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1.
Sci Total Environ ; 803: 149932, 2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-34525681

RESUMO

BACKGROUND: The risk of infectious disease transmission in public washrooms causes concern particularly in the context of the COVID-19 pandemic. This systematic review aims to assess the risk of transmission of viral or bacterial infections through inhalation, surface contact, and faecal-oral routes in public washrooms in healthcare and non-healthcare environments. METHODS: We systematically reviewed environmental sampling, laboratory, and epidemiological studies on viral and bacterial infection transmission in washrooms using PubMed and Scopus. The review focused on indoor, publicly accessible washrooms. RESULTS: Thirty-eight studies from 13 countries were identified, including 14 studies carried out in healthcare settings, 10 in laboratories or experimental chambers, and 14 studies in restaurants, workplaces, commercial and academic environments. Thirty-three studies involved surface sampling, 15 air sampling, 8 water sampling, and 5 studies were risk assessments or outbreak investigations. Infectious disease transmission was studied in relation with: (a) toilets with flushing mechanisms; (b) hand drying systems; and (c) water taps, sinks and drains. A wide range of enteric, skin and soil bacteria and enteric and respiratory viruses were identified in public washrooms, potentially posing a risk of infection transmission. Studies on COVID-19 transmission only examined washroom contamination in healthcare settings. CONCLUSION: Open-lid toilet flushing, ineffective handwashing or hand drying, substandard or infrequent surface cleaning, blocked drains, and uncovered rubbish bins can result in widespread bacterial and/or viral contamination in washrooms. However, only a few cases of infectious diseases mostly related to faecal-oral transmission originating from washrooms in restaurants were reported. Although there is a risk of microbial aerosolisation from toilet flushing and the use of hand drying systems, we found no evidence of airborne transmission of enteric or respiratory pathogens, including COVID-19, in public washrooms. Appropriate hand hygiene, surface cleaning and disinfection, and washroom maintenance and ventilation are likely to minimise the risk of infectious disease transmission.


Assuntos
COVID-19 , Doenças Transmissíveis , Humanos , Pandemias , SARS-CoV-2 , Toaletes
2.
Bull World Health Organ ; 99(11): 762-772A, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34737469

RESUMO

Objective: To determine whether a water, sanitation and hygiene intervention could change hygiene behaviours thought to be important for trachoma control. Methods: We conducted a cluster-randomized trial in rural Ethiopia from 9 November 2015 to 5 March 2019. We randomized 20 clusters to an intervention consisting of water and sanitation infrastructure and hygiene promotion and 20 clusters to no intervention. All intervention clusters received a primary-school hygiene curriculum, community water point, household wash station, household soap and home visits from hygiene promotion workers. We assessed intervention fidelity through annual household surveys. Findings: Over the 3 years, more wash stations, soap and latrines were seen at households in the intervention clusters than the control clusters: risk difference 47 percentage points (95% confidence interval, CI: 41-53) for wash stations, 18 percentage points (95% CI: 12-24) for soap and 12 percentage points (95% CI: 5-19) for latrines. A greater proportion of people in intervention clusters reported washing their faces with soap (e.g. risk difference 21 percentage points; 95% CI: 15-27 for 0-5 year-old children) and using a latrine (e.g. risk difference 9 percentage points; 95% CI: 2-15 for 6-9 year-old children). Differences between the intervention and control arms were not statistically significant for many indicators until the programme had been implemented for at least a year; they did not decline during later study visits. Conclusion: The community- and school-based intervention was associated with improved hygiene access and behaviours, although changes in behaviour were slow and required several years of the intervention.


Assuntos
Higiene , Tracoma , Criança , Pré-Escolar , Etiópia , Humanos , Lactente , Recém-Nascido , Saneamento , Toaletes , Tracoma/prevenção & controle
3.
Artigo em Inglês | MEDLINE | ID: mdl-34769612

RESUMO

In low- and middle-income countries, most latrines are not accessible to young children. We explored how to modify existing pit latrines to make them child friendly. We conducted four focus group discussions with mothers to explore barriers to child latrine use. We then enrolled 20 households with a child aged 3-7 years old to test six enabling technologies developed based on the identified barriers. Two to three weeks after installing the selected enabling technologies in each household, researchers conducted 19 in-depth interviews with caregivers to explore the technologies' acceptance and feasibility. Common barriers included the discomfort of squatting on a large pan, fear of darkness, and fear of a slippery floor. Of the potential solutions, a ring to stabilize the child while squatting in the latrine was preferred by children and was affordable and available. A wooden board with a smaller hole than the usual pan reduced fears of falling and helped eliminate discomfort but was inconvenient to handle and clean. A transparent fiberglass roof tile was affordable, available, increased visibility, and kept the latrine floor dry. In conclusion, the fiberglass roof tile and stability ring were two affordable and locally available technologies that facilitated latrine use by children aged 3-7 years.


Assuntos
Saneamento , Toaletes , Bangladesh , Criança , Pré-Escolar , Características da Família , Feminino , Grupos Focais , Humanos
5.
Front Public Health ; 9: 750309, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34708018

RESUMO

Introduction: In order to meet the sustainable development goals targets of sanitation, countries aim to increase access to safely managed sanitation services for its citizens. Safely managed sanitation services refers to improved sanitation technologies that are not shared with other households and where excreta is treated and disposed; or stored, transported and treated off-site. In most Sub-Saharan Africa (SSA) countries, on-site sanitation facilities such as latrines and septic tanks are common, with low-income urban settlements mainly using pit latrines. However, little is documented about the management of sludge from these facilities, especially in low income settlements in secondary and emerging cities. This lack of data is a major hindrance to public health, development and planning efforts by governments and planning agencies. This study specifically assesses practices and challenges along the sanitation value chain related to containment, emptying, transportation, treatment and recycling of fecal sludge. Methods: The study was carried out in low income settlements in Nakuru, a secondary city in Kenya. Over half the population in Nakuru live in low income areas and majority of these residents use pit latrines. A case study design was selected for this study and data was collected using qualitative methods. Data was collected through In-depth interviews and Focus Group Discussions using in depth interview guide and focus group discussion guides that had questions on sanitation practices along the value chain, challenges, opportunities available, and recommendations for improvement. Analysis was done through content analysis by reading the transcripts multiple times to gain a sense of the flow of the discussion. Thereafter, coding was done by following emergent issues and thereafter categories were identified which formed the basis for providing a picture of FWM practices in the settlements. Results: On site sanitation facilities are dominant in the settlements, but they are few and are shared by several households. These facilities were unclean, and they filled up at a fast rate because of the high number of users. The latrines were emptied by manual emptiers who used mechanized equipment but complemented with manual emptying using buckets. Sludge was transported to a central collection point using large and small scale means of transportation, before transfer to the treatment site for final treatment and disposal. Various stakeholders are involved in capacity building of emptiers as well as in the transportation, treatment and disposal of fecal sludge in the settlements. Challenges along the stages of the value chain included negative community perceptions and attitudes toward fecal sludge management. Conclusion: The results highlight the need to address the challenges along the chain by involvement of state and non-state actors. Low income areas have high populations and thus contribute huge amounts of fecal sludge. Deliberate efforts to consolidate such data from low income areas will result in availability of data, and informed decision making for stakeholders at national and international levels.


Assuntos
Esgotos , Toaletes , Quênia , Pobreza , Saneamento
6.
Health Soc Work ; 46(4): 260-267, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34595532

RESUMO

Transgender people often avoid going to the bathroom in public, at work, and at school because they are afraid of facing problems while using them. Utilizing the 2015 U.S. Transgender Survey, the largest sample to date with transgender people, this study (N = 25,694) aimed to understand the factors associated with avoiding bathroom usage as well as how the avoidance may impact the health of transgender people. Logistic regression was used to examine factors associated with avoidance of bathrooms. More than six out of 10 transgender people avoided using public bathrooms. Being questioned about a person's bathroom choice, gender identity, perception of gender identity, previous experiences of discrimination, suicidal ideation, and serious psychological distress were found to be associated with avoidance of public bathrooms due to fears of having problems when using them. Gender-neutral bathrooms that are safe and accessible for transgender people need to be more available and accessible in the United States.


Assuntos
Toaletes , Pessoas Transgênero , Feminino , Identidade de Gênero , Humanos , Masculino , Ideação Suicida , Inquéritos e Questionários , Estados Unidos
7.
J Water Health ; 19(5): 823-835, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34665774

RESUMO

Access to safe drinking water and adequate sanitation is considered as a basic human right. Swachh Bharat Mission - Gramin (Rural), launched by the Government of India in 2014, is hailed as an attempt towards that direction. On 2nd October 2019, India was declared free from open defecation, with rural households having full toilet coverage. However, despite Government claims, the existing literature indicates the presence of slippage: where households practice open defecation despite having access to toilets. Equating progress in sanitation interventions with mere toilet provision presents a partial assessment of sanitation. To address the gap, the 'Sanitation Well-being' framework, based on Amartya Sen's concept of justice, has been proposed. It identifies slippage as an outcome of various underlying factors across the sanitation life-cycle. The framework provides a lens to analyse existing frameworks and secondary data sets and finds that they do not capture the dynamism inherent in the sector. The efficacy of the framework has been tested in the rural district of Shravasti, Uttar Pradesh, India, through the rapid rural appraisal method. Through our investigation, we found that slippage exists in the field, and that the framework is a feasible instrument to assess sanitation as a comprehensive phenomenon.


Assuntos
Aparelho Sanitário , Saneamento , Características da Família , Humanos , Índia , População Rural , Justiça Social , Toaletes
8.
J Environ Manage ; 300: 113730, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34537558

RESUMO

In order to obviate the economic issues associated with pit latrine emptying and transport such as high water additions and rheologically difficult sludge properties, the implications of prompt solid/liquid separation were investigated. This was achieved through rheological characterisation of fresh human faeces and synthetic faeces, and comparison with aged faecal sludges. Shear yield stress, thixotropy and post-shear structural recovery were characterised for a total solids (TS) concentration range of 5-35% total solids (TS) and stickiness yield stress was determined for concentrations up to 100% TS. Fresh faeces rheology proved to be favourable when compared to aged matrices, evidenced by a lower shear yield stress and higher gel point solids concentration, suggesting that aging could alter the physico-chemical properties of faecal sludge. Fresh and synthetic faeces exhibited similar shear thinning, thixotropic behaviour with the majority of structural breakdown occurring at a low shear rate of 10 s-1, and the extent increasing with higher solids concentrations. At 32% TS, fresh faeces shear yield stress was permanently reduced by 80%, suggesting that low shear pumping could reduce the energy demand required for faeces transport. The sticky phase, which represents the region to avoid faecal transport and mechanical drying processes, was identified to range from 30 to 50% TS, with 25% TS as ideal to commence dewatering processes. This also coincides with the average solids concentration of faeces, which is achievable by source separation. This study has identified that handling of fresh faeces as opposed to aged faecal sludges would result in economic and environmental benefits, with energy, water and labour savings.


Assuntos
Saneamento , Esgotos , Idoso , Fezes , Humanos , Reologia , Toaletes
9.
J Environ Public Health ; 2021: 5569582, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527056

RESUMO

Background: The majority of people practicing open defecation and utilizing unhealthy sanitation facilities are in the developing world. The utilization of unimproved sanitation facilities remains the primary risk factor for many diseases, including nutritional diseases, diarrheal diseases, typhoid, cholera, and dysentery, particularly among children. Objectives: This study was carried out to assess the availability of improved sanitation facilities and factors associated with it in the 12th district of Kandahar city, Kandahar Province, Afghanistan. Methods: The study is a cross-sectional survey, conducted between September and October 2019. A structured questionnaire was used to gather self-reported information of the respondents, including sociodemographic information, household characteristics, and behavioral and environmental characteristics of the available sanitation facilities. Factors associated with the availability of the improved sanitation facility were determined using a multivariable logistic regression model. Results: In this study, the availability of improved sanitation facilities was 85.7% (95% confidence interval (CI) = 77.6%-92.1%). It was significantly influenced by living in a private house (adjusted odds ratio (AOR) = 2.99 (95% CI; 1.43-6.26)); inside location of latrine (AOR = 14.31 (95% CI; 3.59-56.99)); individual household latrine (AOR = 2.03 (1.04-3.95)); and the number of latrines in the household (AOR = 5.04 (2.45-10.35)). Conclusion: The availability of improved sanitation facilities was higher compared to the national level in the study area. This study provides significant evidence on approaches in line with the World Health Organization's (WHO) Joint Monitoring Program and Sustainable Developmental Goals (SDGs) for enhancing the availability of improved sanitation facilities in Kandahar city.


Assuntos
Saneamento , Toaletes , Afeganistão , Estudos Transversais , Humanos , Saneamento/normas , Fatores Socioeconômicos , Toaletes/estatística & dados numéricos
10.
PLoS One ; 16(9): e0257813, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34591873

RESUMO

BACKGROUND: Open defecation practice problem is rampant in most rural areas of developing countries, including Ethiopia. To combat this problem, the Ethiopian government implemented different sanitation interventions including Community-Led Total Sanitation and Hygiene (CLTSH). The CLTSH approach is mainly aimed to eradicate open defecation practice through mobilizing the community to construct a latrine facility and utilize it. Although this intervention has significantly improved households' access to a latrine facility, its impact on bringing behavioral change such as avoiding open defecation is not well studied. OBJECTIVE: Our study aimed to assess the prevalence of open defecation among households having their latrine and its determinant factors in rural settings in Northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted in Machakal district from September 1 to 30, 2019. A total of 472 household heads who had a latrine facility and systematically selected from six rural Kebeles of the district, were involved in the study. The data were collected using a structured questionnaire and observational checklist tools through face-to-face interviews and observation methods. Bivariate and multivariable logistic regression models were run to identify the factors that influence open defecation practice. During the multivariable analysis, statistical significance was declared at the p-value of <0.05 with 95% CI. RESULTS: The prevalence of open defecation practice among household heads who had latrine facility was 27.8% (95% CI, [23.1-32.8]). Female gender (AOR = 2.94, 95% CI [1.13-7.68]), not attending of formal education (AOR = 3.10, CI 95% [1.34-7.13]), having >5 family members (AOR = 1.72, CI 95% [1.05-2.80]), presence of under-five child (AOR = 3.64 CI 95% [2.14-6.21]), preferring leaf as anal cleaning material (AOR = 3.18, CI 95% [1.67-6.08]), having unclean latrine (AOR = 2.15, CI 95% [1.34-3.44]), and having latrine that needs maintenance (AOR = 2.50 CI 95% [1.52-4.11]) variables were associated with open defecation practice. CONCLUSIONS: Among the total respondents, finding more than a quarter of open defecators is concerning for a district that achieved greatly in terms of latrine coverage. This indicates the above-mentioned factors contributed to influence household heads to defecate openly despite having latrines. Therefore, the government and partners need to focus on designing strategies that effectively address determinant factors of open defecation.


Assuntos
Defecação , Saúde da População Rural/legislação & jurisprudência , Toaletes/estatística & dados numéricos , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Projetos de Pesquisa , Fatores de Risco , População Rural , Saneamento , Caracteres Sexuais , Inquéritos e Questionários
11.
J Environ Manage ; 298: 113456, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34364246

RESUMO

Sludge treatment is an integral part of faecal sludge management in non-sewered sanitation settings. Development of pyrolysis as a suitable sludge treatment method requires thorough knowledge about the properties and thermal decomposition mechanisms of the feedstock. This study aimed to improve the current lack of understanding concerning relevant sludge properties and their influence on the thermal decomposition characteristics. Major organic compounds (hemicellulose, cellulose, lignin, protein, oil and grease, other carbohydrates) were quantified in 30 faecal sludge samples taken from different sanitation technologies, providing the most comprehensive organic faecal sludge data set to date. This information was used to predict the sludge properties crucial to pyrolysis (calorific value, fixed carbon, volatile matter, carbon, hydrogen). Samples were then subjected to thermogravimetric analysis to delineate the influence of organic composition on thermal decomposition. Septic tanks showed lower median fractions of lignin (9.4%dwb) but higher oil and grease (10.7%dwb), compared with ventilated improved pit latrines (17.4%dwb and 4.6%dwb respectively) and urine diverting dry toilets (17.9%dwb and 4.7%dwb respectively). High fixed carbon fractions in lignin (45.1%dwb) and protein (18.8%dwb) suggested their importance for char formation, while oil and grease fully volatilised. For the first time, this study provided mechanistic insights into faecal sludge pyrolysis as a function of temperature and feedstock composition. Classification into the following three phases was proposed: decomposition of hemicellulose, cellulose, other carbohydrates, proteins and, partially, lignin (200-380 °C), continued decomposition of lignin and thermal cracking of oil and grease (380-500 °C) and continued carbonisation (>500 °C). The findings will facilitate the development and optimisation of faecal sludge pyrolysis, emphasising the importance of considering the organic composition of the feedstock.


Assuntos
Pirólise , Esgotos , Fezes , Saneamento , Toaletes
12.
Artigo em Inglês | MEDLINE | ID: mdl-34444063

RESUMO

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.


Assuntos
População Rural , Saneamento , Criança , Países em Desenvolvimento , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Toaletes
13.
Sci Rep ; 11(1): 16540, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400687

RESUMO

Malaria risk is highly heterogeneous. Understanding village and household-level spatial heterogeneity of malaria risk can support a transition to spatially targeted interventions for malaria elimination. This analysis uses data from cross-sectional prevalence surveys conducted in 2014 and 2016 in two villages (Megiar and Mirap) in Papua New Guinea. Generalised additive modelling was used to characterise spatial heterogeneity of malaria risk and investigate the contribution of individual, household and environmental-level risk factors. Following a period of declining malaria prevalence, the prevalence of P. falciparum increased from 11.4 to 19.1% in Megiar and 12.3 to 28.3% in Mirap between 2014 and 2016, with focal hotspots observed in these villages in 2014 and expanding in 2016. Prevalence of P. vivax was similar in both years (20.6% and 18.3% in Megiar, 22.1% and 23.4% in Mirap) and spatial risk heterogeneity was less apparent compared to P. falciparum. Within-village hotspots varied by Plasmodium species across time and between villages. In Megiar, the adjusted odds ratio (AOR) of infection could be partially explained by household factors that increase risk of vector exposure, such as collecting outdoor surface water as a main source of water. In Mirap, increased AOR overlapped with proximity to densely vegetated areas of the village. The identification of household and environmental factors associated with increased spatial risk may serve as useful indicators of transmission hotspots and inform the development of tailored approaches for malaria control.


Assuntos
Malária/epidemiologia , Distribuição por Idade , Coinfecção , Materiais de Construção , Estudos Transversais , Reservatórios de Doenças , Água Potável , Ecossistema , Características da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Malária Falciparum/epidemiologia , Malária Vivax/epidemiologia , Masculino , Mosquiteiros , Papua Nova Guiné/epidemiologia , Plasmodium ovale , Prevalência , Fatores de Risco , Classe Social , Toaletes
14.
Artigo em Inglês | MEDLINE | ID: mdl-34204779

RESUMO

BACKGROUND: The ongoing novel coronavirus (COVID-19) global pandemic has resulted in significant levels of morbidity and mortality worldwide, particularly among the elderly and immuno-suppressed groups. Although adequate hand hygiene (HH) behaviour and compliance is widely accepted as being the most effective self-protective measure in preventing the spread of diseases like COVID-19, previous research suggests that normal hand hygiene compliance is poor, but generally improves during a disease pandemic. This research aimed to evaluate the hand hygiene behaviour and compliance of the general public in the initial weeks of the COVID-19 pandemic in Northern Ireland (NI). METHODS: This cross-sectional study involved the use of infrared-imaging cameras to observe the hand hygiene behaviour and compliance of the general public when using one set of male and female public restrooms. RESULTS: The findings of this study indicated that the level of hand hygiene compliance of the general public was poor in the initial weeks, with 82.93% overall not washing their hands adequately. CONCLUSIONS: Inadequate HH behaviour and compliance may have added significantly to the rapid rate of spread of COVID-19 in the initial weeks of the pandemic in NI. Current public health campaigns do not appear, based on this study, to have the desired impact and may need to be reviewed or re-enforced in order to achieve the levels of hand hygiene compliance required to slow the spread of COVID-19 and other communicable diseases in the future.


Assuntos
COVID-19 , Infecção Hospitalar , Higiene das Mãos , Idoso , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Desinfecção das Mãos , Humanos , Masculino , Irlanda do Norte/epidemiologia , Pandemias , SARS-CoV-2 , Toaletes
15.
N Z Med J ; 134(1538): 18-27, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239142

RESUMO

AIMS: To identify the extent of the provision of handwashing amenities in public toilets at the time of the COVID-19 pandemic, and also to make comparisons with a related pre-pandemic survey. METHODS: We collected data from 400 toilet facilities that were open to the public: all those in three contiguous city council territories (228) and a further convenience sample of 172 around other parts of New Zealand. Comparisons were made with the data on the same facilities included in a 2012/2013 survey. RESULTS: Of the toilets in this survey, 2.5% had no water for handwashing and 14.8% had no soap. There was COVID-19-related health messaging signage in 19.5% of toilets, with posters of the COVID-19 QR code used for contact tracing in 12.3%, and generic handwashing signage in 1.8%. The handwashing water had 'no-touch' activation at 28.0% of toilets, and 18.5% of toilets had no-touch bowl flushing. Toilet bowl lids were not present at 32.8%, and 2.3% of toilets had damage that would impair their functionality (eg, broken toilet seats). This new survey found significantly increased provision of soap (risk ratio = 1.47; 95%CI: 1.25 to 1.72), but no increased provision of water, at the 128 sites that had also been examined in the previous survey. CONCLUSIONS: Although handwashing is probably a much less critical COVID-19 control intervention than reducing aerosol transmission, it should still be strongly supported. Yet this survey found multiple deficiencies with handwashing amenities at public toilets and only modest improvements since a previous survey.


Assuntos
COVID-19/prevenção & controle , Desinfecção das Mãos/instrumentação , Logradouros Públicos , Toaletes , Educação em Saúde , Humanos , Nova Zelândia , Pôsteres como Assunto , SARS-CoV-2 , Sabões , Toaletes/normas , Água
16.
Int J Hyg Environ Health ; 236: 113807, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34265632

RESUMO

Contamination of contact surfaces with SARS-CoV-2 has been reported as a potential route for the transmission of COVID-19. This could be a major issue in developing countries where access to basic sanitation is poor, leading to the sharing of toilet facilities. In this study, we report SARS-CoV-2 contamination of key contact surfaces in shared toilets and the probabilistic risks of COVID-19 infections based on detection and quantification of the nucleic acid on the surfaces. We observed that 54-69% of the contact surfaces were contaminated, with SARS-CoV-2 loads ranging from 28.1 to 132.7 gene copies per cm2. Toilet seats had the highest contamination, which could be attributed to shedding of the virus in feces and urine. We observed a significant reduction in viral loads on the contaminated surfaces after cleaning, showing the potential of effective cleaning on the reduction of contamination. The pattern of contamination indicates that the most contaminated surfaces are those that are either commonly touched by users of the shared toilets or easily contaminated with feces and urine. These surfaces were the toilet seats, cistern handles and tap handles. The likelihood (probability) of infection with COVID-19 on these surfaces was highest on the toilet seat (1.76 × 10-4(1.58 × 10-6)) for one time use of the toilet. These findings highlight the potential risks for COVID-19 infections in the event that intact infectious viral particles are deposited on these contact surfaces. Therefore, this study shows that shared toilet facilities in densely populated areas could lead to an increase in risks of COVID-19 infections. This calls for the implementation of risk reduction measures, such as regular washing of hands with soap, strict adherence to wearing face masks, and effective and regular cleaning of shared facilities.


Assuntos
COVID-19/transmissão , RNA Viral/isolamento & purificação , SARS-CoV-2/isolamento & purificação , Saneamento/estatística & dados numéricos , Toaletes/estatística & dados numéricos , Contaminação de Equipamentos , Humanos
17.
BMC Public Health ; 21(1): 1411, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271913

RESUMO

BACKGROUND: Although theory-driven evaluations should have empirical components, few evaluations of public health interventions quantitatively test the causal model made explicit in the theory of change (ToC). In the context of a shared sanitation trial (MapSan) in Maputo, Mozambique, we report findings of a quantitative process evaluation assessing intervention implementation, participant response and impacts on hypothesised intermediary outcomes on the pathway to trial health outcomes. We examine the utility of path analysis in testing intervention theory using process indicators from the intervention's ToC. METHODS: Process data were collected through a cross-sectional survey of intervention and control compounds of the MapSan trial > 24-months post-intervention, sampling adult residents and compound leaders. Indicators of implementation fidelity (dose received, reach) and participant response (participant behaviours, intermediary outcomes) were compared between trial arms. The intervention's ToC (formalised post-intervention) was converted to an initial structural model with multiple alternative pathways. Path analysis was conducted through linear structural equation modelling (SEM) and generalised SEM (probit model), using a model trimming process and grouped analysis to identify parsimonious models that explained variation in outcomes, incorporating demographics of respondents and compounds. RESULTS: Among study compounds, the MapSan intervention was implemented with high fidelity, with a strong participant response in intervention compounds: improvements were made to intermediary outcomes related to sanitation 'quality' - latrine cleanliness, maintenance and privacy - but not to handwashing (presence of soap / soap residue). These outcomes varied by intervention type: single-cabin latrines or multiple-cabin blocks (designed for > 20 users). Path analysis suggested that changes in intermediary outcomes were likely driven by direct effects of intervention facilities, with little contribution from hygiene promotion activities nor core elements expected to mediate change: a compound sanitation committee and maintenance fund. A distinct structural model for two compound size subgroups (≤ 20 members vs. > 20 members) explained differences by intervention type, and other contextual factors influenced specific model parameters. CONCLUSIONS: While process evaluation found that the MapSan intervention achieved sufficient fidelity and participant response, the path analysis approach applied to test the ToC added to understanding of possible 'mechanisms of change', and has value in disentangling complex intervention pathways. TRIAL REGISTRATION: MapSan trial registration: NCT02362932 Feb-13-2015.


Assuntos
Saneamento , Toaletes , Adulto , Estudos Transversais , Humanos , Higiene , Moçambique
18.
Environ Sci Technol ; 55(14): 9989-10000, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34236178

RESUMO

Environmental fecal contamination is common in many low-income cities, contributing to a high burden of enteric infections and associated negative sequelae. To evaluate the impact of a shared onsite sanitation intervention in Maputo, Mozambique on enteric pathogens in the domestic environment, we collected 179 soil samples at shared latrine entrances from intervention (n = 49) and control (n = 51) compounds during baseline (preintervention) and after 24 months (postintervention) as part of the Maputo Sanitation Trial. We tested soils for the presence of nucleic acids associated with 18 enteric pathogens using a multiplex reverse transcription qPCR platform. We detected at least one pathogen-associated gene target in 91% (163/179) of soils and a median of 3 (IQR = 1, 5) pathogens. Using a difference-in-difference analysis and adjusting for compound population, visibly wet soil, sun exposure, wealth, temperature, animal presence, and visible feces, we estimate the intervention reduced the probability of detecting ≥1 pathogen gene by 15% (adjusted prevalence ratio, aPR = 0.85; 95% CI: 0.70, 1.0) and the total number of pathogens by 35% (aPR = 0.65; 0.44, 0.95) in soil 24 months following the intervention. These results suggest that the intervention reduced the presence of some fecal contamination in the domestic environment, but pathogen detection remained prevalent 24 months following the introduction of new latrines.


Assuntos
Saneamento , Solo , Animais , Cidades , Fezes , Toaletes
19.
PLoS One ; 16(7): e0249006, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34197455

RESUMO

BACKGROUND: Unhygienic disposal of children's stools affects children's health in terms of their susceptibility to many diseases. However, there are no existing studies into the impact of unhygienic stool disposal in Cambodia. Therefore, this study aimed to identify factors associated with the unhygienic disposal of children's stools among children under the age of five in Cambodia. METHODS: An analytical cross-sectional study was conducted using data from the Cambodia Demographic and Health Survey (CDHS) 2014. A multivariable binary logistic regression was conducted using Stata to analyze factors associated with the unhygienic disposal of children's stools. RESULTS: Overall, the prevalence of practicing unhygienic disposal of children's stools was 29.27% (95%CI: 27.51%- 31.09%). Factors statistically associated with this practice were: living in the Central Plain, Plateau and Mountains, Coastal and Sea regions (AOR = 1.65; 95% CI: 1.33-2.04), (AOR = 2.53; 95% CI: 1.98-3.24) and (AOR = 4.16; 95% CI: 3.15-5.48) respectively, poor household wealth (AOR = 1.58; 95% CI: 1.31-1.91), the mother having no education (AOR = 1.45; 95% CI: 1.14-1.85), a high number of children aged under five (AOR = 1.11; 95% CI: 1.03-1.20), being in the "other" religious category (AOR = 1.77; 95% CI: 1.25-2.51), living in a household with unimproved toilet facilities (AOR = 1.22; 95% CI: 1.11-1.34), living in a household with inadequate hygiene (AOR = 1.33; 95% CI: 1.12-1.59), and the household not being visited by a family planning worker in the last year (AOR = 1.45; 95% CI: 1.19-1.77). However, an increase in the child's age by even a month had significant negative associations with unhygienic practice (AOR = 0.65; 95% CI: 0.60-0.70), even when controlling for other covariates. CONCLUSION: Almost one third of the mothers do not practice hygienic disposal of children's stools in Cambodia. Unhygienic practices were more prevalent in certain regions, and were also associated with low wealth, lack of education, an increase in the number of children under five in the household, religion, lack of sanitation and access to healthcare professionals. Conversely, the child's age was found to be positively associated with the hygienic disposal of children's stools.


Assuntos
Fezes , Eliminação de Resíduos/normas , Saneamento/estatística & dados numéricos , Adulto , Camboja , Criança , Pré-Escolar , Estudos Transversais , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Modelos Logísticos , Masculino , Mães/psicologia , Razão de Chances , Pobreza , Saneamento/normas , Toaletes/estatística & dados numéricos , Adulto Jovem
20.
J Prev Med Hyg ; 62(1): E48-E53, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34322616

RESUMO

Introduction: Microbiological quality of recreational environments included restrooms, is generally assessed by water and surface monitoring. In this study, an environmental monitoring, conducted in spring, of swimming pool restrooms of a recreation center located in the Marche region has been carried out. Seven water samples and seven surface swabs were collected. Moreover, six air samples have been included. The aim of this study was to evaluate if air microbiological monitoring, along with molecular detection in real-time PCR, could give additional useful information about the hygienic conditions of the facility. Methods: Heterotrophic Plate Count (HPC) both at 22°C (psychrophilic) and 37°C (mesophilic) was determined by separate cultures in all samples. The presence of Legionella pneumophila and Pseudomonas aeruginosa was evaluated by both culture and real-time PCR. Results: The analysis of shower water recorded a HPC load of mesophilic bacteria (37°C) more than 10-fold higher in men restroom, respect to women's one (> 100 vs < 10 CFU/ml), while in air samples was between < 100 and > 500. Concerning pathogen presence, both species Legionella pneumophila and Pseudomonas aeruginosa were detected only in men restroom, but in different sample types by using different methods (culture and real-time PCR). Conclusions: Air sampling may offer the advantage of giving more representative data about microbial presence in restrooms, including bacterial species transmitted through aerosol, like Legionella. Moreover, the concurrent use of molecular and microbiological detection in an integrated approach could offer the advantage of greater sensitivity.


Assuntos
Monitoramento Ambiental , Legionella pneumophila/isolamento & purificação , Legionella/isolamento & purificação , Piscinas , Toaletes/normas , Humanos , Itália , Projetos Piloto , Reação em Cadeia da Polimerase em Tempo Real , Recreação , Microbiologia da Água
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