To What Extent is Drinking Water Tested in Sub-Saharan Africa? A Comparative Analysis of Regulated Water Quality Monitoring.

Water quality information is important for guiding water safety management and preventing water-related diseases. To assess the current status of regulated water quality monitoring in sub-Saharan Africa, we evaluated testing programs for fecal contamination in 72 institutions (water suppliers and public health agencies) across 10 countries. Data were collected through written surveys, in-person interviews, and analysis of microbial water quality testing levels. Though most institutions did not achieve the testing levels specified by applicable standards or World Health Organization (WHO) Guidelines, 85% of institutions had conducted some microbial water testing in the previous year. Institutions were more likely to meet testing targets if they were suppliers (as compared to surveillance agencies), served larger populations, operated in urban settings, and had higher water quality budgets (all p < 0.05). Our results indicate that smaller water providers and rural public health offices will require greater attention and additional resources to achieve regulatory compliance for water quality monitoring in sub-Saharan Africa. The cost-effectiveness of water quality monitoring should be improved by the application of risk-based water management approaches. Efforts to strengthen monitoring capacity should pay greater attention to program sustainability and institutional commitment to water safety.

Cigarette smoking and drinking behavior of migrant adolescents and young adults in Hanoi, Vietnam.

PURPOSE: There has been a large migration from rural to urban areas in much of the developing world. In the past, this was less true in Vietnam, which remains largely agricultural; however, since the 1990s, economic reforms and loosening of government policies that had previously limited movement have led to a large increase in this rural to urban population movement. Risky health behaviors have been found among migrants in many other settings. The purpose of this research was to determine whether migrant adolescents and young adults in the city of Hanoi are more or less likely than local ones to engage in cigarette smoking and alcohol drinking health risk behaviors, to identify factors associated with these behaviors, and to suggest interventions to reduce these health risk behaviors among the study population. METHODS: A cross-sectional survey of 4,550 adolescents and young adults aged 15-24 years was conducted in urban Hanoi in 2006. This study examines current use of cigarettes and alcohol by migration status using multivariate logistic regressions. RESULTS: Cigarette smoking and drinking alcohol are male phenomena. The prevalence of cigarette smoking and alcohol drinking is high among adolescents and young adults in Hanoi and is more common among migrants who came from rural areas of other provinces than nonmigrants in the city. However, multivariate analysis revealed that migrants were neither more likely to smoke cigarettes nor drink alcohol than nonmigrants after controlling for other factors, such as age, full-time worker status, depression, and having close friends who smoke and/or drink. CONCLUSIONS: The results suggest that interventions aiming at smoking and/or drinking reduction should pay more attention to adolescents, especially males, changing health risk behaviors at school and at work, and peer influence than their migration status.

Community and household determinants of water quality in coastal Ghana.

Associations between water sources, socio-demographic characteristics and household drinking water quality are described in a representative sample of six coastal districts of Ghana's Central Region. Thirty-six enumeration areas (EAs) were randomly chosen from a representative survey of 90 EAs in rural, semi-urban and urban residence strata. In each EA, 24 households were randomly chosen for water quality sampling and socio-demographic interview. Escherichia coli per 100 ml H2O was quantified using the IDEXX Colilert system and multi-stage regression models estimated cross-sectional associations between water sources, sanitation and socio-demographic factors. Almost three quarters, 74%, of the households have > 2 E. coli /100 ml H2O. Tap water has significantly lower E. coli levels compared with surface or rainwater and well water had the highest levels. Households with a water closet toilet have significantly lower E. coli compared with those using pit latrines or no toilets. Household size is positively associated, and a possessions index is negatively associated, with E. coli. Variations in community and household socio-demographic and behavioural factors are key determinants of drinking water quality. These factors should be included in planning health education associated with investments in water systems.

Child health status and maternal and child care in Quangtri Province, Vietnam.

Save the Children's CS-18 Project implemented from 2003 to 2008 aimed to improve child health and nutritional status people in Quangtri Province through the increased use of life-saving health interventions, both behaviors and services. This baseline survey, conducted at the start of the project to provide data to evaluate the effectiveness of the intervention upon its completion. A household survey was conducted of four hundred mothers of children under 2 years of age. Logistic regression was used to determine the relationship between maternal care behaviours and child health, controlling for confounding variables. In-depth interviews with 27 mothers and 4 focus group discussions with 38 mothers were also conducted. The rate of childhood malnutrition was 40.5%. The percentage of mothers that gave birth at home was 56.5%, and only 35.4% of these used a clean home delivery kit. Health staff only attended approximately 17.7% deliveries. Few mothers and newborns (23.8%) were checked after delivery. About half the mothers 54% did not feed their child colostrum, and most mothers (81.6%) stopped breastfeeding before 18 months. 58.8% of the children were sick within a month of birth. Child malnutrition was associated with child sex, age, birth weight, ethnicity, and socio-economic status (P < .001). Low rates of safe delivery and child care practices and high rates of infant illness indicate a need for improved service provision and education. Health facilities should be staffed continuously, promote village health workers in villages. Health staff should carry out a health communication campaign about maternal and child health. Family members, especially husbands, should be encouraged to take care of recent mothers during pregnancy and delivery.