Costs and cost-effectiveness of three point-of-use water treatment technologies added to community-based treatment of severe acute malnutrition in Sindh Province, Pakistan.

BACKGROUND: Severe acute malnutrition (SAM) is a major global public health concern. Despite the cost-effectiveness of treatment, ministries of health are often unable to commit the required funds which limits service coverage. OBJECTIVE: A randomised controlled trial was conducted in Sindh Province, Pakistan, to assess whether adding a point of use water treatment to the treatment of SAM without complications improved its cost-effectiveness. Three treatment strategies - chlorine disinfection (Aquatabs); flocculent disinfection (Procter and Gamble Purifier of Water [P&G PoW]) and Ceramic Filters - were compared to a standard SAM treatment protocol. METHODS: An institutional perspective was adopted for costing, considering the direct and indirect costs incurred by the provider. Combining the cost of SAM treatment and water treatment, an average cost per child was calculated for the combined interventions for each arm. The costs of water treatment alone and the incremental cost-effectiveness of each water treatment intervention were also assessed. RESULTS: The incremental cost-effectiveness ratio for Aquatabs was 24 US dollars (USD), making it the most cost-effective strategy. The P&G PoW arm was the next least expensive strategy, costing an additional 149 USD per additional child recovered, though it was also the least effective of the three intervention strategies. The Ceramic Filters intervention was the most costly strategy and achieved a recovery rate lower than the Aquatabs arm and marginally higher than the P&G PoW arm. CONCLUSIONS: This study found that the addition of a chlorine or flocculent disinfection point-of-use drinking water treatment intervention to the treatment of SAM without complications reduced the cost per child recovered compared to standard SAM treatment. To inform the feasibility of future implementation, further research is required to understand the costs of government implementation and the associated costs to the community and beneficiary household of receiving such an intervention in comparison with the existing SAM treatment protocol.

Point-of-use water treatment improves recovery rates among children with severe acute malnutrition in Pakistan: results from a site-randomized trial.

OBJECTIVE: To evaluate effectiveness of point-of-use water treatment in improving treatment of children affected by severe acute malnutrition (SAM). DESIGN: Programme sites were randomized to one of four intervention arms: (i) standard SAM treatment; (ii) SAM treatment plus flocculent/disinfectant water treatment; (iii) SAM treatment plus chlorine disinfectant; or (iv) SAM treatment plus ceramic water filter. Outcome measures were calculated based on participant status upon exit or after 120d of enrolment, whichever came first. Child anthropometric data were collected during weekly monitoring at programme sites. Child caregivers were interviewed at enrolment and exit. Use of water treatment products was assessed in a home visit 4-6 weeks after enrolment. SETTING: Dadu District, Sindh Province, Pakistan. SUBJECTS: Children (n 901) aged 6-59 months with SAM and no medical complications. RESULTS: Recovery rates were 16·7-22·2 % higher among children receiving water treatment compared with the control group. The adjusted odds of recovery were approximately twice as high for those receiving water treatment compared with controls. Mean length of stay until recovery was 73 (sd 24·6) d and mean rate of weight gain was 4·7 (sd 3·0) g/kg per d. Differences in recovery rate, length of stay and rate of weight gain between intervention groups were not statistically significant. CONCLUSIONS: Incorporating point-of-use water treatment into outpatient treatment programmes for children with SAM increased nutritional recovery rates. No significant differences in recovery rates were observed between the different intervention groups, indicating that different water treatment approaches were equally effective in improving recovery.

Prevention-intervention strategies to reduce exposure to e-waste.

As one of the largest waste streams, electronic waste (e-waste) production continues to grow in response to global demand for consumer electronics. This waste is often shipped to developing countries where it is disassembled and recycled. In many cases, e-waste recycling activities are conducted in informal settings with very few controls or protections in place for workers. These activities involve exposure to hazardous substances such as cadmium, lead, and brominated flame retardants and are frequently performed by women and children. Although recycling practices and exposures vary by scale and geographic region, we present case studies of e-waste recycling scenarios and intervention approaches to reduce or prevent exposures to the hazardous substances in e-waste that may be broadly applicable to diverse situations. Drawing on parallels identified in these cases, we discuss the future prevention and intervention strategies that recognize the difficult economic realities of informal e-waste recycling.

Community-based efforts in health promotion in indigenous villages on the Thailand-Myanmar border.

This case study of mainly Karen and Mon communities in Kanchanaburi Province, western Thailand, offers insight into the challenges that these rural villages face with regard to food security and environmental health issues. As non-Thai communities, these villages receive little support from the Thai government, and are often vulnerable in terms of access to food markets, infrastructure, and education and livelihood opportunities. This discussion further considers the involvement of Pattanarak Foundation, a Thai NGO, in health promotion and economic development in these villages as an example of a community partnership at the grassroots level. Examining Pattanarak's efforts to build skills in household vegetable gardening and livestock-raising, raise awareness about child nutrition issues, and improve community sanitation illustrates the value of a participatory process, and also demonstrates some of the challenges associated with on-the-ground health promotion in disadvantaged rural communities. Applying a community-based participatory research (CBPR) framework to pursue partnerships between communities, NGOs, and researchers may offer an avenue for effective interventions to improve health in marginalized communities.

Comparison of exit site infection and peritonitis incidences between povidone-iodine and normal saline use for chronic exit site care in peritoneal dialysis patients

BACKGROUND: Catheter-related exit site infection is a major risk factor for the development of peritonitis and can contribute to failure of treatment maintenance in peritoneal dialysis (PD) patients. Although povidone-iodine can be used for exit site care, the irritation induced by the local application of povidone-iodine could lead to secondary infection. Therefore, we evaluated the clinical effectiveness of normal saline compared with povidone-iodine as a method of exit site care in chronic PD patients. METHODS: In all, 126 patients undergoing PD treatment for>46 months between January 2006 and December 2009 were enrolled. Data were retrospectively analyzed for the incidence of exit site infection and peritonitis for 2 years prior to and after December 2007. In addition, we identified the incidences of catheter- related infections during follow-ups from January 2010 to December 2013. RESULTS: The participants' mean age was 58.87+/-12.9 years. The incidences of exit site infection and peritonitis were one episode per 64.6 patients-months and one episode per 40.4 patients-months in the povidone-iodine group, respectively, whereas these were one episode per 57.5 patients-months and one episode per 45.6 patients-months in the normal saline group, respectively. Whereas Gram-positive bacteria most frequently caused catheter-related infections in both groups, culture-negative infections were dominant in the normal saline group. CONCLUSION: Exit site care using normal saline did not increase the incidence of exit site infection and peritonitis. Therefore, normal saline may be an alternative treatment for exit site care in patients receiving PD.

Effects of low-dose niacin on dyslipidemia and serum phosphorus in patients with chronic kidney disease

BACKGROUND: Niacin supplementation improves dyslipidemia and lowers serum phosphorus levels in patients with chronic kidney disease (CKD). We evaluated whether low-dose niacin supplementation can improve dyslipidemia, lower serum phosphorus levels, and be administered with a low frequency of adverse effects in patients with CKD. METHODS: We retrospectively analyzed the clinical records of patients with CKD who had taken niacin from January 2009 to June 2011. We excluded patients with CKD stage 1 and 5. We then enrolled 31 patients with CKD who had taken niacin at a fixed dose of 500mg/day for 6 months. We also randomly selected 30 patients with CKD who had been taking statin for 9 months as a control group. RESULTS: Among the 34 patients with CKD who were prescribed niacin, five (14%) complained of adverse effects, and three (8%) discontinued niacin. The proportion of patients in the niacin group who had been taking a statin or omega-3 fatty acids was 67.7% and 48.8%, respectively. In the niacin group, high-density lipoprotein cholesterol level was significantly increased and triglyceride level was significantly decreased at 12 and 24 weeks compared with baseline levels (P < 0.05). In the niacin group, phosphorous level (P < 0.05) was significantly decreased, and glomerular filtration rate (GFR) was significantly increased (P < 0.05) at 24 weeks compared with baseline values. CONCLUSION: Low-dose niacin had a low frequency of adverse effects and also improved dyslipidemia, lowered serum phosphorus level, and increased GFR in patients with CKD. Further studies are needed to evaluate the long-term effects of low-dose niacin for renal progression of CKD.

Effects of low-dose niacin on dyslipidemia and serum phosphorus in patients with chronic kidney disease

BACKGROUND: Niacin supplementation improves dyslipidemia and lowers serum phosphorus levels in patients with chronic kidney disease (CKD). We evaluated whether low-dose niacin supplementation can improve dyslipidemia, lower serum phosphorus levels, and be administered with a low frequency of adverse effects in patients with CKD. METHODS: We retrospectively analyzed the clinical records of patients with CKD who had taken niacin from January 2009 to June 2011. We excluded patients with CKD stage 1 and 5. We then enrolled 31 patients with CKD who had taken niacin at a fixed dose of 500mg/day for 6 months. We also randomly selected 30 patients with CKD who had been taking statin for 9 months as a control group. RESULTS: Among the 34 patients with CKD who were prescribed niacin, five (14%) complained of adverse effects, and three (8%) discontinued niacin. The proportion of patients in the niacin group who had been taking a statin or omega-3 fatty acids was 67.7% and 48.8%, respectively. In the niacin group, high-density lipoprotein cholesterol level was significantly increased and triglyceride level was significantly decreased at 12 and 24 weeks compared with baseline levels (P < 0.05). In the niacin group, phosphorous level (P < 0.05) was significantly decreased, and glomerular filtration rate (GFR) was significantly increased (P < 0.05) at 24 weeks compared with baseline values. CONCLUSION: Low-dose niacin had a low frequency of adverse effects and also improved dyslipidemia, lowered serum phosphorus level, and increased GFR in patients with CKD. Further studies are needed to evaluate the long-term effects of low-dose niacin for renal progression of CKD.

Blood Pressure Difference between Right and Left Arms of Some College Freshmen

BACKGROUND: Hypertension is a main cause of heart blood vessel disease. To diagnose and treat hypertension, it is necessary to measure blood pressure accurately. There are various factors that influence blood pressure. According to real clinical demonstrators and some recent studies, blood pressure differences between right and left arms are often observed. This study was intended to know whether the differences are really found and wheather the correlation exists between mid-arm circumferences and the blood pressure differences according to right-handed or left-handed which were considered as an important factor in affecting blood pressures. METHODS: One hundred sixty nine college freshmen of year 2001 were chosen. Among them, 103 were right- handed and 66 left-handed. Which arms to be checked first were determined randomly. This sequence was repeated two times on each person. Their mid-arm circumferences were measured, also. RESULTS: For right-handed persons, systolic blood pressure in right arm (119.2+/-12.3 mmHg) was significantly higher than in left arm (118.0+/-12.0 mmHg) (P<0.005). But diastolic blood pressure differences between right arm (75.3+/-10.0 mmHg) and left arm (75.0+/-9.5 mmHg) was not significant statistically. For left-handed persons, systolic blood pressure was 120.3+/-9.9 mmHg in right arm and 120.0+/-10.3 mmHg in left arm. However, diastolic blood pressure in right arm (76.7 9.4 mmHg) was significantly higher than in left arm (75.0+/-8.6 mmHg) (P<0.005). For right handed persons, their arm circumferences (26.2+/-2.8 cm) were significantly thicker than left ones (25.9+/-2.9 cm). For left-handed, left arm circumference (25.9+/-2.7 cm) was significantly thicker than right one (25.5+/-2.6 cm). As for the blood pressure difference in arm tested order, the first measured systolic blood pressure (right arm; 120.9+/-11.7 mmHg, left arm; 120.0+/-11.9 mmHg) was significantly higher than the second measured one (right arm; 118.3+/-11.8 mmHg, left arm; 117.8+/-11.6 mmHg) (P<0.005). However, the first measured diastolic blood pressure (right arm; 76.3+/-10.5 mmHg, left arm; 75.5+/-9.4 mmHg) did not have more significance than the second measured one (right arm; 75.4+/-9.9 mmHg, left arm; 74.6+/-10.8 mmHg). CONCLUSION: The right-handed person's blood pressure was higher in the right arm, but for the left-handed persons it was not significantly different in both arms. The second measurement of blood pressure was lower than the first measurement in both arms. The arm circumference depending on the right/left-handedness influenced the blood pressure, but clear correlation between them was not observed. Therefore, if possible, when the blood pressure is measured, it is advised to check blood pressure in both arms before diagnosing hypertension.

Intravascular Ultrasound Assessment of the Coronary Intervention

BACKGROUND: Coronary arterigraphy has been used as a tool to assess the degree of coronary artery narrowing and the result of balloon angioplasty, which frequently underestimates the degree of atherosclerosis. Intravascular ultrasound(IVUS) can give more delicate information about plaque morphology and the result of coronary intervention. We compared qualitaive and quantitative measurement between IVUS and coronary angiography after coronary intervention. METHODS: We used 30 or 20 MHz intravascular ultrasound catheter which was connected to Hewlett Packard Sonos 1500 Intravasscular equiment in 5 coronary balloon angiopasty and 3 Palmaz-Schatz stent implantation cases. Sites of intervention were at the left anterior descending coronary artery in 7 patients and at the left circumflex artery in one patient. Quantitative coronary angiography(QCA) was done by CAAS II system. We measured referenc diameter(RD), minimal lumen diamter(MLD), Lumen and vessel cross sectional areas(LCSA,VCSA) obstraction area(OA) and plaque area(PA) and also analysed plaque morphology. RESULTS: 1) IVUS is more sensitive in the detection of eccentricity, Calcification and dissection. 2) Before intervention, the mean reference diameter was 2.87+/-0.42mm,3.07+/-0.39mm,% diameter stenosis was 52.4+/-11.6%,65.3+/-9.22% and MLD was 1.32+/-0.24mm, 1.07+/-0.23mm in IVUS and QCA, respectively, which were no statistical significance between these parameters(p>0.05). After intervention, MLD and OA increased significantly(p0.05). Plaque area measured by IVUS decreased from 9.84 to 7.26mm2 without statistical significance(p>0.05). 3) There was a good correlation in the measurement of the reference segments before intervention but this correlation was much lower after intervention in the reference and stenosis segments between 2 methods(r=0.8723 vs 0.6538, p<0.01). CONCLUSION: IVUS is considered as a sensitive tool in the detection of calcification, eccentricity and dissection and in evaluationg the results of the coronary intervention.