Selection of appropriate on-site household sanitation options for rural communities of Zimbabwe - case of Mbire district, Zimbabwe.

Selecting an appropriate sanitation option involves multiple stakeholders with often conflicting objectives. A multiple criteria decision analysis (MCDA) framework was developed to inform decision makers on selecting appropriate sanitation options for rural communities. Criteria established from literature were evaluated and weighted on-line by stakeholders. A performance matrix was developed by assigning weights to criteria and scoring alternatives. Selection of alternatives was based on a composite appropriateness index from a rank using the simple multi-attribute ranking technique. The framework was evaluated by verification, validation and sensitivity analysis. Five alternatives were evaluated on 14 decision criteria. The first preferred alternative was the urine diverting dry toilet (72.54) then the Blair ventilated improved pit latrine (67.10). The framework was commented as reasonable and robust. A simple and transparent MCDA framework was developed considering local conditions in a participatory manner to select appropriate alternatives for rural sanitation where a single option is encouraged.

Systematizing Information Use to Address Determinants of Health Worker Health in South Africa: A Cross-sectional Mixed Method Study.

Background: Recognizing that access to safe and healthy working conditions is a human right, the World Health Organization (WHO) calls for specific occupational safety and health (OSH) programs for health workers (HWs). The WHO health systems' building blocks, and the International Labour Organization (ILO), highlight the importance of information as part of effective systems. This study examined how OSH stakeholders access, use, and value an occupational health information system (OHIS). Methods: A cross-sectional survey of OSH stakeholders was conducted as part of a larger quasi experimental study in four teaching hospitals. The study hospitals and participants were purposefully selected and data collected using a modified questionnaire with both closed and open-ended questions. Quantitative analysis was conducted and themes identified for qualitative analysis. Ethics approval was provided by the University of Pretoria and University of British Columbia. Results: There were 71 participants comprised of hospital managers, health and safety representatives, trade unions representatives and OSH professionals. At least 42% reported poor accessibility and poor timeliness of OHIS for decision-making. Only 50% had access to computers and 27% reported poor computer skills. When existing, OHIS was poorly organized and needed upgrades, with 85% reporting the need for significant reforms. Only 45% reported use of OHIS for decision-making in their OSH role. Conclusion: Given the gap in access and utilization of information needed to protect worker's rights to a safe and healthy workplace, more attention is warranted to OHIS development and use as well as education and training in South Africa and beyond.

Frameworks for mitigating the risk of waterborne diarrheal diseases: A scoping review.

BACKGROUND: Diarrhea is one of the major cause of death and morbidity around the world. OBJECTIVES: This scoping review summarizes existing frameworks that aim to mitigate the risks of waterborne diarrheal diseases and describe the strengths and weaknesses of these frameworks. ELIGIBILITY CRITERIA: Published frameworks designed to mitigate the risks of waterborne diarrheal diseases. Frameworks published in English, from around the world and published since inception to date. SOURCES OF EVIDENCE: PubMed, Scopus, Web of Science, Google Scholar, Google Free Search, organization websites and reference lists of identified sources. CHARTING METHODS: Data were charted using the Joanna Briggs Institute tool. Results were summarized and described narratively. A criterion to score the strengths and weaknesses of the included frameworks was also developed. RESULTS: Five frameworks were identified including: the hygiene improvement framework, community led total sanitation, global action plan for pneumonia and diarrhea, participatory hygiene and sanitation transformation, and sanitation and family education. These frameworks shared several common components, including identification of problems and risk factors, identification and implementation of interventions, and evaluation and monitoring. The frameworks had several interventions including different infrastructure, health promotion and education, enabling environment and clinical treatments. Most of the frameworks included health promotion and education. All the frameworks were strengthened by including strategies for implementing and delivering intervention, human resource aspect, community involvement, monitoring, and evaluation. The main weakness included not having components for collecting, storing, and transferring electronic data and the frameworks not being specifically for mitigating waterborne diarrheal diseases. In addition, the identified frameworks were found to be effective in mitigating the risk of diarrhea diseases among other health effects. CONCLUSIONS: Existing frameworks should be updated specifically for mitigating waterborne diarrheal diseases that includes the strengths and addresses weaknesses of reviewed frameworks.

Drivers and barriers to sustained use of Blair ventilated improved pit latrine after nearly four decades in rural Zimbabwe.

BACKGROUND: Some latrines remain unused even under conditions of high coverage in rural areas of low- and middle-income countries. Not much is known on household latrine use in the long term in the absence of an intervention. The current work assesses drivers and barriers to sustained use of a ventilated improved pit latrine (Blair VIP) design where it originated and how rural households adapt it to climate change. METHODS: A mixed methods study was conducted from November 2020 to May 2021 among rural households of Mbire district, Zimbabwe. A cross sectional survey of 238 households with Blair ventilated improved pit (BVIP) latrines was conducted using a questionnaire and a latrine observation checklist. Data were analysed using logistic regression. Qualitative data were collected using six focus groups among house heads and analysed by thematic analysis. RESULT: The latrine has perceived health, non-health and hygiene benefits for its sustained use. However, there are design, environmental and social barriers. The quantitative study indicated that determinants of latrine use were contextual (individual and household levels) and technology (individual level) factors. Focus groups indicated that latrine use was influenced by social, technology and contextual factors at multiple level factors. Interplay of factors influenced the intention to adapt the BVIP latrine to climate change. Local climate change adaptation strategies for the latrine were odour and erosion control, construction of the conventional latrine design and raised structures. CONCLUSION: The conventional BVIP latrine design is durable and relatively resilient to climate change with high local household use. High construction cost of the latrine causes households to build incomplete and poor quality designs which affect odour and fly control. These are barriers to sustained latrine use. The government should implement the new sanitation policy which considers alternative sanitation options and offer community support for adapting sanitation to climate change.

Community-level interventions for mitigating the risk of waterborne diarrheal diseases: a systematic review.

BACKGROUND: Waterborne diarrhea diseases are among the leading causes of morbidity and mortality globally. These diseases can be mitigated by implementing various interventions. We reviewed the literature to identify available interventions to mitigate the risk of waterborne diarrheal diseases. METHODS: We conducted a systematic database review of CINAHL (Cumulative Index to Nursing and Allied Health Literature), PubMed, Web of Science Core Collection, Cochrane library, Scopus, African Index Medicus (AIM), and LILACS (Latin American and Caribbean Health Sciences Literature). Our search was limited to articles published between 2009 and 2020. We conducted the review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement checklist. The identified studies were qualitatively synthesized. RESULTS: Our initial search returned 28 773 articles of which 56 studies met the inclusion criteria. The included studies reported interventions, including vaccines for rotavirus disease (monovalent, pentavalent, and Lanzhou lamb vaccine); enhanced water filtration for preventing cryptosporidiosis, Vi polysaccharide for typhoid; cholera 2-dose vaccines, water supply, water treatment and safe storage, household disinfection, and hygiene promotion for controlling cholera outbreaks. CONCLUSION: We retrieved few studies on interventions against waterborne diarrheal diseases in low-income countries. Interventions must be specific to each type of waterborne diarrheal disease to be effective. Stakeholders must ensure collaboration in providing and implementing multiple interventions for the best outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020190411 .

Frameworks for selecting appropriate rural sanitation technology options in low- and middle-income countries: a critical review.

Several rural technology options exist on the sanitation market with different characteristics, yet project failures in some developing countries were attributable to inappropriate technology choices. Frameworks that are used to select sanitation technology options (hard copy, computer programmes) were developed by researchers and project implementers. They vary in design and application as there is no standard format. This appears to create a gap between science and practice. Frameworks should have some key elements needed to select appropriate sanitation technologies. We evaluated 12 available frameworks (2000-2019) used to select sanitation technologies in rural communities of low- and middle-income countries against 22 assessment criteria derived from literature. Criteria that were not fully addressed by some of the reviewed frameworks (scores of 8-50%) included equity, sanitation demand, sanitation behaviour change, ongoing contact, replicability, framework limitations, personnel selection and flexibility. Addressing such limitations may assist in future framework development.

Supervised Kohonen Self-Organizing Maps of Acute Asthma from Air Pollution Exposure.

There are unanswered questions with regards to acute respiratory outcomes, particularly asthma, due to environmental exposures. In contribution to asthma research, the current study explored a computational intelligence paradigm of artificial neural networks (ANNs) called self-organizing maps (SOM). To train the SOM, air quality data (nitrogen dioxide, sulphur dioxide and particulate matter), interpolated to geocoded addresses of asthmatics, were used with clinical data to classify asthma outcomes. Socio-demographic data such as age, gender and race were also used to perform the classification by the SOM. All pollutants and demographic traits appeared to be important for the correct classification of asthma outcomes. Age was more important: older patients were more likely to have asthma. The resultant SOM model had low quantization error. The study concluded that Kohonen self-organizing maps provide effective classification models to study asthma outcomes, particularly when using multidimensional data. SO2 was concluded to be an important pollutant that requires strict regulation, particularly where frail subpopulations such as the elderly may be at risk.

Organizational factors associated with health worker protection during the COVID-19 pandemic in four provinces of South Africa.

BACKGROUND: Health workers, in short supply in many low-and-middle-income countries, are at increased risk of SARS-CoV-2 infection. This study aimed to assess how South Africa, prepared to protect its health workers from SARS-CoV-2 infection. METHODS: This was a cross-sectional study design applying participatory action research in four provinces of South Africa. A semi-structured questionnaire and a qualitative observational HealthWISE walkthrough risk assessment was carried out to collect data on occupational safety and health (OSH) systems in 45 hospitals across four provinces to identify factors associated with health worker protection. Adapting the International Labour Organization (ILO) and World Health Organization (WHO) HealthWISE tool, we compiled compliance scores through walkthrough surveys. We used logistic regression to analyze the relationship between readiness indicators and the actual implementation of protective measures. RESULTS: We found that health facilities in all four provinces had SARS-CoV-2 plans for the general population but no comprehensive OHS plan for health workers. Provincial Departments of Health (PDoH) varied in how they were organized to respond: Provinces A and D had an OSH SARS-CoV-2 provincial coordinating team and a dedicated budget for occupational health; Province A had an occupational health doctor and nurse; while Province B had an occupational health nurse; Province A and D PDoHs had functional OSH committees; and Province D had conducted some health risk assessments specific to SARS-CoV-2. However, none of the assessed health facilities had an acceptable HealthWISE compliance score (≥ 75%) due to poor ventilation and inadequate administrative control measures. While the supply of personal protective equipment was adequate, it was often not worn properly. Our study found that having an OSH SARS-CoV-2 policy was significantly associated with higher personal protective equipment and ventilation scores. In addition, our analysis showed that hospitals with higher compliance scores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98). CONCLUSIONS: Despite some initial preparedness, greater effort to protect health workers is still warranted. Low-and-middle-income countries may need to pay more attention to OSH systems and consider using tools, such as ILO/WHO HealthWISE tool, to protect health workers' health.

Development and validation of a framework to improve neglected tropical diseases surveillance and response at sub-national levels in Kenya.

BACKGROUND: Assessment of surveillance and response system functions focusing on notifiable diseases has widely been documented in literature. However, there is limited focus on diseases targeted for elimination or eradication, particularly preventive chemotherapy neglected tropical diseases (PC-NTDs). There are limited strategies to guide strengthening of surveillance and response system functions concerning PC-NTDs. The aim of this study was to develop and validate a framework to improve surveillance and response to PC-NTDs at the sub-national level in Kenya. METHODS: A multi-phased approach using descriptive cross-sectional mixed-method designs was adopted. Phase one involved a systematic literature review of surveillance assessment studies to derive generalised recommendations. Phase two utilised primary data surveys to identify disease-specific recommendations to improve PC-NTDs surveillance. The third phase utilised a Delphi survey to assess stakeholders' consensus on feasible recommendations. The fourth phase drew critical lessons from existing conceptual frameworks. The final validated framework was based on resolutions and inputs from concerned stakeholders. RESULTS: The first phase identified thirty studies that provided a combination of recommendations for improving surveillance functions. Second phase described PC-NTDs specific recommendations linked to simplified case definitions, enhanced laboratory capacity, improved reporting tools, regular feedback and supervision, enhanced training and improved system stability and flexibility. In the third phase, consensus was achieved on feasibility for implementing recommendations. Based on these recommendations, framework components constituted human, technical and organisational inputs, four process categories, ten distinct outputs, outcomes and overall impact encompassing reduced disease burden, halted disease transmission and reduced costs for implementing treatment interventions to achieve PC-NTDs control and elimination. CONCLUSION: In view of the mixed methodological approach used to develop the framework coupled with further inputs and consensus among concerned stakeholders, the validated framework is relevant for guiding decisions by policy makers to strengthen the existing surveillance and response system functions towards achieving PC-NTDs elimination.

Feasibility of implementing recommendations to improve neglected tropical diseases surveillance and response in Kenya: a modified Delphi study.

BACKGROUND: Effective health information systems (HIS) are critical towards achieving timely response to preventive chemotherapy neglected tropical diseases (PC-NTDs) and their eventual elimination. Strengthened HIS enable prompt case detection and effective response to halt disease transmission and prevent probable outbreaks. This study aimed to assess the importance and feasibility of implementing recommendations for improving surveillance core functions, support functions and surveillance attributes concerning PC-NTDs in Kenya. METHODS: A descriptive web-based Delphi process comprising of two survey rounds was used to achieve group consensus on the importance of recommended actions and feasibility of their implementation. In the first round, participants were enrolled to complete a five-point likert-type self-administered electronic questionnaire comprising of 60 statements across 12 sub-domains on the importance of recommendations. In the second round, participants reappraised their responses following completion of a questionnaire with 56 rephrased statements on feasibility of implementing the recommendations to improve PC-NTDs surveillance and response. Data from both rounds were analysed using descriptive statistics and thematic analysis performed for the open-ended responses. RESULTS: Sixty-two key stakeholders actively involved in surveillance and response activities in seven PC-NTDs endemic counties in Kenya were invited to participate. Of these, 50/62 completed the first round (81 % response rate) and 45/50 completed the second round (90 % response rate). Consensus was achieved (defined as > 70 % agreement) on the importance (93 %) of recommendation statements and feasibility (82 %) of implementing the important recommendations. Stakeholders agreed on the importance and feasibility of specific recommendations across the 12 sub-domains: case detection and registration, reporting, data analysis, feedback, epidemic preparedness and response, supervision, training, resources, simplicity, acceptability, stability and flexibility. However, there was lack of consensus on the feasibility of conducting routine data analysis, increasing supervision of surveillance activities at lower levels and retaining trained surveillance staff across all levels. CONCLUSIONS: Consensus among health stakeholders on implementation of the important and feasible recommendations will inform relevant strategies for strengthening specific surveillance system functions in view of PC-NTDs in Kenya.

Effect of Sanitation Interventions on Health Outcomes: A Systematic Review of Cluster-Randomized Controlled Trials in Rural Communities of Low- and Middle-Income Countries.

A systematic review of published literature (2000-2019) evaluating the impact of sanitation interventions on the prevalence of disease, parasite infestation, and/or child growth using randomized controlled trials (RCTs) was done according to the PRISMA checklist. Earlier reviews indicated mixed evidence citing relatively poor quality evidence from mixed designs. Public health policy and practice appear to rely on evidence from RCTs. Records were searched in six electronic databases. The methodological quality of RCTs was assessed using the Cochrane collaboration risk of bias tool. Fifteen records (2.0%) were included for review. Impact trials were done in rural communities of African and Asian countries. The significant effect of sanitation-focus interventions was found in one trial for the prevalence of childhood diarrhea (14.3%), three trials for parasite infestation (37.5%), and two trials (25.0%) for child growth. Results indicate mixed quality evidence from RCT designs. Evidence is limited and suggestive of the impact of sanitation on parasite infestation and child growth. Further rigorous sanitation intervention trials under varying settings are needed to show what really works and under what settings. Future work may explore sanitation behavior change strategies and latrine options to address the challenges of poor latrine use under high sanitation coverage.

Association between ambient air pollution and cause-specific mortality in Cape Town, Durban, and Johannesburg, South Africa: any susceptible groups?

Studies have confirmed that adverse human health effects that are associated with exposure to air pollution may differ depending on other factors such as age, gender, environmental conditions, and socio-economic factors. This study was conducted to assess the association between ambient air pollution and cause-specific mortality in the three big cities in South Africa and to determine the susceptible groups thereof. Cause-specific mortality data for all ages and PM10, NO2, and SO2 in Cape Town, Durban, and Johannesburg for the period from 1 January 2006 to 31 December 2010 were obtained. Statistical analyses were done to estimate the associations between air pollutants and cause-specific mortality. Susceptibility was therefore investigated in stratified analyses by sex and age (≥60 years) and environmental conditions (heat and cold) followed by models with interaction terms. Our estimates showed independent associations between these air pollutants, environmental conditions, and susceptible groups.

A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: A health workers' perspective.

BACKGROUND: The revised integrated disease surveillance and response (IDSR) guidelines adopted by African member states in 2010 aimed at strengthening surveillance systems critical capacities. Milestones achieved through IDSR strategy implementation prior to adopting the revised guidelines are well documented; however, there is a dearth of knowledge on the progress made post-adoption. This study aimed to review key recommendations resulting from surveillance assessment studies to improve implementation of the revitalised IDSR system in the African region based on health workers' perspectives. The review focused on literature published between 2010 and 2019 post-adopting the revised IDSR guidelines in the African region. METHODS: A systematic literature search in PubMed, Web of Science and Cumulative Index for Nursing and Allied Health Literature was conducted. In addition, manual reference searches and grey literature searches using World Health Organisation Library and Information Networks for Knowledge databases were undertaken. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist for systematic reviews was utilised for the review process. RESULTS: Thirty assessment studies met the inclusion criteria. IDSR implementation under the revised guidelines could be improved considerably bearing in mind critical findings and recommendations emanating from the reviewed surveillance assessment studies. Key recommendations alluded to provision of laboratory facilities and improved specimen handling, provision of reporting forms and improved reporting quality, surveillance data accuracy and quality, improved knowledge and surveillance system performance, utilisation of up-to-date information and surveillance system strengthening, provision of resources, enhanced reporting timeliness and completeness, adopting alternative surveillance strategies and conducting further research to improve surveillance functions. CONCLUSION: Recommendations on strengthening IDSR implementation in the African region post-adopting the revised guidelines mainly identify surveillance functions focused on reporting, feedback, training, supervision, timeliness and completeness of the surveillance system as aspects requiring policy refinement. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42019124108.

Evaluation of health surveillance system attributes: the case of neglected tropical diseases in Kenya.

BACKGROUND: Control of preventive chemotherapy-targeted neglected tropical diseases (PC-NTDs) relies on strengthened health systems. Efficient health information systems provide an impetus to achieving the sustainable development goal aimed at ending PC-NTD epidemics. However, there is limited assessment of surveillance system functions linked to PC-NTDs and hinged on optimum performance of surveillance system attributes. The study aimed to evaluate surveillance system attributes based on healthcare workers' perceptions in relation to PC-NTDs endemic in Kenya. METHODS: A cross-sectional health facility survey was used to purposively sample respondents involved in disease surveillance activities. Consenting respondents completed a self-administered questionnaire that assessed their perceptions on surveillance system attributes on a five-point likert scale. Frequency distributions for each point in the likert scale were analysed to determine health workers' overall perceptions. Data was analysed using descriptive statistics and estimated median values with corresponding interquartile ranges used to summarise reporting rates. Factor analysis identified variables measuring specific latent attributes. Pearson's chi-square and Fisher's exact tests examined associations between categorical variables. Thematic analysis was performed for questionnaire open-ended responses. RESULTS: Most (88%) respondents worked in public health facilities with 71% stationed in second-tier facilities. Regarding PC-NTDs, respondents perceived the surveillance system to be simple (55%), acceptable (50%), stable (41%), flexible (41%), useful (51%) and to provide quality data (25%). Facility locality, facility type, respondents' education level and years of work experience were associated with perceived opinion on acceptability (p = 0.046; p = 0.049; p = 0.032 and p = 0.032) and stability (p = 0.030; p = 0.022; p = 0.015 and p = 0.024) respectively. Median monthly reporting timeliness and completeness rates for facilities were 75 (58.3, 83.3) and 83.3 (58.3, 100) respectively. Higher-level facilities met reporting timeliness (p < 0.001) and completeness (p < 0.001) thresholds compared to lower-level facilities. CONCLUSION: Health personnel had lower perceptions on the stability, flexibility and data quality of the surveillance system considering PC-NTDs. Reporting timeliness and completeness rates decreased in 2017 compared to previous surveillance periods. Strengthening all surveillance functions would influence health workers' perceptions and improve surveillance system overall performance with regard to PC-NTDs.

A health worker knowledge, attitudes and practices survey of SARS-CoV-2 infection prevention and control in South Africa.

BACKGROUND: Health workers are crucial to the successful implementation of infection prevention and control strategies to limit the transmission of SARS-CoV-2 at healthcare facilities. The aim of our study was to determine SARS-CoV-2 infection prevention and control knowledge and attitudes of frontline health workers in four provinces of South Africa as well as explore some elements of health worker and health facility infection prevention and control practices. METHODS: A cross-sectional study design was utilised. The study population comprised both clinical and non-clinical staff working in casualty departments, outpatient departments, and entrance points of health facilities. A structured self-administered questionnaire was developed using the World Health Organization guidance as the basis for the knowledge questions. COVID-19 protocols were observed during data collection. RESULTS: A total of 286 health workers from 47 health facilities at different levels of care participated in the survey. The mean score on the 10 knowledge items was 6.3 (SD = 1.6). Approximately two-thirds of participants (67.4%) answered six or more questions correctly while less than a quarter of all participants (24.1%) managed to score eight or more. A knowledge score of 8 or more was significantly associated with occupational category (being either a medical doctor or nurse), age (< 40 years) and level of hospital (tertiary level). Only half of participants (50.7%) felt adequately prepared to deal with patients with COVD-19 at the time of the survey. The health workers displaying attitudes that would put themselves or others at risk were in the minority. Only 55.6% of participants had received infection prevention and control training. Some participants indicated they did not have access to medical masks (11.8%) and gloves (9.9%) in their departments. CONCLUSIONS: The attitudes of participants reflected a willingness to engage in appropriate SARS-CoV-2 infection prevention and control practices as well as a commitment to be involved in COVID-19 patient care. Ensuring adequate infection prevention and control training for all staff and universal access to appropriate PPE were identified as key areas that needed to be addressed. Interim and final reports which identified key shortcomings that needed to be addressed were provided to the relevant provincial departments of health.

Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya.

BACKGROUND: Effective surveillance and response systems are vital to achievement of disease control and elimination goals. Kenya adopted the revised guidelines of the integrated disease surveillance and response system in 2012. Previous assessments of surveillance system core and support functions in Africa are limited to notifiable diseases with minimal attention given to neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). The study aimed to assess surveillance system core and support functions relating to PC-NTDs in Kenya. METHODS: A mixed method cross-sectional survey was adapted involving 192 health facility workers, 50 community-level health workers and 44 sub-national level health personnel. Data was collected using modified World Health Organization generic questionnaires, observation checklists and interview schedules. Descriptive summaries, tests of associations using Pearson's Chi-square or Fisher's exact tests and mixed effects regression models were used to analyse quantitative data. Qualitative data derived from interviews with study participants were coded and analysed thematically. RESULTS: Surveillance core and support functions in relation to PC-NTDs were assessed in comparison to an indicator performance target of 80%. Optimal performance reported on specimen handling (84%; 100%), reports submission (100%; 100%) and data analysis (84%; 80%) at the sub-county and county levels respectively. Facilities achieved the threshold on reports submission (84%), reporting deadlines (88%) and feedback (80%). However, low performance reported on case definitions availability (60%), case registers (19%), functional laboratories (52%) and data analysis (58%). Having well-equipped laboratories (3.07, 95% CI: 1.36, 6.94), PC-NTDs provision in reporting forms (3.20, 95% CI: 1.44, 7.10) and surveillance training (4.15, 95% CI: 2.30, 7.48) were associated with higher odds of functional surveillance systems. Challenges facing surveillance activities implementation revealed through qualitative data were in relation to surveillance guidelines and reporting tools, data analysis, feedback, supervisory activities, training and resource provision. CONCLUSION: There was evidence of low-performing surveillance functions regarding PC-NTDs especially at the peripheral surveillance levels. Case detection, registration and confirmation, reporting, data analysis and feedback performed sub-optimally at the facility and community levels. Additionally, support functions including standards and guidelines, supervision, training and resources were particularly weak at the sub-national level. Improved PC-NTDs surveillance performance sub-nationally requires strengthened capacities.

High blood pressure and exposure to dust from gold mine dumps among the elderly in South Africa: A cross-sectional study.

Objective: To investigate whether high blood pressure was associated with living close to a mine dump among the elderly in South Africa. Study design: This was a cross-sectional study conducted among the elderly in communities 1-2 km (exposed) and 5 km or more (unexposed), from five pre-selected mine dumps in Gauteng and North West provinces of South Africa. Methods: Structured interviews were conducted with 2397 elderly, using a previously validated ATS-DLD-78 questionnaire from the British Medical Research Council. Results: The prevalence of high blood pressure was 57.51% in the exposed and 46.66% in the unexposed communities, respectively. Results from the multiple logistic regression analysis showed that having high blood pressure was significantly associated with living in exposed communities (AOR = 3.04, 95% CI: 2.41-3.83, P < 0.001). Other significant risk factors were being an previous and current tobacco smoker, age group, tertiary level of educational attainment, and having a history of occupational exposure to dust and chemical fumes. Conclusion: The findings of this study suggest that there are high levels of blood pressure among the elderly residing in communities located near mine dumps in South Africa.

Allergy and Household Living Conditions among Adolescents Living near Gold Mine Tailing Dumps in the Gauteng and North West Provinces of South Africa.

This quantitative exploratory baseline study aimed to investigate whether allergy among adolescents was associated with household living conditions, including living near gold mine tailing dumps in South Africa. A questionnaire based on the International Study of Asthma and Allergies was used to collect information on allergy and household risk factors among adolescents (n = 5611). A chi-square test was applied to determine the relationship between community (exposed/unexposed) and confounding variables. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated using univariate and multiple logistic regression analysis (LRA) to estimate the likelihood of having doctor-diagnosed allergies. The overall prevalence of doctor-diagnosed allergies was 25.5%. The exposed communities had a higher prevalence of doctor-diagnosed allergies (26.97%) compared with the unexposed (22.69%) communities. The study found an association between doctor-diagnosed allergy and having fungus in the house, being female, currently having pets in and around the house, residing in the community for more than three years and living in communities located close to gold mine tailing dumps. Actions to implement buffer zones between gold mine tailing dumps and communities would support Sustainable Development Goals 3 (health) and 11 (sustainable cities and communities), while failing to address the current potential identified risk factors may pose a significant public health challenge. Local policymakers should also apply the precautionary principle to protect the health of children, especially with the location of human settlements relative to air pollution sources.

The Frequency of Fast Food Consumption in Relation to Wheeze and Asthma Among Adolescents in Gauteng and North West Provinces, South Africa.

The prevalence of asthma and allergic diseases have been on the rise, especially in developing countries due to life-style changes. The study aimed to investigate the association between the frequency of fast food consumption with wheeze and asthma among adolescents. A previously validated self-completed questionnaire from the International Study of Asthma and Allergies in Childhood was used to collect information on demographics, socioeconomic status, house characteristics, adolescent respiratory health and diet. The prevalence of wheeze was 38.2% and of asthma was 16.37% among the adolescents. The results from the adjusted regression analyses indicated that eating fast foods three or more times per week was a statistically significant risk factor for wheeze (OR = 1.60; 95% CI: 1.26-2.03) and asthma (OR = 1.37; 95% CI: 1.04-1.91). The study found an association between eating fast foods three or more times per week and wheeze and asthma among adolescents in South Africa. Unhealthy diet plays a crucial role in respiratory health among adolescents; healthy eating habits are encouraged to reduce the burden of respiratory symptoms and diseases.

Non-allergic rhinitis and associated risk factors among the elderly in communities close to gold mine dumps in Gauteng and North West provinces in South Africa: a cross-sectional study.

PURPOSE: To investigate whether non-allergic rhinitis among the elderly was associated with living close to mine dumps METHODS: Elderly persons (n = 2397) residing in communities 1-2 km (exposed) and ≥ 5 km (unexposed) from five preselected mine dumps in Gauteng and North West provinces in South Africa were included in the cross-sectional study, using a previously validated modified ATS-DLD-78 questionnaire from the British Medical Research Council. RESULTS: The overall prevalence of non-allergic rhinitis in this study was 23.99%. In the unexposed, it was found to be 18.82% and 27.08% exposed communities. Multiple logistic regression analysis indicated that having non-allergic rhinitis was significantly associated with living in exposed communities (OR 1.73; 95% CI 1.37-2.17), being an ex-smoker (OR 1.75; 95 CI 1.35-2.26), being a smoker (OR 1.24; 95% CI 1.02-1.62), history of occupational exposure to dust/chemical fumes (OR 1.58; 1.30-1.93) and use of gas as the main residential heating/cooking fuel type (OR 1.61; 1.01-2.57). CONCLUSION: A high prevalence of non-allergic rhinitis was observed in the elderly living in exposed communities. The adverse association was observed between residing in communities close to mine dumps and non-allergic rhinitis.