ABSTRACT
The Maasai have high rates of death from neonatal tetanus, partly due to their custom of packing the umbilical stump with cow dung. We report on the effect of a simple health promotion programme, designed in consultation with the local community and carried out by local women. After introduction of the programme in 1981, neonatal (<6 weeks of age) tetanus rates fell sharply, and by 1988 annual death rates had dropped to 0.75 (range 0-3) per 1000 births in the intervention areas compared with 82 (74-93) per 1000 in control areas.
Subject(s)
Health Promotion , Perinatal Care/methods , Tetanus/mortality , Tetanus/prevention & control , Cultural Characteristics , Female , Humans , Infant, Newborn , Kenya/epidemiology , Tanzania/epidemiology , Treatment OutcomeABSTRACT
BACKGROUND AND AIMS: We have previously reported a reduction in risk of diarrhoeal disease in children who used solar disinfected drinking water. A cholera epidemic, occurring in an area of Kenya in which a controlled trial of solar disinfection and diarrhoeal disease in children aged under 6 had recently finished, offered an opportunity to examine the protection offered by solar disinfection against cholera. METHODS: In the original trial, all children aged under 6 in a Maasai community were randomised by household: in the solar disinfection arm, children drank water disinfected by leaving it on the roof in a clear plastic bottle, while controls drank water kept indoors. We revisited all households which had participated in the original trial. RESULTS: There were 131 households in the trial area, of which 67 had been randomised to solar disinfection (a further 19 households had migrated as a result of severe drought). There was no significant difference in the risk of cholera in adults or in older children in households randomised to solar disinfection; however, there were only three cases of cholera in the 155 children aged under 6 years drinking solar disinfected water compared with 20 of 144 controls. CONCLUSIONS: Results confirm the usefulness of solar disinfection in reducing risk of water borne disease in children. Point of consumption solar disinfection can be done with minimal resources, which are readily available, and may be an important first line response to cholera outbreaks. Its potential in chorine resistant cholera merits further investigation.
Subject(s)
Cholera/prevention & control , Developing Countries , Disinfection , Sunlight , Vibrio cholerae/radiation effects , Water Supply , Child, Preschool , Follow-Up Studies , Humans , Infant , Kenya , Odds Ratio , Randomized Controlled Trials as Topic , RiskABSTRACT
349 Maasai children younger than 6 years old were randomised by alternate household to drink water either left in plastic bottles exposed to sunlight on the roof of the house or kept indoors (control). The trial was run in Maasai by Maasai community elders. Children drinking solar disinfected water had a significantly lower risk of severe diarrhoeal disease over 8705 two weekly follow up visits; two week period prevalence was 48.8% compared with 58.1% in controls, corresponding to an attributable fraction of 16.0%. While this reduction is modest, it was sustained over a year in free living children. It confirms solar disinfection as effective in vivo as a free, low technology, point of consumption method of improving water quality. The continuing use of solar disinfection by the community underlines the value of community participation in research.