Sustainability and acceptability of latrine provision in The Gambia.

All households in 32 villages were provided with improved pit latrines as part of a trachoma control programme in a rural part of The Gambia. Latrine provision was externally driven and was not in response to a request from the communities involved. Materials were provided for free and labour was paid for. To assess durability and acceptability we conducted a follow-up study 25-47 months after construction. Before the intervention only 32% of households in these villages had access to any type of latrine; at follow-up this had risen to 95%. On visual inspection 585/666 latrines (87.3%) were usable and 510 (87.2% of those usable) were currently used. During interviews 566/637 latrine owners (89%) said they were either happy or very happy with their latrines, and 620 (97.3%) reported that they would make a new latrine of some kind when the current one was full or unusable. We interpret these data to suggest that externally driven latrine provision, without additional health education, to an area with poor latrine coverage can result in high, sustainable levels of uptake and generate future demand for sanitation.

How to analyze palliative care outcome data for patients in Sub-Saharan Africa: an international, multicenter, factor analytic examination of the APCA African POS.

CONTEXT: The incidence of life-limiting progressive disease in sub-Saharan Africa presents a significant clinical and public health challenge. The ability to easily measure patient outcomes is essential to improving care. OBJECTIVES: The present study aims to determine the specific factors (if any) that underpin the African Palliative Care Association African Palliative Outcome Scale to assist the analysis of data in routine clinical care and audit. METHODS: Using self-reported data collected from patients with HIV infection in eastern and southern Africa, an exploratory factor analysis was undertaken with 1337 patients; subsequently, a confirmatory analysis was done on two samples from separate data sets (n = 445). RESULTS: Using exploratory factor analysis initially, both two- and three-factor solutions were examined and found to meet the criteria for simple structure and be readily interpretable. Then using confirmatory factor analysis on two separate samples, the three-factor solution demonstrated better fit, with Goodness-of-Fit Index values greater than 0.95 and Normative Fit Index values close to 0.90. The resulting three factors were 1) physical and psychological well-being, 2) interpersonal well-being, and 3) existential well-being. CONCLUSION: This analysis presents an important new opportunity in the analysis of outcome data for patients with progressive disease. It has advantages over both the total scoring of multidimensional scaling (which masks differences between domains) and of item scoring (which requires repeated analyses). The three factors map well onto the underlying concept and clinical goals of palliative care, and will enable audit of facility care.

What palliative care-related problems do patients experience at HIV diagnosis? A systematic review of the evidence.

CONTEXT: Palliative care is an essential element of HIV care throughout the disease trajectory, but there is a lack of information to guide clinical care at HIV diagnosis. OBJECTIVES: This systematic review aimed to identify and appraise the evidence of palliative care-related problems at HIV diagnosis. METHODS: The search strategy combined the term "HIV" with seven key words derived from the World Health Organization definition of multidimensional palliative care, in a systematic search of four databases. Abstracts and papers were screened to identify those recording problems within six months of HIV diagnosis in adults. Sample descriptions, aims, methods, and prevalence findings were extracted from these papers into common tables. RESULTS: Of 5443 titles retrieved, 65 met the inclusion criteria and 34 were retained. Papers included 27 original studies and seven secondary analyses of patient's records, with great heterogeneity in design, sample definition, and outcome measures. Physical and psychological symptoms were highly prevalent (pain 11%-76%, weight loss 8%-89%, fever 32%-89%, diarrhea 6%-54%, anxiety 36%-95%, and depression 18%-47%). At HIV diagnosis, well-being was impaired, suicidal thoughts were frequent, and peace and calmness were reduced. Participants lacked emotional support and feared the reaction of their families. Practical problems included hunger, homelessness, reduced ability to work, and need for childcare. Studies had methodological failings such as the use of unvalidated tools and lack of clarity reporting results. CONCLUSION: People who have recently been diagnosed with HIV have multidimensional palliative care-related problems. HIV care and support services need to assess and manage problems using integrated palliative care, with referral for complex problems. Patient centeredness must be a principle of HIV clinical research.

Household pit latrines as a potential source of the fly Musca sorbens--a one year longitudinal study from The Gambia.

OBJECTIVES: To assess whether the trachoma vector Musca sorbens was breeding in household latrines in a trachoma-endemic part of The Gambia. METHODS: Longitudinal study of flies emerging from 16 sentinel household latrines selected at random from a list of all latrines present in four Gambian villages. Latrines were surveyed and fly traps were set over the drop hole for 24 h once per month for a year. RESULTS: All the sentinel latrines were of the 'Gambian improved household latrine' design, which has a cement slab but is not ventilated or fly-proofed. The latrines were all in regular use by a family, mean number of users per latrine 14.8 (SD 8.0, range 2-29). Of 55 351 flies caught in 192 catches 54 130 (97.8%) were Chrysomya albiceps, 690 (1.2%) Musca domestica, 466 (0.8%) Chrysomya regalis and 65 (0.1%) M. sorbens. Of the M. sorbens caught 61 (93.8%) were female. CONCLUSIONS: Gambian improved household pit latrines cannot be considered a source of the trachoma vector M. sorbens, and the promotion of pit latrines as a method to reduce M. sorbens is warranted. A large number of C. albiceps were caught emerging from the latrines, but this species is not considered to be of medical importance.