A formal model concerning policy strategies to build public acceptance of potable water reuse.

Water stress is an increasing burden in regions with arid climates, aquifer vulnerability, and erratic rainfall. Population growth and competing domestic, industrial, and agricultural uses are also stretching the capacity of water supply systems. Beyond groundwater extraction, surface water overuse, and inter-basin transfers, governments are exploring alternative sources amidst looming supply threats. These alternatives include desalination, greywater recycling, and reclaimed or recycled wastewater. The latter, also known as water reuse with varying levels of treatment, has been applied for irrigation, street cleaning, industrial processes, and groundwater recharge. However, reused water for potable purposes has seen limited uptake, due in part to lack of public acceptance. This article examines the dynamics of public acceptance for potable water reuse. The article's theoretical contribution is a formal mathematical model for understanding public acceptance of water reuse. The model conceptualizes how governments, water utilities and the public interact to facilitate or hinder acceptance of water supply sources, including potable reuse. The article concludes by applying the model to cases of water reuse in Windhoek, Namibia, and Singapore.

Status of birth preparedness and complication readiness in Uttar Dinajpur District, West Bengal.

CONTEXT: Birth Preparedness and Complication Readiness (BPCR) is crucial in averting maternal morbidity and mortality. OBJECTIVES: To find out awareness and practices regarding BPCR among pregnant and recently delivered women in Uttar Dinajpur, West Bengal. MATERIALS AND METHODS: This is a cross-sectional, community-based, mixed methods study. Two-stage, 40 cluster sampling technique was used to select three pregnant and six recently delivered women separately. Information on socio-demographic variables as well as awareness and practices regarding BPCR were collected through semi-structured interview. In-depth interviews with one respondent per cluster were also conducted. For statistical analysis Z test was used. RESULTS: Around 50% of the respondents planned for first antenatal check-up (ANC) within 12 weeks, four or more ANCs and institutional delivery. Proportion of women aware of at least one key danger sign each of pregnancy, labor, postpartum, and newborn ranged from 12.1% to 37.2%, whereas 58.3% knew at least one key component of essential newborn care. Around two-thirds and one-third of women, respectively, especially those from backward and below poverty line (BPL) families knew about cash incentive and referral transport schemes. Proportions of women with first ANC within 12 weeks, four or more ANCs, institutional delivery, saving money, identifying transport, and blood donor were 50.4%, 33.6%, 46.2%, 40.8%, 27.3%, and 9.6%, respectively. Hindu religion, backward castes, BPL status, and education ≥ 5 years influenced the practices except for two regarding ANC. Overall BPCR index of the study population was 34.5. CONCLUSION: Preparedness in health system, ensuring competence, and motivation of workers are needed for promoting BPCR among the study population.

The heterogeneity of measles epidemiology in India: implications for improving control measures.

BACKGROUND: Measles vaccination coverage varies in India. Trainees of the Field Epidemiology Training Programme (FETP) investigated 8 outbreaks from 2004 through 2006 in Himachal Pradesh, Uttaranchal, Tamil Nadu, and West Bengal. We reviewed these outbreaks to contribute to the description of the epidemiology of measles and propose recommendations for control. METHODS: FETP trainees searched for measles cases through stimulated passive surveillance or door-to-door case search; estimated attack rates, case fatality, and the median age of case patients; interviewed mothers about vaccination status of their children; and collected serum samples for immunoglobulin M serological testing whenever possible. For 3 outbreaks, the trainees estimated the vaccine efficacy for children >12 months of age through cohort studies. RESULTS: Six of the 8 outbreaks were serologically confirmed. Compared with outbreaks in other states, outbreaks in states with vaccination coverage of >90% had a higher median age among case patients and a lower median attack rate. Six deaths (case fatality rate, 1.5%) occurred during the 5 outbreaks for which vitamin A was not used. The vaccine efficacy was 84% (95% confidence interval [CI], 74%-91%) in Himachal Pradesh. In West Bengal, it was 66% (95% CI, 44%-80%) in 2005 and 81% (95% CI, 67%-89%) in 2006. CONCLUSIONS: In states with higher coverage, attack rates were lower and case patients were older. Although states with coverage of <90% should increase 1-dose coverage and address coverage in pockets that are poorly reached, a second opportunity for measles vaccination could be considered in states such as Himachal Pradesh and Tamil Nadu. Use of vitamin A for case management needs to be generalized.

Measles in rural West Bengal, India, 2005-6: low recourse to the public sector limits the use of vitamin A and the sensitivity of surveillance.

BACKGROUND: Measles is often underreported. We evaluated the sensitivity of the measles surveillance in 2 districts of West Bengal in 2005-2006. METHODS: We sampled households with children aged <5 years in village clusters selected with probability proportional to size. We searched households door to door to identify World Health Organization-defined suspected measles cases that had occurred during 12 months in 2004-2005 in Howrah and in 2006 in Purulia. We interviewed mothers about use of health care services during episodes and calculated the proportion of patients seen in the public sector. We reviewed surveillance records at all levels to estimate the proportion of cases seen in public health care facilities that had been reported to the district. We calculated the overall sensitivity of measles surveillance by multiplying these 2 proportions. RESULTS: In Howrah, we identified 240 cases of measles. Of these, 8 (3.3% [95% confidence interval {CI}, 1.5%-6.5%]) had been seen in public facilities and recorded. Of 980 cases identified in 448 public facilities in the periphery, 962 (98%) had been transmitted to the district (overall sensitivity of surveillance, 3.2%). In Purulia, we identified 167 measles cases. Of these, 39 (23.4% [95% CI, = 17.2%-30.5%]) had been seen in public facilities and recorded. Of 418 cases identified in public facilities in the periphery, 414 (99%) had been transmitted to the district (overall sensitivity of surveillance, 23.1%). CONCLUSIONS: Measles surveillance captured a minority of measles cases, but cases captured were transmitted well to the district. Surveillance must engage the private sector. Health education focusing on vitamin A treatment for measles might provide an incentive to seek care, which could increase the sensitivity of surveillance.

The 2010 outbreak of cholera among workers of a jute mill in Kolkata, West Bengal, India.

On 10 March 2010, an outbreak of diarrhoeal disease was reported among workers of a jute mill in Kolkata, West Bengal, India. The cluster was investigated to identify the agent(s) and the source of infection and make recommendations. A suspected case of cholera was defined as having >3 loose watery stools in a 24-hour period and searched for case-patients in the workers' colony. The outbreak was described by time, place, and person, and a case-control study was conducted to identify the source of infection. Rectal swabs were collected from the hospitalized case-patients, and the local water-supply system was assessed. In total, 197 case-patients were identified among 5,910 residents of the workers' colony (attack rate 3.33%). Fifteen of 24 stool samples were positive for Vibrio cholerae O1. The outbreak started on 7 March, peaked on 11 March, and ended on 16 March 2010. Compared to 120 controls, 60 cases did not differ in terms of age and socioeconomic status. Drinking-water from the reservoir within the mill premises was associated with an increased risk of illness [odds ratio: 26.7, 95% confidence interval (CI) 11.4-62.6) and accounted for most cases (population attributable risk percentage = 82%, 95% CI 70.8-92.9). An outbreak of cholera occurred among workers of the jute mill due to contamination of the drinking-water reservoir. It occurred within a few days of re-opening of the mill after the workers' strike. Health authorities need to enforce disinfection of drinking-water and regularly test its bacteriological quality, particularly before re-opening of the mill after the strike.

Social perceptions of the impacts of Colombo water supply projects.

The complexity of development activities, in which the interactions between various forces often mean that outcomes are unpredictable and unanticipated, highlights the importance of objective and comprehensive evaluations. In the specific case of the evaluation of towns east and south of Colombo water supply projects, the findings have major implications for the implementation of the Millennium Development Goals, if the water-related objectives are to be fulfilled. The study found that 30% of the households of these towns that are receiving clean, piped water are not using it for drinking. Instead, they are continuing to drink contaminated well water. Whereas it is considered that the main beneficiaries of water supply projects have been women and people who are sick, elderly, or disabled, the general perception is that the health conditions of the families have not improved with the provision of clean water (in fact, many claim that their health conditions have deteriorated). In spite of the higher cost of the supplied water, people are willing to pay for it as long as the supply is reliable.