hygiene (WASH) and their effects in disease prevention and transmission in wetlands. A health risk assessment based on syndromic surveillance of self-reported abdominal complaints and fever gathered from a rural wetland in semiarid Kenya is presented with symptoms serving as proxies for real health threats in wetlands. The incidence of abdominal complaints was significantly higher for those using unimproved water sources compared to improved water users (odds ratio 7.5; 95% CI 2.59-26.9; p=0.001). Drainage of stagnant water near the house (odds ratio 0.2; 95% CI 0.08-0.54; p=0.002) and sanitary hygiene (odds ratio 0.4; 95% CI 0.71-0.97; p=0.056) were associated with reduced risk of abdominal complaints. Drainage of water was also associated with reduced risk of fever (odds ratio 0.3; 95% CI 0.02-0.59; p=0.002) and so was the use of mosquito nets (odds ratio 0.6; 95% CI 0.39-0.02; p=0.063). Usage of wetlands in the afternoon, e.g. for irrigated agriculture, increased the incidence of fever (odds ratio 1.5; 95% CI 0.91-2.33; p=0.040). Overall, there appears a greater likelihood of reducing pathogen exposure in the domestic than in the occupational domain or in the proximity to the wetland. We show that WASH, environmental hygiene and human behaviour are risk factors associated with the contraction of diseases characterized by abdominal complaints (e.g. diarrhoea) and fever (e.g. malaria) in wetlands. The same factors also have the potential to promote human health in the context of wetlands. We demonstrate the applicability of syndromic approaches in surveillance-scarce areas and emphasize the importance of adopting an integrated health-based wetland management that considers WASH and incorporates strategies based on grassroots level risk assessments.

Challenges and opportunities associated with neglected tropical disease and water, sanitation and hygiene intersectoral integration programs.

BACKGROUND: Recent research has suggested that water, sanitation, and hygiene (WASH) interventions, in addition to mass drug administration (MDA), are necessary for controlling and eliminating many neglected tropical diseases (NTDs). OBJECTIVES: This study investigated the integration of NTD and WASH programming in order to identify barriers to widespread integration and make recommendations about ideal conditions and best practices critical to future integrated programs. METHODS: Twenty-four in-depth, semi-structured interviews were conducted with key stakeholders in the global NTD and WASH sectors to identify barriers and ideal conditions in programmatic integration. RESULTS: The most frequently mentioned barriers to WASH and NTD integration included: 1) differing programmatic objectives in the two sectors, including different indicators and metrics; 2) a disproportionate focus on mass drug administration; 3) differences in the scale of funding; 4) siloed funding; and 5) a lack of coordination and information sharing between the two sectors. Participants also conveyed that a more holistic approach was needed if future integration efforts are to be scaled-up. The most commonly mentioned requisite conditions included: 1) education and advocacy; 2) development of joint indicators; 3) increased involvement at the ministerial level; 4) integrated strategy development; 5) creating task forces or committed partnerships; and 6) improved donor support. CONCLUSIONS: Public health practitioners planning to integrate NTD and WASH programs can apply these results to create conditions for more effective programs and mitigate barriers to success. Donor agencies should consider funding more integration efforts to further test the proof of principle, and additional support from national and local governments is recommended if integration efforts are to succeed. Intersectoral efforts that include the development of shared indicators and objectives are needed to foster conditions conducive to expanding effective integration programs.

Control of soil-transmitted helminthiasis in Yunnan province, People's Republic of China: experiences and lessons from a 5-year multi-intervention trial.

The current global strategy for the control of soil-transmitted helminthiasis emphasises periodic administration of anthelminthic drugs to at-risk populations. However, this approach fails to address the root social and ecological causes of soil-transmitted helminthiasis. For sustainable control, it has been suggested that improvements in water, sanitation and hygiene behaviour are required. We designed a 5-year multi-intervention trial in Menghai county, Yunnan province, People's Republic of China. Three different interventions were implemented, each covering a village inhabited by 200-350 people. The interventions consisted of (i) initial health education at study inception and systematic treatment of all individuals aged ≥2 years once every year with a single dose of albendazole; (ii) initial health education and bi-annual albendazole administration; and (iii) bi-annual treatment coupled with latrine construction at family level and regular health education. Interventions were rigorously implemented for 3 years, whilst the follow-up, which included annual albendazole distribution, lasted for 2 more years. Before the third round of treatment, the prevalence of Ascaris lumbricoides was reduced by only 2.8% in the annual treatment arm, whilst bi-annual deworming combined with latrine construction and health education resulted in a prevalence reduction of 53.3% (p<0.001). All three control approaches significantly reduced the prevalence of Trichuris trichiura and hookworm, with the highest reductions achieved when chemotherapy was combined with sanitation and health education. The prevalence of T. trichiura remained at 30% and above regardless of the intervention. Only bi-annual treatment combined with latrine construction and health education significantly impacted on the prevalence of Taenia spp., but none of the interventions significantly reduced the prevalence of Strongyloides stercoralis. Our findings support the notion that in high-endemicity areas, sustainable control of soil-transmitted helminth infections necessitates measures to reduce faecal environmental contamination to complement mass drug administration. However, elimination of soil-transmitted helminthiasis will not be achieved in the short run even with a package of interventions, and probably requires improvements in living conditions, changes in hygiene behaviour and more efficacious anthelminthic drugs and treatment regimens.

Water, sanitation, hygiene, and nutrition: successes, challenges, and implications for integration.

OBJECTIVES: This study explores the integration of water, sanitation, and hygiene (WASH) and nutrition programming for improved child health outcomes and aims to identify barriers to and necessary steps for successful integration. METHODS: Sixteen semi-structured in-depth interviews were conducted with key stakeholders from both the WASH and nutrition sectors, exploring barriers to integration and potential steps to more effectively integrate programs. RESULTS: Key barriers included insufficient and siloed funding, staff capacity and interest, knowledge of the two sectors, coordination, and limited evidence on the impact of integrated programs. To achieve more effective integration, respondents highlighted the need for more holistic strategies that consider both sectors, improved coordination, donor support and funding, a stronger evidence base for integration, and leadership at all levels. CONCLUSIONS: Organizations desiring to integrate programs can use these results to prepare for challenges and to know what conditions are necessary for successfully integrated programs. Donors should encourage integration and fund operational research to improve the efficiency of integration efforts. Knowledge among sectors should be shared and incentives should be designed to facilitate better coordination, especially where both sectors are working toward common goals.

Clinical skill and knowledge requirements of health care providers caring for children in disaster, humanitarian and civic assistance operations: an integrative review of the literature.

INTRODUCTION: Military health care providers (HCPs) have an integral role during disaster, humanitarian, and civic assistance (DHCA) missions. Since 50% of patients seen in these settings are children, military providers must be prepared to deliver this care. PURPOSE: The purpose of this systematic, integrative review of the literature was to describe the knowledge and clinical skills military health care providers need in order to provide care for pediatric outpatients during DHCA operations. DATA SOURCES: A systematic search protocol was developed in conjunction with a research librarian. Searches of PubMed and CINAHL were conducted using terms such as Disaster*, Geological Processes, and Military Personnel. Thirty-one articles were included from database and manual searches. CONCLUSIONS: Infectious diseases, vaccines, malnutrition, sanitation and wound care were among the most frequently mentioned of the 49 themes emerging from the literature. Concepts included endemic, environmental, vector-borne and vaccine-preventable diseases; enhanced pediatric primary care; and skills and knowledge specific to disaster, humanitarian and civic assistance operations. IMPLICATIONS FOR PRACTICE: The information provided is a critical step in developing curriculum specific to caring for children in DHCA. While the focus was military HCPs, the knowledge is easily translated to civilian HCPs who provide care to children in these situations.

Manzanita wood: a sanitizable enrichment option for nonhuman primates.

Wooden objects are often used as nonhuman primate enrichment to provide variety and novelty, promote exploratory behavior, and supply an outlet for curiosity. However, concerns have been raised regarding the ability to sanitize wood by using conventional cage-wash procedures. To address this concern, we examined sanitation outcomes between soiled plastic toys and manzanita wooden manipulanda immediately after a cage-wash cycle. Both an ATP luminometer device, which is capable of providing an immediate assessment of sanitation levels, and traditional bacterial culture were used, with the secondary goal of comparing these methods for sanitation monitoring. Results showed that the wooden objects did not differ from plastic toys with respect to the overall efficacy of cage-wash sanitization. Therefore, manzanita wood can be used as nonhuman primate enrichment without risking pathogen transmission when items are rotated among animals.

Efficacy of delayed atmospheric modification in a heat/modified atmosphere phytosanitary treatment.

The combination of heat and low levels of oxygen increases mortality to insects infesting fruit compared with either heat or low oxygen alone. This combination treatment shows promise to disinfest commodities of quarantine pests. Heated air/modified atmosphere treatments employ the modified atmosphere (e.g., low oxygen) during the entire treatment interval. There is a positive relationship between temperature and efficacy of heat/modified atmosphere treatments. Efficacy of delaying atmospheric modification in a heat/modified atmosphere treatment was studied with the Mexican fruit fly, Anastrepha ludens (Loew) (Diptera: Tephritidae), a quarantine pest of citrus and other fruit in Mexico, Central America, and southern Texas. Larvae were subjected to heat/low oxygen treatments in vitro as well as in grapefruit, Citrus paradisi Macfayden. The relationship between time delay of the modified atmosphere and estimated time required to kill 99% of Mexican fruit fly third instars was not linear, which would indicate an additive relationship, but followed a sigmoid relationship. When infested grapefruit were heated with 47 degrees C air in three atmospheric regimes: 1) air; 2) N2 at 99 kPa plus O2 at 1 kPa; or 3) air for 55 min then N2 at 99 kPa plus O2 at 1 kPa for the remainder of the treatment, estimated 99% prevention of pupariation was 157, 127, and 141 min, respectively.

Molecular epidemiology of Legionella pneumophila serogroup 1 isolates following long-term chlorine dioxide treatment in a university hospital water system.

This paper describes the results of a five-year monitoring programme applied to the water distribution system of the University Hospital of Pisa (Italy). The purpose of the programme was to evaluate the efficacy of an integrated water safety plan in controlling Legionella spp. colonisation of the potable water system. The impact of the safety plan on the ecology of legionella in the water network was evaluated by studying the genetic variability and the chlorine susceptibility of the strains isolated prior to, and throughout, the application of continuous chlorine dioxide treatment. After 45 months of water hyperchlorination, Legionella spp. were still present but the positive supply points were reduced by 79.4%. The samples exceeding 10(3)cfu/L were reduced by 83.8% and the mean counts showed a decrease of 94.6%. The majority of the isolates belonged to Legionella pneumophila serogroup 1 (overall positivity rate: 161/423; 38%). Molecular typing was performed on 61 isolates (37.9% of the positive samples) selected on spatial and temporal criteria. This revealed the circulation and the persistence in the hospital environment of three prevalent types of L. pneumophila Wadsworth, demonstrating allelic and electrophoretic characteristic profiles and different chlorine susceptibility. Two of these, one predominant and pre-dating the sanitation regimen, and one other isolated after three years of water treatment, were chlorine tolerant. Despite the ineffectiveness of chlorine dioxide in eradicating L. pneumophila, the risk management plan adopted appeared to discourage further cases of nosocomial legionellosis.

Problems with provision: barriers to drinking water quality and public health in rural Tasmania, Australia.

INTRODUCTION: Access to safe drinking water is essential to human life and wellbeing, and is a key public health issue. However, many communities in rural and regional parts of Australia are unable to access drinking water that meets national standards for protecting human health. The aim of this research was to identify the key issues in and barriers to the provision and management of safe drinking water in rural Tasmania, Australia. METHOD: Semi-structured interviews were conducted with key local government employees and public health officials responsible for management of drinking water in rural Tasmania. Participants were asked about their core public health duties, regulatory responsibilities, perceptions and management of risk, as well as the key barriers that may be affecting the provision of safe drinking water. RESULTS: This research highlights the effect of rural locality on management and safety of fresh water in protecting public health. The key issues contributing to problems with drinking water provision and quality identified by participants included: poor and inadequate water supply infrastructure; lack of resources and staffing; inadequate catchment monitoring; and the effect of competing land uses, such as forestry, on water supply quality. CONCLUSIONS AND IMPLICATIONS: This research raises issues of inequity in the provision of safe drinking water in rural communities. It highlights not only the increasing need for greater funding by state and commonwealth government for basic services such as drinking water, but also the importance of an holistic and integrated approach to managing drinking water resources in rural Tasmania.

Assessment of the efficiency and economic viability of various methods of treatment of sanitary landfill leachate.

This study assesses the efficiency of various physico-chemical, biological and other tertiary methods for treating leachate. An evaluation study on the treatability of the leachate from methane phase bed (MPB) reactor indicated that at an optimum hydraulic retention time of 6 days, the efficiency of the reactor in terms of biological oxygen demand (BOD) and chemical oxygen demand (COD) removal was 91.29 and 82.69%, respectively. Recycling of the treated leachate through the municipal solid waste layers in the leachate recycling unit (LRU) resulted in a significant increase in the biodegradation of organics present in the leachate. Optimum BOD and COD removal efficiencies were achieved at the third recycle; additional recycling of the leachate did not produce any significant improvement. Physico-chemical treatment of the leachate demonstrated that alum and lime (Option 2) were more economical than coagulants lime and MgCO(3). A cost analysis of the economics of the various treatments revealed that the alternative treatment consisting of a MPB bed followed by a LRU and aerated lagoon is the most cost-effective treatment. However, the alternative consisting of a MPB followed by the LRU and a soil column, which is slightly more costly, would be the most appropriate treatment when adequate land is readily available.