Water quality and hygiene behavior in Burkina Faso: The impact of locally produced sodium hypochlorite solution in schools

Introduction.Sodium hypochlorite is a crucial element in the water treatment process. We aimed to verify if schools that lack adequate access to water and don't provide hygiene education courses would improve water quality after an intervention program. Methods.Twenty schools from the rural area of Burkina Faso were equipped with electro-chlorinator devices that produce sodium hypochlorite and received training to make water drinkable. Data related to behavioral change was collected. In addition, microbiological analysis of fecal coliforms, total coliforms, and fecal streptococci was performed in the drinking water from water stations or water storage containers. These indicators were measured before and two years after the program in six schools that participated, paired with three control schools from the same region. Results.Before the intervention, no schools practiced treating their water. After intervention, schools did it daily. WASH courses and water treatment training were also observed in intervention schools. Only the samples belonging to the control schools contained microorganisms in the drinking water after the intervention, particularly fecal coliforms and total coliforms. Fecal streptococci were not detected in any of the samples analyzed. Before the intervention, 50% of water samples from the intervention group and 66% from the control group were contaminated with fecal coliforms. Conclusion.Schools became independent of external disinfectant production after receiving electro-chlorinator devices and proper training to comply with WASH measures. Our findings might be useful to public health practitioners trying to implement sustainable programs.

Determinants of diarrhoeal disease in children living in low-income households in a periurban community in Cape Town, South Africa

Background. Water, sanitation and hygiene are critically important in reducing morbidity and mortality from childhood diarrhoeal disease and malnutrition in low-income settings.Objectives. To assess the association of diarrhoeal disease with factors relating to domestic hygiene, the environment, sociodemographic status and anthropometry in children <2 years of age.Methods. This was a case-control study conducted in a periurban community 35 km from the centre of Cape Town, South Africa. The study included 100 children with diarrhoeal disease and 100 age-matched controls without diarrhoea, who were recruited at primary healthcare clinics. Sociodemographic status, environmental factors and domestic hygiene were assessed using a structured questionnaire; anthropometry was assessed using the World Health Organization's child growth standards. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with diarrhoea. Results. The results of the univariate logistic regression showed significant susceptibility to diarrhoea in study cases compared with controls when the caregiver was ≥25 years old (odds ratio (OR) 1.82; 95% confidence interval (CI) 1.02 - 3.23; p=0.042); when children were in day care or cared for by a family member or a relative than when cared for by their mother (OR 1.97; 95% CI 1.06 - 3.65; p=0.032); and when the mothers were employed rather than at home (OR 2.23; 95% CI 1.21 - 4.12; p=0.01). Multivariate logistic regression analysis was used to identify predictors of diarrhoea, which entailed relaxing the inclusion criteria for the univariate analysis variables (p<0.25). The predictors significantly associated with diarrhoea were household problems relating to rat infestation (OR 2.44; 95% CI 1.13 - 5.28; p=0.027); maternal employment (OR 2.47; 95% CI 1.28 - 4.76; p=0.007); and children in day care or cared for by a relative (OR 2.34; 95% CI 1.21 - 4.54; p=0.01). Significantly more of the mothers who were employed than those who were unemployed had children in day care or cared for by a relative. Conclusion. Practices relating to employment, childcare and the domestic environment were significant predictors of diarrhoea. Effective policy implementation on water, sanitation and domestic hygiene could prevent diarrhoeal disease and reduce its impact on children's growth, especially during the annual diarrhoeal surge season in this and similar periurban communities.

An approach to acute pulmonary embolism in the primary emergency care environment

Pulmonary embolism (PE) is a common emergency presenting among high risk patients. It is important to have a structured approach to clinical assessment, diagnosis and management of this potentially life-threatening emergency. Clinical and management pathways have improved over the last 10 years as clear guidelines have emerged. Newer diagnostic modalities have become available and will hopefully improve the pick-up rate of PE and reduce the morbidity and mortality. High level evidence presented by the American Society of Haematology and the European Society of Cardiology forms the basis for this review

Toxicant-nutrient interaction as a veritable host resistance against chemical toxicity in the rapidly industrializing developing nations

Growing evidence indicates that chemical utilization including toxic waste in the developing countries is on the increase. These nations have limited facilities for sound chemical management involving production, use and disposal of chemicals with minimal adverse effects on human and environmental health. Though concerns are important to all nations, they appear particularly salient to the industrializing countries under pressures to achieve development and eradicate poverty yet with limited capacity for sound chemical management. This increases the risk of chemical toxicity, with consequences such as genotoxicity, cancer and teratogenicity. The growing chemical burden implies the need for an efficient and effective means of xenobiotic metabolism and host resistance. Relevant literature on nutrients and toxicants interaction in various search engines were reviewed. The possible role of host resistance, essentially involving nutritional modulation has been ignored. Nutrient-toxicant response pathways could be affordable strategies against excessive chemical exposure. Zinc, a prime micronutrient is an antioxidant [Cu-Zn superoxide dismutase (SOD)], component of p53, guardian of the genome; active in the repair of DNA damage and apoptosis; protective against carcinogenesis. Zinc also plays an important role in vitamin A metabolism, in turn important in differentiation and central to retinoids involved in gene expression. Zinc is important in all the stages of the cell cycle, derangement of which may be a pathway to carcinogenesis. Use of this and other protective nutrients including folate and selenium, among others, appears a veritable approach to improving host resistance against chemical toxicity and should be considered promising in developing nations

Wastewater and Solid Waste Disposal Patterns of Dukem Town Households in Ethiopia

The objective of this descriptive; cross-sectional study was to assess wastewater and solid waste management by the households of Dukem; a town in Ethiopia. A total of 391 households were selected using stratified random sampling techniques. Face-to-face interviews were carried out with respondents by asking questions about wastewater and solid waste management in the households. A majority (75.1) of households used unsafe wastewater disposal methods. Approximately two thirds (67.7) of households had a temporary storage container in their compound in which to store solid waste. 53.3 of households used a safe solid waste disposal method. Only 4.9 of the households used waste as manure (compost) for home gardening. More than a quarter (28.1) of households practised burning waste on their premises. The availability of safe wastewater disposal facilities was significantly associated with private home ownership and family size (p-value 0.05). There was no significant association between the availability of safe solid waste disposal facilities and owning a private home or family size (p-value 0.05). Generally; there were inadequate domestic wastewater and solid waste disposal facilities in the studied households. Thus; there is a need for improved waste management in the households. Environmental health and health education programmes should be emphasised in order to improve practices of household waste management

A sero-survey to identify the window of vulnerability to measles in infants in North-Eastern Nigeria

As infants lose maternal measles antibodies (MMAs); they experience periods when their antibody levels are insufficient to protect them against measles. A prospective study was carried out at the University of Maiduguri Teaching Hospital. Sera collected from neonates at birth; and at six weeks; three months; six months and nine months of age; were analysed for MMAs by enzyme-linked immunosorbent assay. Seventy-seven neonates were enrolled. Of these; 73 (94.8) had protective MMAs at birth. This figure declined to 36 (46.8); 28 (36.4); 13 (16.9) and 4 (5.2) at six weeks; three months; six months and nine months of age (?2 = 154.264; p-value = 0.000). Protective MMAs at birth waned rapidly; resulting in an early window of vulnerability to measles by the age of six months. Protecting infants with early measles immunisation with potent; safe vaccines are recommended

"The ""Ten Commandments"" of Treating Preschool Children who Wheeze"

"Wheezing in young children is problematic for most practitioners. Difficulties arise in both the diagnosis and management of this clinical phenotype. Not all preschool children who wheeze have asthma. Therefore; we suggest that the ""Ten Commandments"" of managing preschool wheezing include thinking that in very young infants ( 1 year) wheezing is likely to be viral in origin; realising that allergy testing is mandatory to diagnose the cause of early wheezing; taking a history of asthma and allergy in family members; noting that chronic coughing is a pointer to asthma; using the term ""asthma"" if that is the diagnosis; ensuring that the environmental avoidance of triggers is addressed; using a short course of montelukast for virus-induced wheezing episodes; avoiding steroids to treat virus-induced wheezing; treating associated nasal symptoms; and making sure that the follow-up of children addresses the issue of stopping therapy if it is not working."

Observations on Dust Mites (Acari: Pyroglyphidae) in Coastal Hospitals in South Africa

Surveys of houses in South Africa have shown that dust mites and mite-derived antigens are more common along the eastern and southern coastal lowlands than on the central Highveld plateau. The present study extended this research to hospitals in the three major coastal cities; to determine whether or not dust mites were present in ward furnishings and on floors; and if so; at what densities. Sampling; over 22 months; in provincial and private hospitals in Durban; Port Elizabeth and Cape Town recovered 10 mite species; including the cosmopolitan pyroglyphids; Dermatophagoides farinae; D. pteronyssinus; Euroglyphus maynei and Malayoglyphus intermedius. Mites were found in all sampled habitats without any apparent preferences; but mean densities were mostly below 10/m2; lower than found previously in houses along the coast. To characterise mite habitats in these coastal hospitals; preliminary environmental data were collected in wards and from inside mattresses. These showed nearly constant environments; with moderate temperatures and relative humidity and narrow annual ranges. Temperature and relative humidity levels decreased with increasing latitude from Durban to Cape Town

Microbiological Indoor and Outdoor Air Quality of Two Major Hospitals in Benin City; Nigeria

Air contains large number of microorganisms including bacteria and fungi and their estimation is important as an index of cleanliness for any particular environment. It becomes imperative to undertake a study of the microbiological air quality of the airborne micro-flora in the environments of two major government hospitals; University of Benin Teaching Hospital (UBTH) and Central Hospital; in Benin City metropolis. Both indoor and outdoor air samples were assessed monthly for the three (3) months in the wet season (June - August; 2010) and dry season (November 2010 - January 2011) using the settled plate methods. The study sites were divided into nine (9) units which include accident and emergency ward; laboratory; male ward; female ward; children ward; labour room; treatment room; theatre and outside the hospital gate. The mean airborne bacterial load in the two hospitals ranges from 8.5cfu/min to 172.5cfu/min and 5.5cfu/min to 64.5cfu/min for UBTH and Central hospital in the wet season. While the mean airborne fungal load in UBTH and Central Hospital in dry season ranges from 2.5cfu/min to 9.5cfu/min and 1.5cfu/min to 19.0cfu/min respectively. The female ward; children ward; accident and emergency ward and outside the hospital gate recorded the highest airborne micro-flora. The result revealed the isolation of ten (10) fungal isolates and six (6) bacterial isolates. These include Aspergillus niger; Aspergillus flavus; Botryodiplodia acerina; Rhizopus stolonifer; Nigospora zimm; Mucor sp.; Monilla infuscans; Penicillium sp.; Candida sp. and Trichoderma viridis while the six (6) bacterial isolates include Staphylococcus aureus; Staphylococcus epidermidis; Bacillus cereus; Bacillus sp.; Serratia marcescens and Micrococcus sp. The result shows the highest fungal population of 26.5cfu/min (outdoor) in UBTH followed by 24.0cfu/min (outdoor) in Central Hospital. The highest bacterial load of 172.5cfu/min (outdoor) was recorded in UBTH. The fungal isolates Aspergillus niger (53.0) and Monilla infuscans (43.9) were showed to be the most frequently isolated airborne fungal organisms while Staphylococcus aureus (91.3) and Staphylococcus epidermidis (85.8) were the most frequently isolated bacterial isolates. The statistical analysis showed no significant difference between the microbial population obtained during the wet and dry seasons in both hospitals studied. Data generated underline the usefulness of monitoring hospital environments

Spatial Epidemiology Risk Assessment for Rehabilitated Former Asbestos Mining Areas in Limpopo Province; South Africa; Using Remote Sensing and Conventional Analytical Methods

Abstract:The aim of this study was to conduct a comparative analysis using remote sensing and conventional sample analysis to assess asbestos pollution in rehabilitated former asbestos mining areas. The study focused on the Mafefe and Mathabatha areas of Limpopo Province; South Africa. Field-based remote sensing techniques were used to spectrally differentiate various types of asbestos minerals in order to determine their efficacy in assessing asbestos pollution. X-ray diffraction and scanning electron microscopy were employed for the identification and characterisation of traces of asbestos minerals in soil and water samples collected from the rehabilitated areas. The samples were also examined using in situ remote sensing. An Analytical Spectral Devices field spectrometer was used for spectral analysis of asbestos minerals and that of soil and water samples to compare and validate reflectance spectroscopy findings with laboratory results. Results show that in situ remote sensing techniques are able to reveal traces of asbestos minerals on rehabilitated dry surface areas; suggesting that they can play a significant role in monitoring the distribution of the asbestos minerals for epidemiological risk assessment. However; the spectral characteristics of asbestos minerals in the water medium were not as distinct as compared to laboratory methods. Overall; the results show potential for using remote sensing techniques in spatial epidemiology studies

Level and Determinants of Infant and Child Mortality in Malakal Town - Southern Sudan

This study aims to estimate the levels of infant and under five mortality rates in Malakal town; and to determine the socioeconomic; demographic and environmental factors contributing to infants and child mortality. The primary data for the study were collected using questionnaire and interviews in Malakal town; Sudan; while secondary data were collected from relevant literature. Three hundred eighty four women in the reproductive age (15-49) years were randomly chosen for the sample selected. The data were analyzed statistically using the Statistical Package for Social Sciences (SPSS). Frequency distributions and statistical test based on Chi-square for independence was conducted. The results revealed that infant mortality rate was )* per 1+++ live births; while under five mortality was 1+) deaths per 1+++ live births. Also the study found that child interval; child immunization; family size; family income; and mother's education; have significant influence on infant and under- five mortality. This shows the high need for infant and child immunization in Malakal town in addition to health education campaigns for parents and community in general

Le climat et la demographie peuvent-ils avoir un impact important sur le paludisme en Afrique subsaharienne dans les 20 prochaines annees?

Cette revue de la litterature presente les conditions d'evolution du paludisme en Afrique subsaharienne dans les 20 prochaines annees. Le paludisme est une maladie vectorielle limitee par des contraintes environnementales et humaines. Les limites environnementales sont essentiellement dictees par la sensibilite du vecteur (moustiques du genreAnopheles) et du parasite Plasmodium falciparum au climat. Le paludisme est stable; dit endemique; sur une grande superficie de l'Afrique. Seules les zones ou le paludisme est instable; dit epidemique; principalement les franges de la zone stable (Sahel; altitude) pourront etre influencees par les changements climatiques. L'accroissement de la temperature; notamment; pourrait induire une reduction du paludisme en zone sahelienne ou une augmentation en altitude. Ces tendances globales devraient etre modulees par des evenements meteorologiques exceptionnels conjugues aux activites humaines s'exercant sur l'environnement qui pourront entrainer localement des epidemies dramatiques de paludisme. Les contraintes humaines impliquent en particulier une demographie galopante et un developpement des villes. Des modelisateurs projettent que l'urbanisation va entrainer une reduction de l'exposition palustre de 53;5en 2030. Toutefois; l'adaptation au milieu urbain d'Anopheles gambiae et d'An. arabiensis; principaux vecteurs du paludisme en Afrique subsaharienne; ainsi que leur resistance croissante aux insecticides; pourraient influencer cette diminution. De maniere imprevisible; les mouvements massifs de population resultant de guerres ou de famines pourront aussi entrainer des epidemies palustres inattendues. Enfin les maladies immunosuppressives (HIV; malnutrition) pourraient alterer la susceptibilite des individus au paludisme. Les contraintes sociales impliquent l'activite anthropique qui modifie l'utilisation des sols. On sait que l'utilisation des terres (deforestation; irrigation)peut influencer le poids du paludisme qui lui-meme depend des determinants locaux de la transmission. In fine; la contrainte sociale la plus importante demeure l'acces des populations aux interventions pour prevenir et lutter contre le paludisme

The Modified Overt Aggression Scale: How Valid in this Environment?

Background:The Modified Overt Aggression Scale (MOAS) has been validated for use in the study of aggression in the developed world; unlike in the undeveloped world. The aim of this study therefore is to ascertain the discriminant validity of the MOAS for use in this part of the world using psychiatric in-patients at the Jos University Teaching Hospital. Methodology: Forty aggressive psychiatric patients and 40 non-aggressive healthy subjects were randomly selected for this study. The psychiatric patients were enlisted after fulfilling the ICD-10 (World Health Organization; 1993) criteria for a specific clinical diagnosis. The 40 non-aggressive subjects were mainly medical students and hospital staff. The MOAS was subsequently used to assess aggression in the entire cohort.Results: The males had higher mean global weighted score than the females in both the aggressive and nonaggressive categories. The mean global weighted scores of the aggressive and non-aggressive categories were 13.70+ 7.25 and 0.65 + 1.01 respectively. The difference in means is statistically significant; hence the MOAS has discriminant validity. Conclusion: Therefore; the modified overt aggression scale is a valid instrument in this environment for the study of aggression

The Modified Overt Aggression Scale: How Valid in this Environment?

Background:The Modified Overt Aggression Scale (MOAS) has been validated for use in the study of aggression in the developed world; unlike in the undeveloped world. The aim of this study therefore is to ascertain the discriminant validity of the MOAS for use in this part of the world using psychiatric in-patients at the Jos University Teaching Hospital. Methodology: Forty aggressive psychiatric patients and 40 non-aggressive healthy subjects were randomly selected for this study. The psychiatric patients were enlisted after fulfilling the ICD-10 (World Health Organization; 1993) criteria for a specific clinical diagnosis. The 40 non-aggressive subjects were mainly medical students and hospital staff. The MOAS was subsequently used to assess aggression in the entire cohort.Results: The males had higher mean global weighted score than the females in both the aggressive and nonaggressive categories. The mean global weighted scores of the aggressive and non-aggressive categories were 13.70+ 7.25 and 0.65 + 1.01 respectively. The difference in means is statistically significant; hence the MOAS has discriminant validity. Conclusion: Therefore; the modified overt aggression scale is a valid instrument in this environment for the study of aggression

Environment and health in Africa

The World Health Organization has identified four priority areas related to the environment and of vital importance to people's well-being in Africa. These include adequate and safe supply of water; hygienic disposal of human excreta; disposal of solid and household wastes; hygiene and appropriate housing. Contaminated water constitutes the most important vehicle for disease transmission. Therefore; provision of safe drinking water is essential in provision of public health services. Hygienic disposal of excreta reduces contamination of water. Safe disposal of solid and household wastes is also of extreme importance to families and communities wishing to maintain a reasonable standard of public hygiene and to keep their village and homes clean and attractive. Habitat; which encompasses the house and its immediate surroundings is where all people spend at least two-thirds of their life. It has a crucial influence on the physical; mental; and social well-being of all individuals; families and communities. The principles outlined in this article aim to make this influence favourable to people