Epidemiology of Underweight among Infants in Rural Burkina Faso.

Infant undernutrition is thought to contribute to growth failure and mortality. We evaluated the patterns in underweight in a population-based sample of children aged 1-11 months in rural northwestern Burkina Faso. Data were collected during the baseline assessment of a community-randomized trial evaluating mass azithromycin distribution in Nouna District, Burkina Faso. A door-to-door census was undertaken for all households in all communities. Infants aged 1-11 months were weighed for weight-based dosing in the trial and their weights were used to calculate weight-for-age Z-scores (WAZ). Underweight was defined as WAZ ≤ 2. We evaluated the age patterns in WAZ and underweight by demographic, seasonal, and geographic characteristics. Of 7,109 infants, 6,077 had accurate weight and global positioning system (GPS) coordinate data (85.5%). Infants were a median of 6 months old (interquartile range [IQR] 3-8) and 48.4% were female. Mean WAZ was -0.68 (SD 1.6) and 19.0% were underweight. The WAZ decreased with increasing age, and the prevalence of underweight increased from 2.5% among 1-month-olds to 27.6% among 11-month-olds. Underweight was more common among boys than girls (22.1% among boys versus 15.6% among girls). Improved latrine use by the household was associated with increased WAZ, and this effect was stronger in male compared with female infants. Given the large burden of underweight among infants, interventions addressing undernutrition should specifically include infants.

"Kicked out": LGBTQ youths' bathroom experiences and preferences.

Attention toward who can use which gender binary, multi-stall bathroom has brought to the forefront, once again, the ways in which youth are supported or marginalized. No study has documented sexual and gender minority youths' experiences with and perspectives about bathrooms. We collected qualitative data in 2014-2015. Participants were 25 lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth, aged 14-19, in the United States and Canada. Their comments describe first- and second-hand bathroom experiences, identify advocacy efforts, and highlight the roles of peers and adults in making bathrooms safe (or not). Youth emphasized the importance of gender-neutral bathrooms in fostering a sense of safety and inclusivity. Adult support and gay-straight alliances (GSAs) were important contributors to a welcoming environment and fostered advocacy efforts for gender-neutral bathrooms. We encourage purposeful inclusivity of youths' voices when enacting bathroom-specific policies and legislation that directly influence their health and well-being.

Shared sanitation and the prevalence of diarrhea in young children: evidence from 51 countries, 2001-2011.

Shared sanitation is defined as unimproved because of concerns that it creates unsanitary conditions; this policy is being reconsidered. We assessed whether sharing a toilet facility was associated with an increased prevalence of diarrhea among children < 5 years of age. We use data from Demographic and Health Surveys conducted in 51 countries. Crude and adjusted prevalence ratios (PRs) for diarrhea, comparing children from households that used a shared facility with children from households that used a non-shared facility, were estimated for each country and pooled across countries. Unadjusted PRs varied across countries, ranging from 2.15 to 0.65. The pooled PR was 1.09; differences in socioeconomic status explained approximately half of this increased prevalence (adjusted PR = 1.05). Shared sanitation appears to be a risk factor for diarrhea although differences in socioeconomic status are important. The heterogeneity across countries, however, suggests that the social and economic context is an important factor.

Hygiene versus fertiliser: the use of human excreta in agriculture--a Vietnamese example.

The use of human excreta as fertiliser in agriculture is a common practice in parts of South East Asia benefiting production but at the same time a risk factor for increased helminth infections. This paper describes the hygienic handling of human excreta for use in agriculture in Central Vietnam from a practical farming perspective presenting the farmers perceived health risks and benefits of its use. Further, in the study findings are discussed relating to the new Vietnamese guidelines for the use of human excreta in agriculture to their implications on an on-farm context. A total of 471 households in five communes responded to a structured questionnaire. This survey was supplemented by focus group discussions, key informant interviews and participant observations. More than 90% of the surveyed households used their own excreta as fertiliser and a total of 94% composted the excreta before use, either inside or outside the latrine. However, due to the prevailing design of the latrine and the three annual cropping seasons, it was found that for a minimum of one cultivation season per year 74% of the households will have only 3-4 months for composting before the input is needed in production, which is short of the 6 months stipulated in the national guidelines. The community associated great benefits from using human excreta in agriculture, especially if composted, and did not associate risks with the use of composted excreta if it was dry and lacked odour. It is recommended that the guidelines be revised and attempts made to identify ways of reducing the time needed to ensure the die-off of helminth eggs, including the use of pH regulators, such as an increased use of lime in the latrines.

Palaeoparasitology in Japan--discovery of toilet features.

The development of palaeoparasitology in Japan has occurred in recent decades. Despite the fact that archaeology in Japan has been slow to develop techniques for excavating ancient toilets, important information about the development of sanitation has been derived from the analysis of a few sites. This shows that the earliest people had very simple methods of sanitation. As populations increased, sanitation became more complex. Ditches surrounding early towns were used for excrement disposal. Eventually distinct toilets were developed followed by cesspit type toilets and flushing toilets. The parasites recovered from these toilets include many species that infect humans today. These parasite spectra reflect local use of aquatic, marine, and land animals. Fecal borne disease was an increasing problem as represented by whipworm and ascarid roundworm eggs. Interestingly, ascarid roundworms were absent in the earliest cultures and only became common with rice agriculture. Finds of pollen and seeds in toilet sediments reveal the use of medicinal plants to control the emerging problem of parasites.

A study of prevalence of protein energy malnutrition among 0-5 years in rural Benue State, Nigeria.

Three hundred and seventy pre-school children (181 males and 189 females) were studied in order to document the prevalence of protein energy malnutrition and factors that militate it. The prevalence of protein energy malnutrition among the children was revealed to be 41.6% (154). One hundred and fiftyone (40.8%) of them were found to have weight-for-height below -2SD indicating level of stunting among the children. Most malnourished children belonged to mothers who were illiterate 97 (54.8%) when viewed from the mothers' educational perspective. This study also showed the following factors that were statistically significant with PEM: educational status of mothers (p<0.05), marital status (p<0.05) of mothers, occupational status of mothers (p=0.000), parental income per annum (p=0.000), length of breastfeeding (p=0.000), water supply and regularity, type of housing and toilet facilities. Intensification of health education aimed at encouraging beneficial childhood feeding practices in the community is needed together with further study on the subject, which will be directed at actual analysis of the nutritive values of available local foodstuffs as a prerequisite for an effective intervention programme.

Choosing a commode for the ward environment.

The choice of appropriate equipment to promote patient independence and enhance nursing care is of major concern to the nurse in the ward environment. This article reports on a recent evaluation of specialist commodes, (Ballinger et al, 1994), with reference to the programme funded by the Medical Devices Agency, Department of Health, under whose auspices the project was carried out. The results of user evaluations and technical tests of six mobile commodes are presented, the preferred model being the Mayfair commode supplied by Carters (J&A) Ltd. The article concludes by identifying a number of important considerations to bear in mind when selecting a commode.

Family latrines and paediatric shigellosis in rural Bangladesh: benefit or risk?

BACKGROUND: The potential benefits of installing excreta disposal facilities on the burden of paediatric diarrhoea in less-developed settings remain controversial. We conducted a longitudinal study to evaluate whether family latrines are associated with interruption of the transmission of shigellosis to younger children in rural Bangladesh. METHODS: We prospectively studied 1529 children under 5 years of age exposed to index cases of Shigella dysentery. In all 219 children with culture-proven shigellosis detected during 1 month of follow-up were compared with 1310 control children who did not develop shigellosis or Shigella-negative dysentery. RESULTS: Overall, the presence of a family latrine appeared to be associated with a higher, not a lower, risk of paediatric shigellosis (adjusted odds ratio (ORa) = 1.37, 95% confidence interval (CI): 0.99-1.89). While use of a pit or sanitary latrine revealed no evidence of a protective association (ORa = 0.96, 95% CI: 0.43-2.15), use of a hanging latrine in which faeces were discharged directly onto the ground or into a body of water was associated with a notable increase of risk (ORa = 1.42, 95% CI: 1.02-1.98, P < 0.05). CONCLUSIONS: While cautioning that installation of sanitary latrines may not be sufficient to reduce the burden of paediatric shigellosis in less-developed settings, these data suggest that eliminating unsanitary latrines constitutes a potentially important intervention in its own right in these settings.

Household sanitation in Uasin Gishu district in Kenya.

In rural Uasin Gishu District in 1990, 78.2% of the households had pit latrines, 11.3% ventilated improved pit latrines, 0.8% water-borne and 9.7% with no toilet facilities. On inspection, 97% of the toilet facilities were in use. Compost pits were present in 52.3% of the households. Utensil drying racks were found in 56.0% of the households. Compared to previous estimates, these levels represent a tremendous improvement in sanitation service coverage. It is recommended that the impact of water and sanitation programmes on health status needs to be evaluated. There is a need for studies to be done on the value of utensil drying racks in disease control.