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1.
BMC Oral Health ; 20(1): 32, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-32005114

RESUMEN

BACKGROUND: Oral hygiene practices can be linked to personal hygiene practices, including access to water and other sanitation facilities. The objective of the study was to determine if there is an association between oral hygiene practices and water and sanitation hygiene (WASH) practices among street-involved young people (SIYP). METHODS: A cross-sectional study recruited SIYP age 10-24 years in two States in Nigeria recruited through respondent-driven sampling in December 2018. Interviewer-administered questionnaires were used to collect data on water access, sanitation, personal and oral hygiene. The instruments used for collecting the data were standardized tools for measuring the phenomena studied. The association between knowledge and practice of oral hygiene; oral hygiene and water, sanitation and hygiene (WASH); and indicators of good oral hygiene were determined using binary logistic regression guided by two models. RESULTS: A total of 845 study participants were recruited. The proportion of SIYP with good knowledge of oral hygiene was low (31.2%), and fewer had good oral hygiene practice (8.9%). There were significant associations between knowledge and practice of tooth cleaning, use of fluoride-containing toothpaste, dental flossing, consumption of sugar between meals, and frequency of dental check-ups (p < 0.001 respectively). Respondents with good water collection and storage practices (AOR: 2.01; 95% CI: 1.24-3.24; P = 0.005) and those residing in Lagos (AOR: 2.85; 95% CI: 1.61-5.06; P = 0.001) had a higher likelihood of having good oral hygiene. CONCLUSION: Good oral hygiene practices of SIYP in Nigeria is associated with access to water collection and storage. WASH programs can have an impact on health through improved oral hygiene practices.

2.
Ecotoxicol Environ Saf ; 191: 110233, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-32004944

RESUMEN

Poor water quality exacerbates multidimensional poverty in developing nations. Often centralized treatment facilities generate acceptable water quality, but the water is contaminated during distribution. Methods to assess sources of contamination in water distribution systems are lacking. A case study of two methods, human risk assessment linked to water distribution system sampling was conducted in Hyderabad, Pakistan to determine areas requiring infrastructure rehabilitation. Water samples from source water (i.e., the Indus River), treatment plant effluent and from taps in the water distribution system were analyzed by atomic adsorption spectroscopy for metals and metalloids (As, Cd, Cr, Hg, and Pb) and water quality parameters (dissolved and suspended solids, pH, conductivity, and total organic carbon). Source water exceeded acceptable drinking water levels for As, Cd, total Cr, and Pb, while the treatment plant effluent concentrations were acceptable. Concentrations of all metals and metalloids, except Hg, increased in the water distribution system post-treatment, exceeding safe drinking limits in at least one location, suggesting contamination of the water during distribution. A deterministic and a probabilistic risk assessment were conducted to evaluate two scenarios: (1) unrestricted use of piped water for all household purposes, including as drinking water and (2) restricted use of the water for purposes other than drinking in the household, including only dermal and inhalation exposure pathways. The water was deemed unsafe for unrestricted use as the sole source of drinking water by both risk assessment methods. Yet when an alternative source of drinking water was assumed and the piped water was used only for bathing and dish washing, the probabilistic risk assessment revealed acceptable health risks to the population, while the overly conservative deterministic risk assessment suggested unacceptable risks. The combined methods of water sampling, risk assessment and correlation analysis suggested areas for rehabilitation of the water distribution system in Hyderabad, Pakistan and these methods can be adopted in other developing nations to target limited funds for infrastructure rehabilitation.

3.
Philos Trans A Math Phys Eng Sci ; 378(2167): 20190440, 2020 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-32008447

RESUMEN

Fresh water sustains human life and is vital for human health. It is estimated that about 800 million people worldwide lack basic access to drinking water. About 2.2 billion people (nearly one-third of the global population) do not have access to a safe water supply, free of contamination. Also, over 2 billion people live in countries experiencing high water stress. Current supply of fresh water needs to be supplemented to meet future needs. Living nature has evolved species which can survive in the most arid regions of the world by water collection from fog and condensation in the night. Before the collected water evaporates, species have mechanisms to transport water for storage or consumption. These species possess unique chemistry and structures on or within the body for collection and transport of water. In this paper, an overview of arid desert conditions, water sources and plants and animals, lessons from nature for water harvesting, and water harvesting data from fog and condensation are presented. Consumer, emergency and defence applications are discussed and various designs of water harvesting towers and projections for water collection are presented. This article is part of the theme issue 'Bioinspired materials and surfaces for green science and technology (part 3)'.

4.
J Environ Manage ; 258: 110039, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-31929073

RESUMEN

Water scarcity is a global issue that is threatening social and economic development. One approach to alleviating scarcity is the incorporation of new water sources into supply systems, including desalinated seawater for industrial and municipal use. In Chile, large volumes of water are used in water-scarce regions where mining takes place, alongside agriculture and small communities. This situation has driven a debate around policies to increase the use of seawater to satisfy the water demand of the mining industry. The economic, social and environmental implications of such a policy, however, are poorly understood and the current regulatory framework to address concerns and uncertainties is inadequate. This paper presents a technical, legal, economic and environmental appraisal of such a policy and considers options to improve outcomes. The appraisal suggests that clear regulations derived from economic, social and environmental analysis must be generated to provide legal certainty and reduce risks. Alternative or complementary water supply options should be allowed where mining operations can demonstrate negligible hydrological and social impacts or use innovative solutions such as stakeholder water rights swaps and water efficiency technologies. We provide insight that will help to drive a better policymaking process aimed at tackling water scarcity in Chile and in similar areas of the world.


Asunto(s)
Purificación del Agua , Agua , Chile , Política Pública , Abastecimiento de Agua
5.
J Environ Manage ; 258: 110040, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-31929074

RESUMEN

Measures to protect irrigation water supplies for food security continue to receive international attention to address growing water scarcity when faced by increased food demands combined with reduced water supply reliability. Yet, a common problem where water is delivered with earthen canals is delivery inefficiency combined with low economic values per unit of water. In many of the world's arid regions, climate stressed water shortages have raised the importance of discovering measures to improve irrigation delivery efficiency. However, little research grade work to date has presented an integrated analysis of the economic performance of irrigation delivery improvements faced by drought and climate stressed regions. This paper's unique contribution is to investigate the economic performance of water conservation infrastructure combined with dynamically optimized use of saved water. We develop a state-of-the arts empirical dynamic optimization model to discover land and water use patterns that optimize sustained farm income. Results from the upper watershed irrigation region of the Canadian Basin in the southwestern US show that canal and delivery system lining can raise the sustained economic value of water for crop irrigation. The saved water can see immediate use in dry years. It can also be stored in wet years to mitigate the most adverse impacts of future climate water stress. This double dividend is especially important in rain-fed watersheds for which surface water supplies for irrigation are difficult to forecast accurately. Findings light a path for water managers and other stakeholders who bear responsibility of finding economically responsible measures to improve irrigation water productivity in the world's dry regions.


Asunto(s)
Conservación de los Recursos Hídricos , Riego Agrícola , Canadá , Conservación de los Recursos Naturales , Ambiente , Reproducibilidad de los Resultados , Abastecimiento de Agua
6.
J Sch Health ; 2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31994194

RESUMEN

BACKGROUND: Federal law requires water access in schools where meals are served. Schools report high rates of water accessibility in cafeterias, but observations indicate lower adherence. Although observation is costly, it permits a more detailed assessment of a water source to determine whether it provides effective access that encourages water consumption and thus, healthy hydration for students. METHODS: To offer a less costly alternative to observations, researchers developed and validated a photo-evidence tool to examine characteristics of effective school drinking water access. Two observers recorded characteristics of 200 water sources in 30 schools, including type, wear, cleanliness, and water flow, and examined obstructions and beverage promotion near sources, as well as, drinking vessel availability. Observers photographed sources which were coded by a separate research team. Agreement between observation audits and photograph coding was assessed through percent agreement, and kappa statistics and correlation coefficients. RESULTS: Kappas indicated substantial (K > 0.60) or near perfect agreement (K > 0.80) for all characteristics of effective drinking water access with exception of wear. There was moderate agreement (r = 0.66) for water source cleanliness. CONCLUSIONS: Development and validation of a photo-evidence tool to examine characteristics of effective drinking water access in schools.

7.
Matern Child Nutr ; : e12929, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-31999395

RESUMEN

Dietary diversity is a crucial pathway to child nutrition; lack of diversity may deprive children of critical macro and micronutrients. Though water along with hygiene and sanitation is a known driver of child undernutrition, a more direct role of household water in shaping dietary diversity remains unexplored. Existing literature provides a sound theoretical basis to expect that water could affect dietary diversity among young children. Here, we test the proposition that suboptimal household access to water and low regional water availability associate with lower dietary diversity among young children. Using the nationally representative 2015-2016 India Demographic and Health Survey data, we conducted a probit analysis on the sample of 69,841 children aged 6-23 months to predict the probability that a child achieves minimum standards of dietary diversity (MDD). After controlling for relevant socioeconomic and gender-related covariates, we found that children in household with suboptimal household water access were two percentage points less likely to achieve MDD, when compared with those from households with optimal water access. Children in high water availability regions had nine percentage points greater probability of achieving MDD compared with children from low water availability regions, accounting for household water access. As dietary diversity is central to nutrition, establishing the role of water access in shaping early childhood dietary diversity broadens the framework on how household material poverty shapes child malnutrition-independent of sanitation and hygiene pathways. This provides additional window for nutrition planning and intervention wherein water-based strategies can be leveraged in multiple ways.

8.
ACS Appl Mater Interfaces ; 12(1): 1665-1676, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31820919

RESUMEN

Water is the basis of life in the world. Unfortunately, resources are shrinking at an alarming rate. The lack of access to water is still the biggest problem in the modern world. The key to solving it is to find new unconventional ways to obtain water from alternative sources. Fog collectors are becoming an increasingly important way of water harvesting as there are places in the world where fog is the only source of water. Our aim is to apply electrospun fiber technology, due to its high surface area, to increase fog collection efficiency. Therefore, composites consisting of hydrophobic and hydrophilic fibers were successfully fabricated using a two-nozzle electrospinning setup. This design enables the realization of optimal meshes for harvesting water from fog. In our studies we focused on combining hydrophobic polystyrene (PS) and hydrophilic polyamide 6 (PA6), surface properties in the produced meshes, without any chemical modifications, on the basis of new hierarchical composites for collecting water. This combination of hydrophobic and hydrophilic materials causes water to condense on the hydrophobic microfibers and to run down on the hydrophilic nanofibers. By adjusting the fraction of PA6 nanofibers, we were able to tune the mechanical properties of PS meshes and importantly increase the efficiency in collecting water. We combined a few characterization methods together with novel image processing protocols for the analysis of fiber fractions in the constructed meshes. The obtained results show a new single-step method to produce meshes with enhanced mechanical properties and water collecting abilities that can be applied in existing fog water collectors. This is a new promising design for fog collectors with nano- and macrofibers which are able to efficiently harvest water, showing great application in comparison to commercially available standard meshes.

9.
Soc Sci Med ; 245: 112561, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31790879

RESUMEN

BACKGROUND: Lack of access to clean water has well known implications for communicable disease risks, but the broader construct of water insecurity is little studied, and its mental health impacts are even less well understood. METHODS AND FINDINGS: We conducted a mixed-methods, whole-population study in rural Uganda to estimate the association between water insecurity and depression symptom severity, and to identify the mechanisms underlying the observed association. The whole-population sample included 1776 adults (response rate, 91.5%). Depression symptom severity was measured using a modified 15-item Hopkins Symptom Checklist for Depression. Water insecurity was measured with a locally validated 8-item Household Water Insecurity Access Scale. We fitted multivariable linear and Poisson regression models to the data to estimate the association between water insecurity and depression symptom severity, adjusting for age, marital status, self-reported overall health, household asset wealth, and educational attainment. These models showed that water insecurity was associated with depression symptom severity (b = 0.009; 95% confidence interval [CI], 0.004-0.15) and that the estimated association was larger among men (b = 0.012; 95% CI, 0.008-0.015) than among women (b = 0.008; 95% CI, 0.004-0.012. We conducted qualitative interviews with a sub-group of 30 participants, focusing on women given their traditional role in household water procurement in the Ugandan context. Qualitative analysis, following an inductive approach, showed that water insecurity led to "choice-less-ness" and undesirable social outcomes, which in turn led to emotional distress. These pathways were amplified by gender-unequal norms. CONCLUSIONS: Among men and women in rural Uganda, the association between water insecurity and depression symptom severity is statistically significant, substantive in magnitude, and robust to potential confounding. Data from the qualitative interviews provide key narratives that reveal the mechanisms through which women's lived experiences with water insecurity may lead to emotional distress.

10.
Am J Hum Biol ; 32(1): e23358, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31746081

RESUMEN

OBJECTIVES: The Galápagos provides an important setting to investigate the health impacts of a new drinking water treatment plant (DWTP) in a limited resource environment. We examine how household perceptions and practices affect the relationship between water quality and infections before and after DWTP. METHODS: Ethnographic data and self-reported infections were collected from 121 mothers and 168 children ages 2 to 10 from Isla San Cristóbal. Household tap water samples were tested for levels of fecal contamination. Community level infection rates were estimated using discharge records from the Ministry of Public Health. The effects of the new DWTP and fecal contamination levels on infections were tested using logistic and Poisson models. RESULTS: Perceptions of water quality and household practices influenced exposures to contaminated tap water. We found minimal change in drinking water sources with 85% of mothers sampled before the DWTP and 83% sampled after using bottled water, while >85% from the pooled sample used tap water for cooking and hygiene practices. The DWTP opening was associated with lower odds of fecal contamination in tap water, reported urinary infections, and community level rates of urinary and gastrointestinal infections. The household practice of recently washing the cistern contributed to higher contamination levels after the DWTP opened. CONCLUSIONS: To ensure access to clean water, public health works need to consider how household perceptions and practices influence tap water use and quality, in addition to infrastructure improvements. Exposures to contaminated tap water contribute to the burden of infectious disease in environments with inadequate water infrastructure.

11.
Sci Total Environ ; 698: 134185, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31505354

RESUMEN

Drinking water quality has been regulated in most European countries for nearly two decades by the drinking water directive 98/83/EC. The directive is now under revision with the goal of meeting stricter demands for safe water for all citizens, as safe water has been recognized as a human right by the United Nations. An important change to the directive is the implementation of a risk-based approach in all regulated water supplies. The European Union Framework Seventh Programme Aquavalens project has developed several new detection technologies for pathogens and indicators and tested them in water supplies in seven European countries. One of the tasks of the project was to evaluate the impact of these new techniques on water safety and on water safety management. Data were collected on risk factors to water safety for five large supplies in Denmark, Germany, Spain and the UK, and for fifteen small water supplies in Scotland, Portugal and Serbia, via a questionnaire aiming to ascertain risk factors and the stage of implementation of Water Safety Plans, and via site-specific surveys known as Sanitary Site Inspection. Samples were collected from the water supplies from all stages of water production to delivery. Pathogens were detected in around 23% of the 470 samples tested. Fecal contamination was high in raw water and even in treated water at the small supplies. Old infrastructure was considered a challenge at all the water supplies. The results showed that some of the technique, if implemented as part of the water safety management, can detect rapidly the most common waterborne pathogens and fecal pollution indicators and therefore have a great early warning potential; can improve water safety for the consumer; can validate whether mitigation methods are working as intended; and can confirm the quality of the water at source and at the tap.

12.
Asia Pac J Clin Nutr ; 28(4): 665-674, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31826362

RESUMEN

Water is essential for life survival and development. It plays a pivotal role in metabolic function, modulates normal osmotic pressure, maintains the electrolyte balance, and regulates body temperature. Adequate water intake is necessary for optimal hydration-both excessive and insufficient water consumption can have adverse effects on health. Water requirements among people vary based on various factors such as gender, age, physical activity, dietary factors, ambient temperature, and renal concentrating capacity. In recent years, water intake guidelines have been developed in some countries and by some organisations. Even in China, it is important to develop such guidelines considering specific dietary habits, height of people, and environmental factors. In 2013, guidelines for adequate water intake were developed in China, but the scope was somewhat limited; there are still specific challenges in formulating such recommendations. Future water-related studies should focus on surveying water intake among infants and toddlers, older adults, and pregnant and lactating women. Moreover, additional studies should be conducted to elucidate water intake among adults and adolescents in different regions and seasons, and the association between water intake and related diseases should also be investigated. It is imperative to transform the results of scientific research into action plans for water-related health education so as to inform and evaluate pertinent public health programmes.

13.
Am J Trop Med Hyg ; 2019 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-31837131

RESUMEN

Household water treatment including solar disinfection (SODIS) is recognized worldwide as an important intervention for prevention and control of diarrheal and other waterborne diseases. However, in Ethiopia's countryside, SODIS is not being practiced. Therefore, the objective of this qualitative study conducted in villages of Dabat district in northwest Ethiopia was to explore barriers to and enabling factors for consistent and wider implementation of SODIS. This phenomenological study design included four focus group discussions with 25 parents of children younger than 5 years and interviews with four key informants to elicit their experiences and opinions. ATLAS.ti 8.0 software (GmbH, Berlin, Germany) was used for data organization, and the content was analyzed thematically. Enabling factors were categorized into four themes, such as supportive values for SODIS (positive attitude, advantage of SODIS, and cultural acceptance of SODIS), consistent use of SODIS (community's interest, health education, availability of bright sunlight, and simplicity of the method), participation of family and community in daily implementation of the SODIS process (controlling theft of bottles and recognizing the importance of SODIS technology), and willingness to pay for new PET bottles. On the other hand, barriers were grouped into three themes such as sociocultural (poor knowledge, hesitation to leave SODIS bottles unguarded outdoor, less attention, and unplanned social events), environmental (cloud, shadow over SODIS bottles, turbidity and leeches in source water, and geographical settings), and behavioral (mishandling of SODIS bottles and drinking water). The analysis of the data revealed that all the participants had positive attitude toward the implementation of SODIS, and it was culturally accepted. They identified the barriers to and enabling factors for the implementation of SODIS. Promoting enabling factors and mitigating barriers are substantially important for consistent implementation of SODIS as a long-term interventional measure widely in rural Ethiopia for the achievement of the goal of safe drinking water for all.

14.
Aust Health Rev ; 2019 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-31751211

RESUMEN

ObjectiveThe aim of this study was to identify the challenges anticipated by clinical staff in two Melbourne health services in relation to the legalisation of voluntary assisted dying in Victoria, Australia.MethodsA qualitative approach was used to investigate perceived challenges for clinicians. Data were collected after the law had passed but before the start date for voluntary assisted dying in Victoria. This work is part of a larger mixed-methods anonymous online survey about Victorian clinicians' views on voluntary assisted dying. Five open-ended questions were included in order to gather text data from a large number of clinicians in diverse roles. Participants included medical, nursing and allied health staff from two services, one a metropolitan tertiary referral health service (Service 1) and the other a major metropolitan health service (Service 2). The data were analysed thematically using qualitative description.ResultsIn all, 1086 staff provided responses to one or more qualitative questions: 774 from Service 1 and 312 from Service 2. Clinicians anticipated a range of challenges, which included burdens for staff, such as emotional toll, workload and increased conflict with colleagues, patients and families. Challenges regarding organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and how voluntary assisted dying would fit within the hospital's overall work were also raised.ConclusionsThe legalisation of voluntary assisted dying is anticipated to create a range of challenges for all types of clinicians in the hospital setting. Clinicians identified challenges both at the individual and system levels.What is known about the topic?Voluntary assisted dying became legal in Victoria on 19 June 2019 under the Voluntary Assisted Dying Act 2017. However there has been little Victorian data to inform implementation.What does this paper add?Victorian hospital clinicians anticipate challenges at the individual and system levels, and across all clinical disciplines. These challenges include increased conflict, emotional burden and workload. Clinicians report concerns about organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and effects on hospitals' overall work.What are the implications for practitioners?Careful attention to the breadth of staff affected, alongside appropriate resourcing, will be needed to support clinicians in the context of this legislative change.

15.
Pan Afr Med J ; 33: 244, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692810

RESUMEN

Introduction: Access to drinking water and sanitation has been a long-standing issue between many States. However, it represents a daily struggle for hundreds of thousands of city dwellers who live mainly in the developing countries. The government of Cameroon with the assistance of providers of funds have implemented strategies to make sanitation and access to safe drinking water a reality. We have therefore decided to assess sanitation and access to drinking water in Douala V sub division. Method: We conducted a cross-sectional descriptive study from May to June 2018. We used a two-stage random sampling. Data were collected using a questionnaire. The analysis was conducted using Epi Info Version 7.1.3.3. Results: Our study shows that 22.47% of subjects discharged waters into the natural environment after use. Then, 65,55% (493/752) of households consumed borehole water; 53.69% of households rode between 1 to 5 km, 49.25% walked more than 15 minutes to collect water and 85,50% of households did not use a water treatment method. Only 14.49% of subjects used a water treatment method. No household used solar water disinfection (SODIS); 2/752 households (0.26%) had no latrine. Most of the households (54.52%; 410/752) discharged domestic wastes onto the street. Conclusion: The creation of decentralized units: the drillings, waste disposal systems and water treatment education to meet basic needs are essential.


Asunto(s)
Agua Potable/normas , Saneamiento/normas , Abastecimiento de Agua/normas , Camerún , Estudios Transversales , Países en Desarrollo , Desinfección/métodos , Composición Familiar , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Cuartos de Baño/estadística & datos numéricos
16.
Artículo en Inglés | MEDLINE | ID: mdl-31614511

RESUMEN

Residents in the Eastern Region, Ghana with access to improved water sources (e.g., boreholes and covered wells) often choose to collect water from unimproved sources (e.g., rivers and uncovered wells). To assess why, we conducted two field studies to coincide with Ghana's rainy and dry seasons. During the rainy season, we conducted semi-structured in-depth interviews among a convenience sample of 26 women in four rural communities (including one woman in the dry season). We asked each participant about their attitudes and perceptions of water sources. During the dry season, we observed four women for ≤4 days each to provide context for water collection and water source choice. We used a grounded theory approach considering the multiple household water sources and uses approach to identify three themes informing water source choice: collection of and access to water, water quality perception, and the dynamic interaction of these. Women selected water sources based on multiple factors, including season, accessibility, religious/spiritual messaging, community messaging (e.g., health risks), and ease-of-use (e.g., physical burden). Gender and power dynamics created structural barriers that affected the use of unimproved water sources. A larger role for women in water management and supply decision-making could advance population health goals.

17.
Parasit Vectors ; 12(1): 491, 2019 Oct 18.
Artículo en Inglés | MEDLINE | ID: mdl-31627736

RESUMEN

BACKGROUND: Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis. METHODS: The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires. RESULTS: There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95% CI: 0.72-1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95% CI: 1.04-1.75), living in a household with more than six people (aOR: 1.32, 95% CI: 1.02-1.72), and sampling during the rainy season (aOR: 1.23, 95% CI: 1.04-1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95% CI: 0.57-0.88). CONCLUSIONS: Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12614000680662. Registered 27 June 2014, retrospectively registered. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366540 .

18.
Artículo en Inglés | MEDLINE | ID: mdl-31600942

RESUMEN

Stunting is a global burden affecting nearly 160 million children younger than five years of age. Whilst the linkages between nutrition and stunting are well recognized, there is a need to explore environmental factors such as water and sanitation, which may influence feeding practices and result in potential infection pathways. This paper explores the linkages between stunting and water, sanitation and hygiene (WASH) factors in Ethiopia, which is a relatively understudied context. The research draws upon baseline data for children under the age of five from 3200 households across four regions in Ethiopia as part of a wider study and integrated program led by the United Nations Children's Fund (UNICEF). Using World Health Organization (WHO) z-scoring, the average stunting rate in the sample is 47.5%. This paper also takes into account demographic and social behavioural factors such as the age, gender of children, and gender of the primary caregiver, in addition to handwashing behaviour and drinking water facilities. The evidence recommends efforts to improve handwashing behaviour for mothers and children with a focus on access to clean water. Higher stunting rates with an increase in the age of children highlight the need for continued interventions, as efforts to improve nutrition and WASH behaviours are most effective early on in promoting long-term health outcomes for children.

19.
PLoS One ; 14(10): e0223557, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31603926

RESUMEN

BACKGROUND: The critical importance of safe and affordable access to water, sanitation and hygiene (WASH) is highlighted in Goal 6 of the Sustainable Development Goals, which seeks to achieve universal and equitable access for all by 2030. However, people with disabilities-who comprise 15% of the global population-frequently face difficulties meeting their WASH needs. Unmet WASH needs amongst people with disabilities may not be captured through current approaches to tracking progress towards Goal 6, which focus on household- rather than individual-level access. OBJECTIVE: To evaluate access to safe water, sanitation and hygiene (WASH), at the individual- and household-level, amongst people with disabilities in the Tanahun district of Nepal. METHODS: A population-based survey of disability was conducted from August-October 2016 to evaluate access to improved water and sanitation facilities between households with members with disabilities (n = 198) and those without (n = 1,265) in the Tanahun district of Nepal. A nested case-control then compared individual-level access between cases aged 15 and above with disabilities (n = 192) and age-sex-location matched controls without disabilities (n = 189), using the newly developed 21-item "Quality of WASH Access" questionnaire. Multivariate regression was used to compare household- and individual-level indicators between people and households with and without disabilities. In-depth interviews with 18 people with disabilities and their caregivers was conducted to assess the acceptability and appropriateness of the "Quality of WASH Access" questionnaire. FINDINGS: There were no significant differences between households with and without members with disabilities in access to an improved sanitation facility or water source. However, at the individual-level, people with disabilities experienced significantly greater difficulties accessing water, sanitation and hygiene compared to people without disabilities (p<0.001 for all three scores). Amongst people with disabilities, water difficulty scores were associated with having a physical impairment and greater disability severity; sanitation difficulty scores were associated with lower socioeconomic status and physical or self-care limitations; and hygiene difficulty scores were positively associated with self-care limitations and lower socioeconomic status, and inversely associated with hearing impairments. Qualitative research found the "Quality of WASH Access" questionnaire was well understood by participants and captured many of the challenges they faced. Additional challenges not covered by the tool included: (1) time spent on WASH, (2) consistency of access, (3) sufficiency of access, and (4) dignity of access. CONCLUSION: People with disabilities face substantial challenges to meeting their WASH needs, particularly in using services autonomously, consistently, hygienically, with dignity and privacy, and without pain or fear of abuse. These challenges are not captured through household-level data, and so individual-level WASH access are needed to monitor progress towards universal WASH access. The Quality of WASH Access questionnaire may provide a useful data collection tool.

20.
Midwifery ; 79: 102541, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31581000

RESUMEN

OBJECTIVE: The objective of this study was to explore the views, experiences, perceptions of and access to water immersion for labor and birth in Australia. DESIGN: A sequential exploratory mixed methods study commenced in 2016. The first phase involved an online survey. The second phase is due to commence in 2019 and will involve focus groups and interviews. This paper presents a subset of results from phase one that asked women to self-rate the benefits and risks associated with water use on Likert-scales and for those who had a previous birth not involving water, how the two experiences compared. PARTICIPANTS: A total of 740 Australian women who had used water immersion for labor and/or birth rated the benefits against 7-point Likert scales and 736 responded to 5-point Likert scales relating to commonly cited concerns surrounding the option. RESULTS: Women highly rated water immersion against all benefits. Benefits that were most highly rated (by numbers of 'entirely agree' on 7-point Likert scales) included sense of safety (80.14%), an alert baby (75.00%), a positive birth experience (72.70%), water as soothing (72.03%) and freedom of movement (71.35%). Women were most concerned (by selecting 'somewhat' to 'extremely concerned' on 5-point Likert scales) about being told to get out of the water when they did not want to (n = 120/736, 16.30%), their contractions going away (n = 76/736, 10.33%) and unsupportive staff (n = 65/736, 8.83%). More than 90% (n = 682/740) of women mostly to entirely agreed that they would recommend water immersion to others. Women rated water immersion as more comfortable, more satisfying and more relaxing when compared to previous births that they had that did not involve water. KEY CONCLUSIONS: Women value water immersion for labor and birth. They have very little to no concern for the most common adverse events as documented in the literature. IMPLICATIONS FOR PRACTICE: The results add to the growing evidence base surrounding water immersion for labor and birth. Whilst there remains ongoing debate about the safety of water immersion, women's experiences should be considered alongside outcome data. The results of this study may assist policy makers and clinicians in their advocacy and support of women who choose water immersion. ETHICAL CONSIDERATIONS: The Human Research Ethics Committee of the University of South Australia approved the research.

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