RESUMO
Background: A major health consequence of rapid population growth in urbanareas is the increased pressure on existing overstretched water and sanitationservices. This study of an expanding periurban neighbourhood of Yangon Region,Myanmar, aimed to ascertain the prevalence of acute diarrhoea in children under5 years; to identify household sources of drinking-water; to describe purificationand storage practices; and to assess drinking-water contamination at point-of-use.Methods: A survey of the prevalence of acute diarrhoea in children under 5years was done in 211 households in February 2013; demographic data werealso collected, along with data and details of sources of drinking water, waterpurification, storage practices and waste disposal. During March–August, a subsetof 112 households was revisited to collect drinking water samples. The sampleswere analysed by the multiple tube fermentation method to count thermotolerant(faecal) coliforms and there was a qualitative determination of the presence ofEscherichia coli.Results: Acute diarrhoea in children under 5 years was reported in 4.74%(10/211, 95% CI: 3.0–9.0) of households within the past two weeks. More thanhalf of the households used insanitary pit latrines and 36% disposed of their wasteinto nearby streams and ponds. Improved sources of drinking water were used,mainly the unchlorinated ward reservoir, a chlorinated tube well or purified bottledwater. Nearly a quarter of households never used any method for drinking-waterpurification. Ninety-four per cent (105/112) of water samples were contaminatedwith thermotolerant (faecal) coliforms, ranging from 2.2 colony-forming units(CFU)/100 mL (21.4%) to more than 1000 CFU/100 mL (60.7%). Of faecal(thermotolerant)-coliform-positive water samples, 70% (47/68) grew E. coli.Conclusion: The prevalence of acute diarrhoea reported for children under 5 yearswas high and a high level of drinking-water contamination was detected, thoughit was unclear whether this was due to contamination at source or at point-of-use.Maintenance of drinking-water quality in study households is complex. Furtherresearch is crucial to prove the cost effectiveness in quality improvement of drinkingwater at point-of-use in resource-limited settings. In addition, empowerment ofhouseholders to use measures of treating water by boiling, filtration or chlorination,and safe storage with proper handling is essential
RESUMO
We studied the role of infections in ectopic pregnancy and the different methods of detecting Chlamydia trachomatis infection using serology, cervical and tubal PCR assays, by using a hospital-based, case-control study conducted between November 2007 and September 2009. The sample size was 339 with 113 cases and 226 controls. The cases were women admitted for the management of ectopic pregnancy while the controls were women admitted for spontaneous miscarriage. Both cases and controls were tested for syphilis and chlamydial infection by serology. In addition, cervical samples from controls and both cervical and tubal samples from cases were examined for the presence of chlamydia and gonococcal DNA. Sociodemographic data and past histories were collected using set Proforma. Independent variables for multivariate analysis included previous history of spontaneous abortion, ectopic pregnancy, symptoms of sexully transmitted infections (STI), and use of contraception. Women with a previous history of ectopic pregnancy (adjusted OR 28.3; 95% CI 5.8-138.8; p = 0.01) and a past history of having had symptoms of STI (adjusted OR 11.06; 95% CI 5.45-22.44; p = 0.0005) were significantly more likely to have an ectopic pregnancy than those without such a history. Syphilis serology was positive in 13.3% of ectopic pregnancy cases compared to only 3.5% of controls (crude OR 0.24; 95% CI -0.10-0.58; p = 0.001). From cervical swabs, chlamydia DNA was detected significantly more frequently in cases than controls (8.0% vs 2.2%; crude OR 0.261; 95% CI -0.09-0.80, p = 0.012) but gonorrhea DNA detection rates were not significantly different (3.5% vs 0.9%, crude OR 0.24; 95% CI -0.04-1.35; p = 0.1). Chlamydia was positive in cases only as diagnosed tubal samples for PCR in 17 (15.0%), cervical samples for PCR in 9 (8.0%) and IgM ELISA in 6 (5.3%). Among the three STI tested for in this study, C. trachomatis was the most frequently associated with ectopic pregnancy and was more frequently diagnosed by PCR on tubal samples than PCR on cervical samples or chlamydia IgM serology.
