Sexual Nursing Care For The Postpartum Period And Its Impact On Sexual Dysfunction And Life Satisfaction Among Egyptian Women

@#Many couples experience postpartum period of decreasing sexual satisfaction. Postpartum sexual dysfunction is a very common and relevant clinical problem, with significant adverse effects on women's health. The aim of this study was to evaluate the impact of sexual nursing care for the postpartum period on sexual dysfunction and life satisfaction among Egyptian women. A quasi-experimental design was used to study 219 women selected using a purposive sample. The study was conducted in out-patients maternity clinic at Zagazig university hospitals, Sharkia Governorate, Egypt, between the periods from February 2019 to February 2020. Data was collected using three tools. The first: Structured interview questionnaire that consist from three parts, part one: socio demographic characteristics , part two obstetric history and part three sexual history, the second: Female Sexual dysfunction index (FSDI), and the third: Satisfaction with Life Scale (SWLS).Four session about sexual education was done. The Results showed an improvement in sexuality and life satisfaction after application of sexual nursing care for the postpartum period including kegel’s exercise, positioning and distractions techniques post intervention compared to pre intervention. The study concluded that sexual nursing intervention for postpartum period improve sexual functioning and create enjoyable intercourse and there was high positive correlation between sexuality and life satisfaction after implementation of the sexual nursing care intervention. The study recommended to provide counselling /training program about sexual nursing care intervention during postpartum period for nurses working in different health care settings.

Determinants of unintended pregnancy and its impact on the health of women in some governorates of Upper Egypt

Worldwide, more than half of all unintended pregnancies end in abortion, indicating the preference for increasingly smaller families. The present work aimed to assess the determinants of unintended pregnancy and its impact on women's health in El Fayoum and Benisuef governorates. A community-based cross-sectional household survey was conducted among 827 married women of reproductive age. The study was conducted in two governorates, El Fayoum and Benisuef, for a period of 6 months. The current study revealed that 15.9% of women who participated in the study had an unmet need for family planning, with subsequent unintended pregnancy. Higher age of women and her age at the time of marriage, illiteracy, short interpregnancy spacing, exceeding the desired number of children, negative attitude of husbands toward the use of family planning methods, and absence of discussion between partners on the use of means to postpone pregnancy increased the number of unintended pregnancies. Also, women with unintended pregnancy were at a higher risk of experiencing health problems during her pregnancy. Despite the efforts taken by family planners, the problem of unintended pregnancy continues to increase in Egypt, with its adverse effect on pregnancy and maternal outcomes. Therefore, the strategy for maternal mortality reduction in Egypt should focus on addressing the unmet needs of high-parity, uneducated, nonworking women

Women's awareness of obstetric danger symptoms: is there a need to promote a preconceptional educational program?

Awareness towards the symptoms of obstetric complications will lead to timely access to appropriate emergency obstetric care. The aim of the study was to assess and compare the awareness towards obstetric danger symptoms among never-pregnant and ever-pregnant women and to identify predictors of their awareness as a measure for the need to promote a preconceptional educational program in Egypt. This study was conducted in selected villages of Alfayoum and Benisuef governorates as a comparative study between 173 newly married never-pregnant women and 827 ever-pregnant women who were randomly targeted by a structured interview during a period of 8 months. The questionnaire included personal data, social data, and data related to awareness of obstetric danger symptoms, complications, and action taken on having any of these symptoms. The scoring system was designed for women's awareness, with one degree allocated for a correct answer. The study revealed that the percent of women who gained a score of knowledge of at least 50% was higher among ever-pregnant women than among never-pregnant women [43.9 and 19.1%, respectively]. Although bleeding is the highest reported cause for obstetric complications and is one of the reported causes of maternal deaths in the studied villages, only 26.6 and 20.2% of the never pregnant and 43.9 and 34.3% of the ever pregnant groups, respectively, knew that bleeding is a danger symptom during delivery and the postnatal period. Meanwhile, better awareness about obstetric danger symptoms and exposure to health educational messages was significantly higher among ever-pregnant women [OR = 3.08 and 2.28, respectively] [P < 0.001]. This study reflects the need for intensifying antenatal health educational messages given to pregnant women and the need for the implementation of preconceptional health education programs

Influence of sociodemographic factors and environmental conditions on husbands' behavior toward maternal healthcare

Improving maternal health depends on husband's behavior which is affected by certain sociodemographic factors and environmental conditions. The study aimed to assess the husband's behavior toward maternal healthcare and emergency first aid measures for pregnancy and obstetric risks that might put life of women at risk of maternal death. The study also determined the socio-demographic factors and environmental conditions that influenced husband's behavior and attitude toward antenatal care providers and providers of assisted delivery. One thousand husbands of women in childbearing period were randomly selected through a community-based study that was conducted in 23 rural villages of four chosen districts of Benisuef and Al Fayoum governorates of Egypt. The study is a cross-sectional investigation conducted over a period of 8 months starting from July 2010 until February 2011. Data were collected from interviews of husbands on their sociodemographic characteristics, environmental conditions, and their knowledge, attitudes, intention, and practices toward maternal healthcare and services provided as well as toward providers of maternal healthcare. The study revealed that husbands who were younger than 20 years at the time of marriage, had a lower middle environmental score, and an upper middle income were nearly two or more times as likely of being unaware of the risk symptoms during pregnancy [odds ratio [OR] = 2.73, 1.37, and 1.59, respectively], during delivery [OR = 1.93, 1.31, and 1.76, respectively], and during the postnatal period [OR = 2.42, 1.36, and 1.77, respectively] compared with those older than 20 at the time of marriage, who had an upper middle environmental score, and a lower middle income. It is recommended to target husbands as an influential factor among high-risk wives by educating them on maternal health risks and by increasing their accessibility to maternal and obstetric health services, with special emphasis on younger men and those living under poor environmental conditions irrespective of their economic status

Cyclooxygenase-2 expression is associated with elevated AST level in hepatocellular carcinoma

Cyclooxygenase-2, the inducible rate-limiting enzyme of prostaglandins biosynthesis, has been reported to be involved in the pathogenesis of a variety of chronic inflammation-related human malignancies including Hepatocellular Carcinoma [HCC]. However, its clinical significance in HCC remains obscure. Our objectives were to evaluate COX-2 expression in HCC and correlate its expression to the different clinicopathological parameters and to assess its impact on patient survival. The present study was conducted on 17 HCC and 21 adjacent non-tumor liver tissues obtained from 22 HCC patients underwent curative hepatectomy at the National Cancer Institute, Cairo University, Egypt. Eight normal liver tissues taken from normal donors and HepG2 cell line were used as controls. Total RNA from tissues and cells was extracted and COX-2 mRNA was detected by RT- PCR and correlated to the clinicopathological criteria as well as to patient's survival. COX-2 mRNA was detected in 58.8% of the HCC tissues and in 28.6% of the adjacent non-tumor liver tissues. COX-2 expression was significantly associated with elevated levels of serum aspartate aminotransferase [AST] with high specificity for the detection of the disease. However, there was no significant correlation between COX-2 expression and any of the histopathological criteria. COX-2 expression may be involved in HCC carcinogenesis with high specificity for the detection of the disease It was significantly associated with elevated AST levels indicating disease severity. However cox2 expression seems to be an independent factor with no correlation to any of the clinicopathological data or patient's survival

Impact of two commercial types of feed supplement on rumen juice properties and body weight in Goats

Non pregnant female goats [12 animals] free from internal and external parasites and kept under observation for 4 weeks before being supplemented with two different kind of feed supplement for 8 weeks. Goats of experiment were divided into 3 groups each of them consists of 4 goat. [G1]: Treated with probiotic TOP 2X[R] with dose 1ml/liter of water, [G2]: treated with another supplement which contain fibrolytic enzymes GALZYM[R] with dose 1ml/3liters of water and [G3]: control group. Rumen juice samples were obtained weekly to observe the effect of bacterial probiotics TOP-2X[R] and fibrolytic enzymes Galzym[R] on the food digestibility of the small ruminants [goat] as well as the effect of them on some physical and biochemical properties of ruminal juice as well as body weight of treated animals and also to throw some lights on hematological parameters. Results of the study showed that using of bacterial probiotic TOP2X[R] as a dietary supplement is more beneficial than using of the supplement which contain fibrolytic enzymes GALZYM[R]. TOP2X[R] the bacterial probiotic enhancing body weight, protozoal count, level of T.V.F.A more than GALZYM

Compliance with haemodialysis practice guidelines in Egypt

Evidence- and consensus-based clinical practice guidelines for haemodialysis have recently been developed in Egypt. This study aimed to measure compliance with the guidelines in a sample of 16 government hospitals in Cairo and Giza governorates. Each haemodialysis unit was visited to assess the haemodialysis unit and patient care practices for all patients under dialysis at the time of the visit. The mean percentage compliance with haemodialysis guidelines among all study hospitals was 59.3% [SD 11.2%] overall. Within the 5 separate domains, compliance was: 58.8% [SD 12.4%] for personnel, 68.5% [SD 16.0%] for patient care practices, 61.3% [SD 15.4%] for infection prevention and control, 51.5% [SD 18.2%] for the facility and 56.5% [SD 7.1%] for documentation/ records. There were no statistically significant differences between Cairo and Giza governorates except for facility measures which were slightly better in Giza. Overall, compliance with the developed practice guidelines for haemodialysis in Egypt was not satisfactory and was not uniform across facilities

Molecular characterizaton of mycoplasma gallisepticum isolated from chicken and turkey

Mycoplasma gallisepticum [MG] infection in chicken and turkey is still one of the important reasons causing economic losses in poultry. The current study concerned with rapid detection and molecular characterization of MG isolates. The all samples positive by culture were positive by PCR and rt- PCR. Five isolated [four from chicken and one from turkey] were sequenced for mgc2 gene. The present molecular study proved that four wild-type MG strains. [Eis 3- C-10, Eis 4- C-10, Eis 5- C-10 were recovered from chicken and one [Eis 6-T-10] was recovered from turkey. While Eis 7-C-10 [vaccinal F-strain] was isolated from commercial layer flock vaccinated with F- strain vaccine. We concluded that mgc2 gene was able to distinguish between MG wild - type and vaccinal strains

Efficacy of different antibiotic combinations on uropathogenic multi-drug resistant Escherichia coli

Using checkerboard titration method as well as time-kill curve technique, the potential synergy of combinations of beta-lactams [ceftazidime and cefepime], aminoglycosides [amikacin, gentamicin, and tobramycin] and fluoroquinolones [ciprofloxacin, levofloxacin, and ofloxacin] were compared against multidrug resistant uropathogenic Escherichia coli isolated from patients with urinary tract infections. In the checkerboard titration studies, none of 21 combinations demonstrated antagonism against 8 strains, five of the 21 combinations showed synergism for more than 40% of the test strains, i.e. ceftazidime tobramycin, ceftazidime levofloxacin, amikacin levofloxacin, amikacin with ofloxacin, and tobramycin with levofloxacin, synergy occurred more often with levofloxacin combined with amikacin [7/8 strains]. Corresponding to the respective fractional inhibitory concentration [FIC] indices, the bactericidal activity determined in combinations of amikacin with ceftazidime or levofloxacin at sub-minimum inhibitory concentrations produced a significant reduction in bacterial count [>/= 2 log 10 cfu/ml] observed within 6 hours of drug administration, at 24 hours, both combinations were bactericidal [reduction in colony count >/= 3 log 10]. Results of this study suggest that amirioglycosides [amikacin and or tobramycin] combination with levofloxacin or ceftazidime could be promising alternatives for the treatment of serious urinary tract infections due to multi drug resistant E. coli

Seasonal variation of infestation rate with lice, tick and mite among rodents in certain Egyptian regions

Four species of mites [Ornithonyssus bacoti, Haemolaelaps glusgowi, Echinolaelaps echinolelaps and Dermanyssus gallinae], two species of ticks [Rhipicephalus sanguineus and Hyalomma dromedarrii] and one species of lice [Polyplax spinulose] were identified on rodents during 4 successive seasons [2005] trapped in five governorates [Suez, Menoufia, Giza, Damietta and Beni-Sewaf]. The rodents were Rattus norvegicus, Rattus rattus alexandrinus, Rattus rattus frugivourus, Acomys cahirinus and Mus musculus Rodents in Suez were the highly ecto-parasites infested ones

Rodents as reservoir host of intestinal helminthes in different Egyptian agroecosystems

Hymenolepis diminuta were detected in rodents in all zones surveyed Governorates under studied [Suez, Menoufia, Giza, Damietta and Beni-Sewaf]. The highest infestation recorded at Suez and Demiatta Governorates. On the other hand, rodents at Menoufia and Beni-Sewaf showed there is no convincing evidence that they infested with H. diminuta. The existence of one species of nematode namely, Streptopharagus kuntzi were recorded at Suez, Giza and Demiatta Governorates only. While Menoufia and Beni-Sewaf Governorates showed no convincing evidence that, they infested with nematode. Worms were recovered from Norway rats. Data indicated that Rattus norvegicus were the most vulnerable species at infection with H. diminuta and Streptopharagus kuntzi. Summer is highly infested with nematode in comparison with other seasonal study

Effect of alocasia macrorrhiza extract on hepatorenal functions in mice

Alocasia macrorrhiza [L] Schott and Endl is an ornamental perennial herbaceous plant which grows in coastal wetlands and valleys. Its common English name is Giant Elephant's Ear. The study planned to follow up the effect of the plant extract of Alocasia macrorrhiza on hepatorenal functions in mice following treated and recovery periods. Animals were divided into two major groups, a control and an experimental group. Animals of the experimental group received Alocasia extract orally day by day in a dose of 144.6mg / kg /day for 20 days. Animals were sacrificed after treated and recovery periods of 10 and 20 days respectively, blood samples were collected for hematological tests and biochemical analysis. Liver and kidney specimens were obtained and fixed in 10% formol saline for histological and histochemical study. RBCs, Hb were significantly decreased after treated period. Total protein, albumin and globulin were significantly decreased, while, AST, ALT, GGT, LDH, urea, creatinine, total lipid and cholesterol were significantly increased after treated and recovery period of 10 days. Histological changes in treated sections of the liver showed evidence of cellular degeneration and necrosis and in Kidney sections, tubular necrosis, glomerular shrinkage and atrophied glomerular tuft of capillaries were prominent. Mallory stained sections in liver showed increased collagen fibers around congested central veins, blood sinusoids and portal areas. While in kidney sections, the extract could not induce any change in the collagen fibers in the connective tissue. The changes which were observed after treatment disappeared after a recovery period of 20 days. However, the vascular congestion persisted. Histochemical studies revealed a significant decrease in PAS positive material in kidney after treated and a recovery period of 10 days. However DNA content showed non significant difference in all the experimental periods. The high LD[50] of the reversible action of the plant need more studies in different suitable doses before recommendation to use it safety as medicinal plant

Flowcytometric analysis of T-lymphocytes and serum tumour necrosis factor alpha [TNF- alpha] levels in schistosoma mansoni patients

Analysis of T-lymphocytes by flowcytometry, estimation of serum TNF-alpha level by solid phase enzyme amplified sensitivity immunoassay [EASIA] and IHAT were done for chronic schistosomiasis mansoni patients without hepatic fibrosis, with hepatosplenomegaly and 20 healthy controls. The sensitivity and specificity of IHAT in schistosomiasis mansoni were 85% and 90% respectively. Chronic schistosomiasis mansoni patients showed increase in CD8% [27.3 +/- 5.3] and decrease in CD4% [44.2 +/- 4.68]. Hepatosplenomegaly cases showed increase in CD4% [46.5 +/- 4.1] and decrease in CD8% [23.2 +/- 2.18]. Serum level of TNF-alpha was significantly higher in cases with hepatosplenomegaly compared to either cases of chronic schistosomiasis mansoni or controls. No significant difference was between chronic schistosomiasis mansoni patients and controls. A correlation between hepatosplenomegaly and increase of CD4 and/or decrease of CD8 and significant high level of TNF-alpha indicated TNF-alpha role in granuloma formation

Study of the effect of maternal malnutrition and antenatal care on pregnancy outcome among women living in squatter areas of Cairo, Egypt

Adequate maternal nutrition and proper antenatal and natal care can prevent unfavorable outcome of pregnancy. The present study aims to assess the quality of antenatal care, to study the prevalence of some maternal nutritional health problems and to study their effect on the outcome of pregnancy among ever-married women in the childbearing period [15-49 years] in some squatter areas of Cairo Governorate. The study examined 1164 ever-married women in the childbearing period. The sample size was calculated according to each indicator required to be measured and according to the prevalence of the studied problems. Six unplanned poor areas of Cairo were chosen randomly. A questionnaire sheet was designed to collect data from ever married women in the childbearing period in the household. It contained information about pregnancy care and pregnancy outcome for the last five years. Weight and height were measured for the entire studied sample and detection of hemoglobin level was done for a subsample of 303 women. The results revealed that the percentage of women who received antenatal care [ANC] in their last pregnancy was 55.6% and the quality of ANC was mostly poor [62.9%] in all squatter areas. Around half of children in squatter areas were born at home [48.2%] and doctors assisted more than half [56.0%] of all deliveries whereas pregnancy or delivery complications were detected in 27.9%. The overall percentage of the unfavorable outcome of pregnancy [abortion, stillbirth and ectopic pregnancy] was 22.5%. The percentage of women who had body mass index [BMI] below 18.5 was 3.4% indicating chronic energy deficiency. There was a high prevalence of severe anemia among non-pregnant [10.5%] and pregnant women [10.3%] and all the studied squatter areas showed high prevalence of moderate anemia among pregnant [76.5%] and non-pregnant [61.5%] women. The study concludes that there are high prevalence of moderate and severe anemia and high percentage of obesity [35.2%], the quality of ANC is mostly poor [62.9%] in all squatter areas and that the significant risk factors affecting unfavorable outcome of pregnancy are: poor quality of ANC, low maternal age and height [

Postprandial platelet depleted plasma 5-hydroxytrypamine concentration in symptomatic female with diarrhea predominant irritable bowel syndrome

Serotonin [5-HT] may play an important role in the regulation of colonic motility in humans. However, Meal ingestion is often associated with exacerbation of gastrointestinal symptoms in subjects with irritable bowel syndrome [IBS]. Abnormalities of 5-HT release after a meal might explain some of the postprandial symptoms associated with the irritable bowel syndrome [IBS]. To assess plasma serotonin [5-HT], 5-hydroxyindole acetic acid [5-HIAA] concentrations, 5-HT turnover, platelet 5-HT stores, and any relationship to symptomatology. In addition, to determine whether patients with different clinical manifestations of IBS have different mucosal disposition of 5-HT. After an overnight fast, 20 healthy female volunteers [aged 21- 46 years] [mean 29.3], and 39 female subjects with diarrhea predominant irritable bowel syndrome [d-IBS] [aged 20-48 years] [mean 31.4], were given a standard carbohydrate meal [457 Kcal]. Platelet depleted plasma 5-HT, and 5-HIAA concentrations for two hours [60 minute intervals] under fasting conditions, and then for a further four hours [30 minute intervals] after standard carbohydrate meal were assessed, together with fasting platelet 5- HT concentrations. IBS symptomatology, in particular abdominal pain and bloating, and urgency to defecate were assessed throughout the study. Colonic mucosal specimens ranging from the ascending colon to the rectum were obtained from patients with diarrhea-predominant and from subjects with normal bowel habit by endoscopic biopsy, the tissue concentrations of 5-HT and its major metabolite, 5-hydroxyindoleacetic acid, were determined by reversed-phase high-performance liquid chromatography with fluorescence detection. When related to fasting level, there was no statistically significant difference in postprandial plasma 5-HT concentrations between d-IBS and healthy subjects. However, when fasting levels were not taken into consideration, d-IBS subjects exhibited higher postprandial plasma 5-HT concentrations compared with healthy subjects [p = 0.040]. Furthermore, d-IBS subjects who exhibited postprandial symptomatology had higher levels of postprandial plasma 5-HT, whether assessed with respect to fasting baseline levels [p = 0.065] or not [p = 0.046], compared with dIBS subjects who did not report postprandial symptomatology. This appeared to be associated with a concomitant increase in plasma 5-HIAA [p = 0.162] but reduction in turnover [0.057]. Also, d-IBS subjects had higher platelet concentrations of 5-HT than healthy subjects [p = 0.009]. The mean mucosal 5-HT concentrations obtained from the rectum regions of the colon. In addition, the overall mean mucosal 5-HT concentrations obtained from patients with d-IBS were significantly [p = <0.05] lower than those obtained from the control subjects. No significant difference were observed in 5-HIAA concentrations among the two groups. These data suggest that postprandial symptomatology may be associated with increased platelet plasma 5-HT concentrations in female subjects with d-IBS. The increased release of 5-HT into plasma leads to depletion of mucosal 5-HT in subjects with d-IBS. The presence of increased platelet stores of 5-HT may act as a useful marker for the diagnosis and management of d-IBS

Peg - in hole osteotomy for correction of the hallux valgus deformity

In this study, 17 osteotomies were performed in 13 patients with a mean age of 23.23 [ +/- 4.6]. None of them had severe arthritic pain, severe restriction of movement, DM or peripheral vascular disease. Also, their X-rays did not show severe degenerative changes. The patients were followed up for an average period of 2.1 years. Excellent clinical results were achieved in 13 feet, good results in 2, while a fair result was achieved in one foot and a poor result in one foot. The radiological evaluation showed a good improvement of the valgus angle in 15 feet, fair improvement in two with no poor cases. No cases of avascular necrosis of the head, non-union or displacement of the osteotomy were reported

Cryopreservation of trichomonas vaginalis: a trial of useing four different cryoprotectants

To reach the maximum survival rate of Trichomonas vaginalis after cryopreservation, four substances; namely, dimethylsulfoxide [DMSO], glycerol, egg yolk and horse serum, were used as cryoprotectants. T. vaginalis trophozoites, in the logarithmic phase, cultured on TYM-S medium were used. Rapid and slow freezing schedules were followed. Examinations for viable organisms were done after a month duration in liquid nitrogen. Immediate and delayed thawing was tried. Viability scores depended on the presence of live organisms in the thawed parasite suspensions determined by the presence of motile trophozoites under microscopic examination, by dye uptake and re-suspension of the organisms in fresh TYM-S and watching for parasite growth and multiplication. Rapid freezing protocol failed to cryopreserve T. vaginalis with any cryoprotectant. DMSO was superior to glycerol, especially in 10% concentration by slow freezing. Viable organisms were more when the suspensions were immediately thawed without delay

Molecular identification of coproantigens of Cryptosporidium parvum compared to conventional staining techniques

To compare the immunologic techniques with the conventional staining methods [mainly modified Ziehl-Neelsen, MZN], 93 children [65 immunocompromised and 28 immunocompetent] potentially at risk of Cryptosporidium parvum were studied. Using MZN, a prevalence of 10.7% in diarrheic children was found. ELISA coproantigen and detection of 23 kDa band of immunoblotting by serum IgG were sensitive and specific. They gave 85.7% sensitivity, 100% specificity, 100% diagnostic accuracy, 100% positive predictive value and 98.9% negative predictive value. ELISA detection of serum IgG gave 85.7% sensitivity, 97.7% specificity, 96.8% diagnostic accuracy, 75% positive predictive value and 98.9% negative predictive value. So, it was concluded that 23 kDa band determined by ELISA is a valuable sensitive and specific mean of diagnosing cryptosporidiosis, as this antigen is a consistent target of the humoral immune response

Compatibility of Biomphalaria alexandrina snails to Infection with Schistosoma mansoni after exposure to sublethal concentations of Myrrh

The effect of exposing B. alexandrina to the sublethal dose [LC10 and LC20] of myrrh, on its susceptibility to infection with S. mansoni miracidia were determined. At three weeks post miracidial exposure, cercarial shedding was monitored. No shedding of cercariae was observed from snails treated with LC20. In snails treated with LC10, longer prepatent cercarial and shorter cercarial production periods than those of the control group were recorded. The number of infected snails and shedding cercariae was decreased. The study revealed that the sublethal values of myrrh decreased the compatibility of B. Alexandrina to S. mansoni infection, thus proved to have an important role in the control of schistosomiasis

Upgrading of awareness, attitude and practice of rural females towards some health hazards

The objective of the present study was to assess and upgrade the level of awareness, attitude and practice of village hygiene volunteers [VHVs], rural females belonging to their correspondence villages and trusted by their communities towards certain health topics including sanitary housing, personal hygiene, indoor and outdoor health hazards, water hygiene and pollution, food safety [storage and pollution] and sanitary sewage and waste disposal. This was carried out by building the capacity of 375 VHVs located in Fayoum, Beni-Suif and El-Minia governorates through training with the basic knowledge that facilitates dissemination of what they learn to their communities. The implementation of the training courses resulted in a significant improvement in the majority of environmental topics, especially safe housing properties, sources of water pollution, proper handling of water, food hygiene, personal hygiene, preventing milk and fool transmitted diseases and the proper handling and maintenance of latrines