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Editorial: Handwashing with soap - A new way to prevent ARIs?
Tropical Medicine & International Health
Abstract
In the early part of the twentieth century, British and American sanitary engineers and epidemiologists, impressed by the beneficial effects of water supply on child mortality, also discussed with some curiosity what came to be called the Mills-Reinicke phenomenon. By this they referred to the surprising fact that the reduction in child mortality accompanying improvements in water supply was greater than what could be accounted for by the fall in mortality caused by enteric, waterborne diseases. A satis- factory explanation was never found, but with the
... Most literature on water-washed or water-related diseases focuses on roundworm, hookworm, conjunctivitis, scabies and other infections found in developing country or refugee settings but recent evidence suggests that handwashing also reduces the risk of acute respiratory infections (Cairncross 2003). 28 For late nineteenth century London, the availability of water likely resulted 27 Transcribed registration district mortality data was kindly shared with us by Brian Beach. ...
... We mapped registration district data to our 20 health districts. 28 Cairncross (2003) argues that handwashing may provide explanation for the Mills-Reincke phenomenon observed during the late nineteenth century (Ferrie and Troesken 2008). in more frequent handwashing and may have played a role in reducing the transmission of a number of non-waterborne diseases through these broader improvements in the sanitary environment. ...
What are the benefits of moving from intermittent water delivery (which limits user access to less than 24 hours per day) to constant service? To address this question, we study the transition from intermittent to constant water supply in London. Between 1871 and 1910, the proportion of London households with access to a constant water supply (24 hours a day, 7 days a week) rose from less than 20 to 100 percent. Idiosyncratic delays in the negotiation process between companies and property owners generated random variation in the timing of the transition across London districts. Exploiting this variation, we find that a one percentage point increase in a local population with access to constant service decreased deaths from waterborne diseases by as much as 0.4 percent and explains approximately a fifth of the late nineteenth century decline in waterborne disease mortality. Results are robust to the inclusion of controls for population density, concerns regarding the reporting of cause-of-death, district-specific time trends, district demographics and spatial autocorrelation.
... Despite its effectiveness, washing hands with soap is not a common practice among children. (Cairncross, 2003). Several studies have found that hand washing techniques resulted in the isolation of disease causing bacteria from children's hands. ...
Pathogenic bacteria pose a serious risk in schools, where students come into contact with a variety of microbes on a daily basis. Classrooms are thought to be ideal environments for young children to harbor germs. The current study sought to determine the extent of the spread of bacteria in different places in primary schools, as well as to determine whether the schools are sterile and clean for children or whether they are the real cause of their illness. Samples were taken from the primary schools. The schools are located in Wadi Jaref ,Sirte. 30 samples were collected from different classrooms and from places the student comes into contact with, such as door handles, desk, and children’s hands. The organisms isolated in this study, based on colonial morphological, and biochemical characteristics the results showed the presence of bacteria Staphylococci epidermidis(35%), Staphylococcus aureus (22%), Esherichia coli (13%), klebsiella pp, micrococcus and Streptococcus (9%), bacillus(4%). The study showed that the largest number of bacterial colonies (Colony Forming Units) (CFU) found on the hands (75 CFU), Desks(26 CFU) and Door handles (22 CFU). This study emphasized the wide range of possible diseases and demonstrated the presence of harmful bacteria in primary schools. This is related to the increasing number of students in primary schools which lack proper hygiene conditions and due to the failure to carry out routine cleaning and sterilization of schools and the lack of facilities. Keywords: Primary schools, Bacteria, Contamination, Microorganisms, Children, Colony, Wadi Jaref, Sirte.
... O papel da água na transmissão de doenças infecciosas respiratórias foi sugerido décadas após a classificação original das doenças relacionadas à água. No entanto, o foco estava principalmente no efeito protetor da lavagem das mãos (Cairncross, 2003;Fung & Cairncross, 2006). Recentemente, uma quinta categoria de doenças relacionadas à água foi proposta (Bartram & Hunter, 2015): ÁGUA5 -transmissão associada aos sistemas de abastecimento de água e esgotamento sanitário, incluindo a inalação de gotículas ou aerossóis gerados em encanamentos (por exemplo, Legionella). ...
... O papel da água na transmissão de doenças infecciosas respiratórias foi sugerido décadas após a classificação original das doenças relacionadas à água. No entanto, o foco estava principalmente no efeito protetor da lavagem das mãos (Cairncross, 2003;Fung & Cairncross, 2006). Recentemente, uma quinta categoria de doenças relacionadas à água foi proposta (Bartram & Hunter, 2015): ÁGUA5 -transmissão associada aos sistemas de abastecimento de água e esgotamento sanitário, incluindo a inalação de gotículas ou aerossóis gerados em encanamentos (por exemplo, Legionella). ...
Passados os primeiros meses da pandemia do novo coronavírus no Brasil, o Observatório Covid-19 Fiocruz, em parceria com a Editora Fiocruz e com o apoio da Rede SciELO Livros, traz para o público leitor um conjunto de livros instantâneos sobre as análises nele realizadas desde que foi criado para subsidiar o seu combate. Nesta série Informação para Ação na Covid-19 será apresentado um balanço do conjunto de documentos (notas e relatórios técnicos, boletins, ensaios, informes, recomendações, ensaios, artigos, entre outros) produzidos em resposta à pandemia. Cada volume da série se estrutura em torno de um tema: aspectos globais da pandemia e da diplomacia em saúde; cenários epidemiológicos e vigilância em saúde; as políticas e a gestão dos serviços e sistemas de saúde; orientações para os cuidados e a saúde dos trabalhadores da saúde; impactos sociais e desigualdades sociais na pandemia. Com a publicação destes estudos em livros instantâneos e de acesso aberto colocamos à disposição do público o conjunto de informações e conhecimentos gerados no âmbito do Observatório Covid-19 Fiocruz, realizamos um balanço e uma reflexão sobre como chegamos ao cenário atual e apontamos caminhos para um futuro próximo. E, ao mesmo tempo, mantemos o registro histórico desse conhecimento produzido a quente, no calor da hora.
... O papel da água na transmissão de doenças infecciosas respiratórias foi sugerido décadas após a classificação original das doenças relacionadas à água. No entanto, o foco estava principalmente no efeito protetor da lavagem das mãos (Cairncross, 2003;Fung & Cairncross, 2006). Recentemente, uma quinta categoria de doenças relacionadas à água foi proposta (Bartram & Hunter, 2015): ÁGUA5 -transmissão associada aos sistemas de abastecimento de água e esgotamento sanitário, incluindo a inalação de gotículas ou aerossóis gerados em encanamentos (por exemplo, Legionella). ...
Passados os primeiros meses da pandemia do novo coronavírus no Brasil, o Observatório Covid-19 Fiocruz, em parceria com a Editora Fiocruz e com o apoio da Rede SciELO Livros, traz para o público leitor um conjunto de livros instantâneos sobre as análises nele realizadas desde que foi criado para subsidiar o seu combate. Nesta série Informação para Ação na Covid-19 será apresentado um balanço do conjunto de documentos (notas e relatórios técnicos, boletins, ensaios, informes, recomendações, ensaios, artigos, entre outros) produzidos em resposta à pandemia. Cada volume da série se estrutura em torno de um tema: aspectos globais da pandemia e da diplomacia em saúde; cenários epidemiológicos e vigilância em saúde; as políticas e a gestão dos serviços e sistemas de saúde; orientações para os cuidados e a saúde dos trabalhadores da saúde; impactos sociais e desigualdades sociais na pandemia. Com a publicação destes estudos em livros instantâneos e de acesso aberto colocamos à disposição do público o conjunto de informações e conhecimentos gerados no âmbito do Observatório Covid-19 Fiocruz, realizamos um balanço e uma reflexão sobre como chegamos ao cenário atual e apontamos caminhos para um futuro próximo. E, ao mesmo tempo, mantemos o registro histórico desse conhecimento produzido a quente, no calor da hora.
... Some studies now support the plausible aerosol transmission of SARS-CoV-2. 3 The role of water in the transmission of respiratory infectious diseases was suggested in 2003, however it mainly emphasized about handwashing. 25,26 Recently, a novel category of water-related diseases was suggested. 27 This transmission was associated with inhalation of droplets or aerosols generated in plumbing systems (e.g. ...
Background: An institutional quarantine facility in India reported 5 cases in 9 days. The latter 2 cases incited a suspicion of internal outbreak as they were residing in a different room than the index cases and onset of symptoms was after the expiry of quarantine period. Subsequently, 75 more cases tested positive from this facility.Methods: A retrospective-prospective study was conducted. Data regarding the travel history, health-events thereafter, daily activities, layout of the facility and standard procedures followed in the facility was collected. The epidemiological pattern of presentation and evolution of cases was studied.Results: The outbreak pattern and investigation revealed a common bathroom as the cause of intra-floor spread. Inter-floor spread was also observed and 93.75% cases were detected from rooms using their floor bathrooms located vertically below one another and interconnected by plumbing systems. SAR for room contacts of index cases was 90% and SAR was 82.14% for bathroom contacts of index cases. The positivity rate amongst individuals assigned bathroom number 1 on the floors vertically located below the top floor was 64.10%.Conclusions: The investigation and results show local spread of SARS-CoV-2 through usage of common bathroom facility. An interesting trend of inter-floor spread with concentration of cases only in the rooms dedicated to vertically located bathrooms was found which indicates spread through waste-water plumbing system, a phenomenon previously observed in SARS-CoV in 2003. Single floor quarantine facilities are recommended with lesser dependency on common bathrooms.
... The role of water in the transmission of respiratory infectious diseases was suggested decades after the original classification of waterrelated diseases. However, the focus was mainly on the protective effect of handwashing (Cairncross, 2003;Fung and Cairncross, 2006). Recently, a fifth category of water-related diseases was proposed (Bartram and Hunter, 2015): WATER5: engineered water systemassociated transmission, including inhalation of droplets or aerosols generated in plumbing systems (e.g. ...
Detection of the SARS-CoV-2 virus in stools and sewage has recently been reported, raising the hypothesis of faecal-oral transmission. If confirmed, this could have far-reaching consequences for public health and for pandemic control strategies. In this paper, we argue that a comprehensive and more nuanced analysis is required to test this hypothesis, taking into consideration both taking into consideration both environmental dynamics and the persistence of viral infectivity. First, we examine the evidence regarding the presence of the virus in stools and sewage. Then we discuss the current framework of disease transmission through water and excreta and how the transmission of a respiratory disease fits into it. Against this background, we propose a framework to test the faecal-oral hypothesis, unpacking the different environmental routes from faeces to the mouth of a susceptible person. This framework should not be seen as a confirmation of the hypothesis but rather as an expanded view of its complexities, which could help shaping an agenda for research into a number of unanswered questions. Finally, the paper briefly discusses practical implications, based on current knowledge, for containment of the pandemic.
... Evidence demonstrating that good hygiene practices, especially hand-washing with soap, can significantly reduce the transmission of ARI abounds. In view of the link between ARI and hygiene, it can now be considered a waterwashed disease [40,41,42]. ...
Despite numerous efforts by government at various levels and other agencies interested in water and its safety, waterborne diseases are still a major public health and environmental concern. The huge investment towards water research, although worth the spending, has not yielded the much expected result as waterborne diseases continue to plague developing countries with Africa and Asia having the worse hit. The unavailability of pipe-borne water and the dependence of rural dwellers on surface waters which are often contaminated with faecal materials are undoubtedly the major causes of the rising prevalence of waterborne diseases. Water availability and poor hygienic practices amongst these rural dwellers are also of paramount concern as they play significant roles in the spread of water-washed diseases. Also, poor environmental practice which encourages the breeding of insects and other forms of vectors within residential areas contribute to the increasing prevalence of waterborne diseases. This review focuses on waterborne diseases, its classification and the various methods employed in the bacteriological analysis of water.
Objective:
To understand mask-wearing and handwashing behaviors of Chinese rural residents during the COVID-19 pandemic and to analyze the associated factors.
Methods:
This study used a multi-stage random sampling method to conduct a cross-sectional questionnaire survey during the period of July to December of 2021, in six counties located in Shandong, Shanxi, and Yunnan provinces representing the eastern, central, and western regions of China, respectively. A total of 3864 villagers were surveyed with a questionnaire, and 3832 valid questionnaires were finally analyzed. Descriptive statistics and logistic regression analysis were used for statistical analysis.
Results:
Around ninety-four percent (93.6%) of rural residents reported mask-wearing during the COVID-19 pandemic, but only 44.5% of them could replace masks in time. Multivariate logistic regression analysis showed that those who were female, aged 15-59, had an education level of high school and above, were divorced/widowed, worked as farmers (workers), or were rural residents in Shandong Province were more likely to wear masks. Furthermore, those who were female, aged 15-59, had an education level of high school and above, were unmarried and married, were business and service workers, or were rural residents in Shandong and Shanxi Province replaced masks more timely. Around seventy percent (69.7%) of rural residents reported using soap when washing their hands, but only 38.0% of rural residents could wash their hands properly. Multivariate logistic regression analysis showed that rural residents who were aged 35-59, had an education of high school and above, or lived in Shandong Province and Shanxi Province were more likely to wash their hands with soap. Those who were aged 15-59, had an education of high school and above, worked as farmers (workers), were employees of governmental departments and retirees, were business and service workers, or were students had higher proper handwashing rates.
Conclusion:
During the COVID-19 pandemic, the proportion of Chinese rural residents wearing masks reached 93.6%, but only 44.5% were able to replace masks in time, gender, age, education level, marital status, occupation, and living place had an impact on mask-wearing. The proportion of Chinese rural residents who could wash hands with soap reached 69.7%, but only 38.0% could wash their hands properly. Age and education level were influencing factors for both washing-hand with soap and proper handwashing.
Rural areas largely lack access to improved drinking water, sanitation, and hygiene (WaSH) facilities in India. This requires documentation of WaSH practices at the local level for better understanding and sustainable development. In this paper, a global positioning system (GPS)-based household survey was carried out in 67 villages of Phagi tehsil using individual questionnaires to evaluate the existing WaSH conditions spatially at the panchayat level. Three sub-indices were used for WaSH risk areas mapping and prediction with the integration of machine learning algorithms. Survey results indicate the improvement in the availability of toilet facilities; however, a gap was found between toilet ownership and its usage by villagers. Data show that only six panchayats have almost zero open defecation practices among the 32 panchayats of Phagi tehsil. The findings highlight that presence of toilets in house, water supply in toilets, and high literacy rate lead to an increase in toilet usage by the population. WaSH index scores indicate that panchayats like Mandawari, Mendwas, Chandma Kalan, and Rotwara have worst conditions and fall in the high-risk category. Moreover, support vector machine regression (SVMR) results reveal that WaSH scores are mainly affected by open defecation (r = 0.94), water supply in toilets (r = 0.92), and female members’ participation in sanitation facilities decision-making (r = 0.53), followed by literacy rate (r = 0.33). Findings demonstrate the association between gender inequalities and WaSH conditions, and the potential of the WaSH index as a monitoring tool by local policymakers to shrink the WaSH gaps.
Pathogenic microorganisms are serious threats in schools, where contact with many microorganisms occur frequently throughout the school day. Classrooms are considered an optimal place for contact between microorganisms and young children. The aim of the current study was to study the prevalence of bacteria isolated in samples from different sites in primary schools and to show whether schools are sanitized and clean for children or it is just the core reason for their illness. The study was done in a highly standard private school and a public school in order to study the effect of variance in the social classes on the cleanliness of the schools. Different colonies were separated and identified by staining techniques and biochemical tests. Thirteen different types of bacteria with different amounts were isolated from 176 samples collected from different surfaces. It was found that the number of bacteria in public school is higher than that of the private school. The distribution of bacterial strains isolated from the two schools averaged 37.1% for Staphylococcus sp. followed by 11.3% for Enterobacter sp. and then 7.3%, 7.1% and 6.3% for Yersinia sp. Streptococcus sp. and Micrococcus sp. respectively. Other strains ranged between 5.9% to 1.5%. Bacterial isolates were tested for their susceptibility by well diffusion test against three commercial disinfectants commonly used for surface and hand cleaning in schools, namely; Clorox, Renol and Dettol. The highest percentage of resistance was seen against Renol (50%) followed by Dettol (38%) and was identified to be Escherichia coli, while least resistance occurring among all isolates was noticed against Clorox (18%). Children in private and public schools are at high risk of catching serious bacterial infections and they are surrounded by a cram of microorganisms. The current research shows that new ways must be developed to improve our schools’ hygiene to make it a healthier and safer place to learn in.
Swine flu is a highly contagious respiratory viral disease which is caused by
influenza a virus. The disease can be found everywhere in the world especially in
those peoples rearing pigs. The virus can circulate between human, avian, and swine. It
spread through aerosol transmission, via contact with affected pigs and contaminated
objects with the virus. Different factors including immuno suppression predispose
individuals to the disease. Swine influenza manifested by coughing, anorexia and
lethargy in pigs while sudden fever and cough in human. The disease can be diagnosed
either by laboratory or by observing signs and symptoms. It has a devastating effect
on the economy and health of the communities even though it can be prevented and
controlled with different measures like vaccines and antiviral drugs. Recently, an active
case reported in Addis Ababa, Ethiopia. So, due to its highly spread and economic
importance, it should have to be reported immediately to authorities if the cases
have been seen and care should be taken if a person showing the sign of the disease is
observed.
Keywords: Ethiopia; Influenza A virus; Pandemic; Swine; Swine flu; Laboratory;
Coughing; Anorexia; Lethargy; Fever; Diagnosed
Background
Nigeria has the second highest estimated number of deaths due to acute respiratory infection (ARI) among children under five in the world. A common hypothesis is that the inequitable distribution of socioeconomic resources shapes individual lifestyles and health behaviors, which leads to poorer health, including symptoms of ARI. This study examined whether lifestyle factors are associated with ARI risk among Nigerian children aged less than 5 years, taking individual-level and contextual-level risk factors into consideration. Methods
Data were obtained from the nationally representative 2013 Nigeria Demographic and Health Survey. A total of 28,596 surviving children aged 5 years or younger living in 896 communities were analyzed. We employed two-level multilevel logistic regressions to model the relationship between lifestyle factors and ARI symptoms. ResultsThe multivariate results from multilevel regressions indicated that the odds of having ARI symptoms were increased by a number of lifestyle factors such as in-house biomass cooking (OR = 2.30; p < 0.01) and no hand-washing (OR = 1.66; p < 0.001). An increased risk of ARI symptoms was also significantly associated with living in the North West region and the community with a high proportion of orphaned/vulnerable children (OR = 1.74; p < 0.001). Conclusions
Our findings underscore the importance of Nigerian children’s lifestyle within the neighborhoods where they reside above their individual characteristics. Program-based strategies that are aimed at reducing ARI symptoms should consider policies that embrace making available basic housing standards, providing improved cooking stoves and enhancing healthy behaviors.
Diarrhoeal disease was ranked fifth on the list of causes of premature mortality in South Africa in 2000. High standards of hygiene and access to safe water and sanitation services can be related to a reduced risk of diarrhea. Based on the understanding and interpretation of good sanitation, hygiene and related practices in South Africa, all sanitation programmes and interventions in the country focus to some degree on hand washing practices and behaviours. Health and hygiene interventions are implemented from the knowledge that hand washing can act as a barrier to several of the transmission routes of diarrhoeal pathogens. As a result, many sanitation interventions in South Africa begin with a baseline assessment which includes a review of present sanitation, hygiene and related practices. This paper focuses specifically on the measurement of one aspect of health and hygiene awareness in South Africa, namely hand washing behaviours. The paper is a critique of methods used in assessing these household behaviours in two villages in the Mpumalanga Province of South Africa.
Background:
Global Handwashing Day (GHD) is a handwashing promotion campaign organized by the Global Public-Private Partnership of Handwashing with Soap. In China, it has been promoted by the Chinese public health authorities, international organizations and multinational corporations through various channels including social media such as Sina Weibo, the leading Chinese microblogging site similar to Twitter. The objective of this study is to qualitatively assess Chinese social media users' reactions to a health promotion campaign using Global Handwashing Day (GHD) 2012 as an example.
Methods:
We conducted a qualitative content analysis of 552 Weibo posts generated on GHD 2012 by Weibo users with 1000 or more followers with the Chinese keyword for "handwashing." We categorized the Weibo posts into groups by keywords that frequently appeared in the data set. These groups were either exact reposts of an original post, or they conveyed similar information.
Results:
We observed the interconnections between traditional media and social media in handwashing promotion. Social media were found to serve as amplifiers of contents provided by traditional media. We observed the contextualization of global hygiene messages in a unique national social media market in China.
Discussion:
Our study showed that social media and traditional media are two interconnected arms of the GHD campaign in China. Our analysis demonstrated that public health campaigns in China can be evaluated using social media data. The themes and topics identified in this study will help public health practitioners evaluate future social media handwashing promotion campaigns.
Preventing the spread of infection in the care home can be as simple as washing hands properly and containing coughs and sneezes. Dr Rosalind Stanwell-Smith reviews the methods of infection control for influenza and other acute upper respiratory infections.
This fact sheet looks at the role of environmental health in improving child survival, focussing on three important causes of child mortality; acute respiratory infection (ARI), diarrhoeal disease and unintentional injury(including drowning and poisoning). A broad overview is presented. Specific details of implementing interventions are not considered.
The scope of this article is to analyze the prevalence and factors associated with the development of infectious diseases that affect children in daycare centers, namely respiratory infections, diarrheal disease and parasitic infections. Bibliographic research was conducted in the MEDLINE, LILACS and SciELO databases, and observational studies were included. 129 studies were identified, of which 21 were considered relevant to this study, namely two longitudinal and 19 cross-sectional studies. The systematization of the reviewed studies highlighted: i) the presence of intestinal parasites was the main outcome analyzed, followed by respiratory infections; ii) only one study investigated the occurrence of diarrheal disease; iii) the Giardia lamblia was the most prevalent parasitosis; iv) the variables that were most often associated with the development of intestinal parasitosis were child age, family income and maternal education; v) the attendance at daycare centers was a risk factor for intestinal parasites and respiratory infections. Respiratory and parasitic infections are major problems in institutionalized children in daycare centers. The reduction of such diseases involves a complex web of socio-economic, sanitation and daycare center infrastructure aspects.
In 2010, toxigenic Vibrio cholerae was newly introduced to Haiti. Because resources are limited, decision-makers need to understand the effect of different preventive interventions. We built a static model to estimate the potential number of cholera cases averted through improvements in coverage in water, sanitation and hygiene (WASH) (i.e., latrines, point-of-use chlorination, and piped water), oral cholera vaccine (OCV), or a combination of both. We allowed indirect effects and non-linear relationships between effect and population coverage. Because there are limited incidence data for endemic cholera in Haiti, we estimated the incidence of cholera over 20 years in Haiti by using data from Malawi. Over the next two decades, scalable WASH interventions could avert 57,949-78,567 cholera cases, OCV could avert 38,569-77,636 cases, and interventions that combined WASH and OCV could avert 71,586-88,974 cases. Rate of implementation is the most influential variable, and combined approaches maximized the effect.
This article examines farmers’ livelihood responses and vulnerability to climate variability and other stressors in Morogoro, Tanzania, to understand their implications for adaptation to climate change by agricultural households in developing world more generally. In Morogoro, agricultural households have extended cultivation, intensified agriculture, diversified livelihoods and migrated to gain access to land, markets and employment as a response to climatic and other stressors. Some of these responses have depleted and degraded natural resources such as forest, soil and water resources, which will complicate their living with climate change in the future. This will be particularly problematic to vulnerable groups such as women, children and pastoralists who have limited access to employment, markets and public services. In this light, fair adaptation to climate change by agricultural households in Morogoro and elsewhere in developing countries requires several complementary responses. Adaptation efforts should involve effective governance of natural resources because they function as safety nets to vulnerable groups. In addition, strengthening of national markets by infrastructure investments and institutional reforms is needed to give incentives to intensification and diversification in agriculture. Market participation also demands enhancement of human capital by public programs on health, education and wellbeing.
The sustainability of the urban environment has been on the minds of policymakers around the globe for decades as megacities continue to grow and thrive contrary to expectation. The common wisdom is that environmental stress will severely curtail any future potential. China is in some respect at the forefront of this debate with cities such as Beijing and Shanghai, which seem to have made reasonable accommodation with their limited natural resources. This is the result of a unique combination of institutional reform and judiciously applied technologies borrowed from elsewhere. This continues to be a great dynamic whereby urban environmental management is continually one step behind economic progress. China's environmental path bears watching since much can be learned and it has become very clear that the rest of the globe will either suffer or benefit as a result.
Objective:
To study the association between water and sanitation coverage and epidemiological indicators in Latin America, using secondary data from the Pan American Health Organization (PAHO) for the period of 2005 to 2010.
Methods:
An ecological study was carried out including data from 21 Latin American countries, with a total estimated population of 596 million. The following variables were analyzed: infant mortality in children under 1 year in 2008, mortality in children under 5 years in 2008, and mortality from acute diarrheal diseases in children under 5 years in 2008. These indicators were analyzed by means of the "one-on-one" correlation with risk factors in five categories (demographic, socioeconomic, child health, public spending on health care, health care, and sanitation coverage).
Results:
The average values for the region were 18.2 deaths per 1 000 live births in children under 1 year of age, 23.5 deaths per 1 000 live births for children under 5 years, and 5.8% mortality for acute diarrheal diseases in children under 5 years. Higher water and sanitation coverage was linked with lower mortality in children under 1 and under 5 years of age. Higher mortality from acute diarrheal diseases in children under 5 years was associated with higher annual population growth.
Conclusions:
The improvement of public health in Latin America depends on the expansion of access to public water and sanitation systems.
Every year, billions of dollars of environmental aid flow from the rich governments of the North to the poor governments of the South. Why do donors provide this aid? What do they seek to achieve? How effective is the aid given? And does it always go to the places of greatest environmental need? From the first Earth Summit in Stockholm in 1972 to the G8 Gleneagles meeting in 2005, the issue of the impact of aid on the global environment has been the subject of vigorous protest and debate. How much progress has there been in improving environmental protection and clean-up in the developing world? What explains the patterns of environmental aid spending and distribution - is it designed to address real problems, achieve geopolitical or commercial gains abroad, or buy political mileage at home? And what are the consequences for the estimated 4 million people that die each year from air pollution, unsafe drinking water, and lack of sanitation? All of these questions and many more are addressed in this groundbreaking text, which is based on the authors' work compiling the most comprehensive dataset of foreign aid ever assembled. By evaluating the likely environment impact of over 400,000 development projects by more than 50 donors to over 170 recipient nations between 1970 and 2001, Greening Aid represents a unique, state of the art picture of what is happening in foreign assistance, and its impact on the environment. Greening Aid explains major trends and shifts over the last three decades, ranks donors according to their performance, and offers case studies which compare and contrast donors and types of environmental aid. Available in OSO: http://www.oxfordscholarship.com/oso/public/content/economicsfinance/9780199213948/toc.html
In Swaziland, access to safe water supply and sanitation has improved significantly and was expected to result in improved health and, in particular, reduced infant mortality rates. On the contrary, mortality rates in the under 5 years age group are high and have doubled from 60 in 1996, to 120 deaths per 1000 in 2006. The main objective of the study was to assess whether the water projects permit, and are accompanied by, changes in hygienic behaviour to prevent transmission of diseases. The study area was Phonjwane, located in the dry Lowveld of Swaziland, where water projects play a significant role in meeting domestic water demands. Hygienic behaviour and sanitation facilities were analysed and compared before and after project. The results of the study show that domestic water supply projects have significantly reduced distances travelled and time taken to collect water, and that increased quantities of water are collected and used. While the majority of respondents (95.6%) used the domestic water project source, the quantities allowed per household (125 l which translates to an average of 20.8 l per person) were insufficient and therefore were supplemented with harvested rainwater (57.8%), water from a polluted river (17.8%), and water from a dam (2.2%). Increased water quantities have permitted more baths and washing of clothes and hands, but significant proportions of the population still skip hygienic practices such as keeping water for washing hands inside or near toilet facilities (40%) and washing hands (20%). The study concludes that the water supply project has permitted and improved hygienic practices but not sufficiently. The health benefits of safe domestic water supplies are hampered by insufficient quantities of water availed through the projects, possible contamination of the water in the house, poor hygienic behaviours and lack of appropriate sanitation measures by some households. There is a need to provide sufficient quantities of safe water to meet all domestic demands. Domestic water supply must be accompanied by appropriate sanitation and hygienic education.
Avian influenza (AI) can be highly pathogenic and fatal. Preventive behavior such as handwashing and wearing face masks has been recommended. However, little is known about what psychosocial factors might influence people's decision to adopt such preventive behavior. This study aims to explore risk perception and other factors associated with handwashing and wearing face masks to prevent AI.
An interviewer-administered survey was conducted among 352 traditional market workers and shoppers in Taiwan between December 2009 and January 2010. Factors associated with the recommended AI preventive behavior (i.e., when in a traditional market, wearing a face mask and also washing hands after any contact with poultry) included: having correct knowledge about the fatality rate of AI (adjusted odds ratio [AOR] = 4.18), knowing of severe cases of AI (AOR = 2.13), being informed of local AI outbreaks (AOR = 2.24), living in northeastern Taiwan (AOR = 6.01), having a senior high-school education (AOR = 3.33), and having a university or higher education (AOR = 6.86). Gender interactive effect was also found among participants with a senior high-school education, with males being less likely to engage in the recommended AI preventive behavior than their female counterparts (AOR = 0.34).
Specific information concerning AI risk perception was associated with the recommended AI preventive behavior. In particular, having correct knowledge about the fatality rate of AI and being informed of severe cases and local outbreaks of AI were linked to increased AI preventive behavior. These findings underscore the importance of transparency in dealing with epidemic information. These results also have practical implications for prevention and policy-making to more effectively promote the recommended AI preventive behavior in the public.
Public health importance of hand washing as well as its importance in reduction of communicable diseases such as diarrhea and acute respiratory infections have been highlighted in many studies worldwide.
This study was designed to study the hand washing practices followed in two urban slums as well as to assess and compare the status of different components of hand washing at the pre- and post-intervention phases.
A community-based cross-sectional intervention study on hand washing practices was carried out at two urban slums situated in two states of Eastern India with similar sociocultural and linguistic background. The study was carried out by using an interview technique as well as observation of hand washing practices. Interpersonal communication for behavioural change was chosen as a method of intervention.
The majority (>90%) practiced hand washing after defecation in both the study areas. However, hand washing following all six steps and for stipulated time period was seen to be poor before intervention. Significant improvement was observed in all the aspects of hand washing after intervention in both the areas. The poor practice of hand washing was observed in some situations and needed attention. Use of soap and clean material for drying hands after hand washing was poor initially followed by improvement after intervention.
Based on the findings of the study, it could be suggested that Behaviour Change Communication program should be further planned with emphasis on different components of hand washing with a final objective to bring down the incidence of target diseases.
We examine the impact of piped water on the under-1 infant mortality rate (IMR) in Brazil using a recently developed econometric procedure for the estimation of quantile treatment effects with panel data. The provision of piped water in Brazil is highly correlated with other observable and unobservable determinants of IMR -- the latter leading to an important source of bias. Instruments for piped water provision are not readily available, and fixed effects to control for time-invariant correlated unobservables are invalid in the simple quantile regression framework. Using the quantile panel data procedure in Chen and Khan [Chen, S., Khan, S., Semiparametric estimation of non-stationary censored panel model data models with time-varying factor. Econometric Theory 2007; forthcoming], our estimates indicate that the provision of piped water reduces infant mortality by significantly more at the higher conditional quantiles of the IMR distribution than at the lower conditional quantiles (except for cases of extreme underdevelopment). These results imply that targeting piped water intervention toward areas in the upper quantiles of the conditional IMR distribution, when accompanied by other basic public health inputs, can achieve significantly greater reductions in infant mortality.
Exploitation of nickel-copper (Ni-Cu) at Selebi Phikwe, Botswana is considered to have environmental and human health implications. Of particular concern is the labour force, which experiences a higher level of exposure to environmental hazards due to mining, compared to other categories of residents within the Ni-Cu mining environment. Health effects associated with Ni-Cu mining on workers living within the area were thus investigated through the administration of questionnaires. Results depicted workers suffering from different symptoms and illnesses as follows in percentages: body weakness 42, loss of body weight 16, influenza/common colds 66, headaches 70, chest pain 40, repeated coughing 45, need to spit often 6, shortness of breath 18, palpitations 14, regular lower abdominal pain 31, pain when urinating 4, genital discharge at some time 5, nausea/vomiting 12, frequent diarrhoea 12 and constant constipation 10. Values obtained for same symptoms and diseases at the control site were in general lower than those closer to the mining area. Frequent chest pains, repeated coughing, constant influenza/common cold and persistent headaches, which workers of the environment suffer from were very significantly higher compared to those at the control site and incidences of their occurrences increased with closeness to mining area. The unusual high occurrences of these ailments and illnesses coupled with associated diseases among workers at Selebi Phikwe were attributed to several environmental factors including contaminated Particulate Air Matter (PAM) (rich in sulphur and heavy metals) linked to the mining and smelting of Ni-Cu. These findings are in conformity with those of previous related studies and infer possible similarities for workers of business enterprises within other Ni-Cu mining environments around the world.
Improving sanitation and hygiene to prevent infectious diseases is of high priority in developing countries. This study attempts to gain in-depth understanding of hygiene and sanitation perceptions and practices among four Ethnic Minority Groups (EMGs) in a rural area of northern Vietnam. It is based on extensive participatory observations in 4 villages and 20 case households over a period of six months (May-October 2008). In addition, 10 key informants and 60 household-members were interviewed and 4 focus group discussions conducted.
The influenza pandemic caused by the new H1N1 virus has by now affected all the continents of the world. However, the extent and likely impact are still uncertain. Like seasonal flu, the illness is mild and self-limiting in a great majority of cases, with only 1%-2% of patients requiring hospitalization. In a few cases, the clinical course can deteriorate in a matter of hours, leading to severe complications and eventually death. The risk of complications is higher among those who have preexisting diseases, such as asthma, heart disease and kidney disease, and among pregnant women. In such cases, antiviral treatment should not be delayed pending laboratory confirmation. The preferred antiviral drug is oseltamivir, and zanamivir is an alternative. Antiviral treatment is not necessary for those who are otherwise healthy, and have mild or uncomplicated illness. It is beneficial for patients with progressive lower respiratory tract disease or pneumonia, and those with underlying medical conditions and pregnant patients. As the supply of antivirals is limited, they should be used judiciously and where appropriate. There is a limited supply of pandemic influenza vaccine available in a few countries and efforts to produce it in India are presently underway. Effective personal preventive measures include shielding one's mouth and nose while coughing and sneezing, frequent washing of hands with soap, avoiding mass gatherings and voluntary isolation by symptomatic individuals. While at present the virus is causing a mild disease, the next wave may be more severe. Hence, enhanced surge capacity of health services is required for the clinical management of an increased patient load.
Hygiene promotion can greatly improve the benefits of water and sanitation programmes in developing countries at relatively limited costs. There are, however, few studies with hard data on the costs and effectiveness of individual programmes and even fewer have compared the cost-effectiveness of different promotional approaches. This article argues that objectively measured reductions of key sanitation and hygiene risks are better than DALYs for evaluating hygiene and sanitation promotion programmes. It presents a framework for the cost-effectiveness analysis of such programmes, which is used to analyse six field programmes. At costs ranging from US dollar 1.05 to US dollar 1.74 per person per year in 1999 US dollar values, they achieved (almost) complete abandonment of open defecation and considerable improvements in keeping toilets free from faecal soiling, safe disposal of child faeces, and/or washing hands with soap after defecation, before eating and after cleaning children's bottoms. However, only two studies used a quasi-experimental design (before and after studies in the intervention and - matched - control area) and only two measured costs and the degree to which results were sustained after the programme had ended. If the promotion of good sanitation and hygiene is to receive the political and managerial support it deserves, every water, sanitation and/or hygiene programme should give data on inputs, costs, processes and effects over time. More and better research that reflects the here-presented model is also needed to compare the cost-effectiveness of different promotional approaches.
In the Mekong Delta in the south of Vietnam about 5.7 million people lack access to safe drinking water and 10 million people in rural areas live without adequate sanitation. Between May and August, 2007 a survey was carried out in An Bin, a peri-urban ward in the Mekong Delta, to gain insight into water, sanitation and health as well as to health-related hygiene behaviour. The study employed a combination of quantitative (standardized questionnaire) and qualitative (focus group discussions, semi-structured interviews) methods. The most important features in the choice of drinking water sources are matters of hygiene and the taste of the water. The majority (74%) of the 120 households surveyed indicated their ownership of a sanitation facility, but the fish pond toilet (64%) which is predominantly utilized is considered to be unimproved sanitation. The local peri-urban population link water and hygiene to health, but sanitation instead to environmental pollution. This and other outcomes lead to the assumption that people have a basic knowledge of proper hygiene behaviour. However, hygiene measures such as hand washing are put into practice in an untimely manner, most likely due to a misconception of risks and/or a lack of background knowledge of cause-effect relationships as well as ingrained habits.
Infectious acute respiratory disease (ARD) is a significant cause of worldwide morbidity, disproportionately affecting individuals living in crowded conditions, such as found at military training centers, school dormitories, and correctional facilities. Vaccines have been used to protect against ARD; however, these are not always available or effective.
The medical literature (1963-2004) on preventive nonvaccine ARD interventions (NOVARDIs) for infectious diseases, which addressed personal measures, administrative controls, and engineering controls, was studied during 2000 to 2004. Population-based studies in community settings (non-health care) were reviewed in detail to evaluate the effectiveness of NOVARDIs. Budgetary and logistic factors as well as acceptance were considered in formulating recommendations for implementation of NOVARDIs in military training centers.
Thirty-eight population-based studies contained in 35 publications were examined. Three studies contained information on multiple NOVARDIs. Nine studies supported the use of personal measures relating to hand hygiene. Ten studies supported administrative controls such as cohorting military training units to reduce contact between units (4 studies), providing adequate personal space to reduce crowding (5), and cloth barriers between beds (1); and 14 studies supported the use of engineering controls such as increased indoor air dilution and ventilation (2), dust suppression (4), and air sterilization (8).
Promoting hand hygiene and reducing crowding through the provision of adequate living space and cohorting of training units may offer benefits in respiratory disease control. These interventions, along with UV lights and air dilution/ventilation, deserve further evaluation in controlled studies to assess their efficacy. NOVARDIs could benefit military and other populations living in close contact.
This review examines the literature, including literature in Chinese, on the effectiveness of handwashing as an intervention against severe acute respiratory syndrome (SARS) transmission. Nine of 10 epidemiological studies reviewed showed that handwashing was protective against SARS when comparing infected cases and non-infected controls in univariate analysis, but only in three studies was this result statistically significant in multivariate analysis. There is reason to believe that this is because most of the studies were too small. The evidence for the effectiveness of handwashing as a measure against SARS transmission in health care and community settings is suggestive, but not conclusive.
We reviewed evidence of hand-washing compliance in community settings during the 2003 SARS outbreak. Literature was searched through PubMed, Cochrane Library, Wan Fang database and Google. English and Chinese papers were reviewed. Studies containing data on hand-washing, self-reported or directly observed, in community settings were selected. Case-control studies and studies in healthcare settings were excluded. Fourteen studies were reviewed. Self-reported hand-washing compliance increased in the first phase of the SARS outbreak and maintained a high level 22 months after the outbreak. The decline of hand-washing in Hong Kong after SARS was relatively slow. A significant gender difference in hand-washing compliance (female > male) was found in eight studies. The importance of family support and 'significant female others' in hand hygiene promotion are noted. The impact of education is uncertain. Perceived susceptibility to and severity of SARS, and perceived efficacy of hand-washing in preventing SARS, also predicted self-reported hand-washing compliance.
To describe the increased risk of acquiring infectious diseases associated with out-of-home childcare and the effectiveness of measures for the control and prevention of diseases transmission at daycare and preschool education centers.
A review of literature in the MEDLINE, LILACS and Cochrane Library databases, found using the descriptors daycare, infection, infection control and infectious diseases and focusing on studies that have compared the risk of infectious diseases for children cared for in and out of the home, related risk to the type of out-of-home care and assessed the effectiveness of preventative measures.
Children cared for at daycare or in preschool education exhibit a two to three times greater risk of acquiring infections, which impacts both on individual health and on the dissemination of diseases through the community. Among other factors, the risk is associated with the characteristics of daycare centers, and simple preventative measures are effective for reducing transmission of diseases. Recommended measures include: appropriate hand washing after exposure; employment of standard precautions; standardized routines for changing and disposal of used diapers, location and cleanliness of changing area, cleaning and disinfection of contaminated areas; use of disposable tissues for blowing noses; separate workers and area for handling foods; notification of infectious diseases; training of workers and guidance for parents.
In the face of growing utilization of daycare and preschool education and their association with increased risk of acquired infections, control measures are indispensable to the prevention and control of infectious diseases.
Current estimates of the global burden of disease for diarrhoea are reported and compared with previous estimates made using data collected in 1954-79 and 1980-89. A structured literature review was used to identify studies that characterized morbidity rates by prospective surveillance of stable populations and studies that characterized mortality attributable to diarrhoea through active surveillance. For children under 5 years of age in developing areas and countries, there was a median of 3.2 episodes of diarrhoea per child-year. This indicated little change from previously described incidences. Estimates of mortality revealed that 4.9 children per 1000 per year in these areas and countries died as a result of diarrhoeal illness in the first 5 years of life, a decline from the previous estimates of 13.6 and 5.6 per 1000 per year. The decrease was most pronounced in children aged under 1 year. Despite improving trends in mortality rates, diarrhoea accounted for a median of 21% of all deaths of children aged under 5 years in these areas and countries, being responsible for 2.5 million deaths per year. There has not been a concurrent decrease in morbidity rates attributable to diarrhoea. As population growth is focused in the poorest areas, the total morbidity component of the disease burden is greater than previously.
Hands often become contaminated with respiratory viruses, either directly or through contact with contaminated surfaces. Spread of such viruses could then occur by touching the nasal mucosa or the conjunctivae. In this quantitative study, we compared the survival of mucin-suspended human parainfluenza virus 3 (HPIV-3) and rhinovirus 14 (RV-14) and the transfer of the viruses to and from the fingers of adult volunteers. When each finger pad was contaminated with 10 microliters of either HPIV-3 (1.3 x 10(5) to 5.5 x 10(5) PFU) or RV-14 (2.1 x 10(4) to 1.1 x 10(5) PFU), less than 1.0% of HPIV-3 and 37.8% of RV-14 remained viable after 1 h; after 3 h, nearly 16% of RV-14 could still be detected, whereas HPIV-3 became undetectable. Tests on the potential spread of viruses from contaminated hands or surfaces were conducted 20 min after contamination of the donor surface by pressing together donor and recipient surfaces for 5 s. Transfer of HPIV-3 from finger to finger or finger to metal disk could not be detected, but 1.5% of infectious HPIV-3 was transferred from disk to finger. Irrespective of the type of donor or recipient surface, 0.7 to 0.9% of RV-14 was transferred. The relatively rapid loss of HPIV-3 infectivity on hands suggests that their role in the direct spread of parainfluenza viruses is limited. However, the findings of this study further reinforce the view that hands can be vehicles for rhinovirus colds. These results also suggest a role for nonporous environmental surfaces in the contamination of hands with respiratory viruses.
Rhinoviruses can survive on environmental surfaces for several hours under ambient conditions. Hands can readily become contaminated after contact with such surfaces, and self-inoculation may lead to infection. Whereas hand washing is crucial in preventing the spread of rhinovirus colds, proper disinfection of environmental surfaces may further reduce rhinovirus transmission. In this study, the capacities of Lysol Disinfectant Spray (0.1% o-phenylphenol and 79% ethanol), a domestic bleach (6% sodium hypochlorite diluted to give 800 ppm of free chlorine), a quaternary ammonium-based product (7.05% quaternary ammonium diluted 1:128 in tap water), and a phenol-based product (14.7% phenol diluted 1:256 in tap water) were compared in interrupting the transfer of rhinovirus type 14 from stainless steel disks to fingerpads of human volunteers upon a 10-s contact at a pressure of 1 kg/cm2. Ten microliters of the virus, suspended in bovine mucin (5 mg/ml), was placed on each disk, and the inoculum was dried under ambient conditions; the input number on each disk ranged from 0.5 x 10(5) to 2.1 x 10(6) PFU. The dried virus was exposed to 20 microliters of the test disinfectant. The Lysol spray was able to reduce virus infectivity by > 99.99% after a contact of either 1 or 10 min, and no detectable virus was transferred to fingerpads from Lysol-treated disks. The bleach (800 ppm of free chlorine) reduced the virus titer by 99.7% after a contact time of 10 min, and again no virus was transferred from the disks treated with it.(ABSTRACT TRUNCATED AT 250 WORDS)
Around 50% of people, almost all in developing countries, rely on coal and biomass in the form of wood, dung and crop residues for domestic energy. These materials are typically burnt in simple stoves with very incomplete combustion. Consequently, women and young children are exposed to high levels of indoor air pollution every day. There is consistent evidence that indoor air pollution increases the risk of chronic obstructive pulmonary disease and of acute respiratory infections in childhood, the most important cause of death among children under 5 years of age in developing countries. Evidence also exists of associations with low birth weight, increased infant and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal cancer, cataract, and, specifically in respect of the use of coal, with lung cancer. Conflicting evidence exists with regard to asthma. All studies are observational and very few have measured exposure directly, while a substantial proportion have not dealt with confounding. As a result, risk estimates are poorly quantified and may be biased. Exposure to indoor air pollution may be responsible for nearly 2 million excess deaths in developing countries and for some 4% of the global burden of disease. Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making. Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infections. A more systematic approach to the development and evaluation of interventions is desirable, with clearer recognition of the interrelationships between poverty and dependence on polluting fuels.
Much infectious intestinal disease (IID) arises in the home environment. If programmes to prevent infection are to be effective it is essential to both identify the particular practices that risk disease transmission, and to understand the reasons for these practices. An in-depth, multidisciplinary study of carer and child hygiene in the domestic environment in the Wirral, UK, employed structured observation, surface swabbing for polio vaccine virus and enteric marker organisms, semi-structured interviews, projective interviews and focus group discussions. Observations revealed that child carers washed hands with soap after changing a dirty nappy on 42% of occasions, and that one in five toilet users did not wash hands with soap afterwards. Microbiological samples were taken from household surfaces at sites thought likely to be involved in the transfer of faecal material. 15% of bathroom samples showed contamination with polio vaccine virus. Nappy changing took place mainly in living rooms. Contact with living room surfaces and objects during nappy changing was frequent and evidence of faecal contamination was found in 12% of living room samples. Evidence of faecal contamination was also found in kitchens, again on surfaces thought likely to be involved in the transmission of faeces (taps and soap dispensers). Key factors motivating hygiene were the desire to give a good impression to others, protection of the child and aesthetics. In this setting, the particular risk practices to be addressed included washing hands with soap after stool and nappy contact and preventing the transfer of pathogenic organisms to the kitchen. The occasion of the birth of a child may be a privileged moment for the promotion of safer home hygiene practices. Using polio vaccine virus as an indicator of faecal contamination produces results that could be used in large-scale studies of household disease transmission. A better understanding of the household transmission of the agents of IID using multidisciplinary methods is needed if effective hygiene promotion programmes are to be designed.
This study was designed to explore the physical characteristics and child care practices of child care centres as potential risk factors for respiratory infections and diarrhoea in children 3-35 mo of age. A dynamic cohort averaging 667 children from 40 child care centres in Campinas (Brazil) was followed up for 8 mo. Direct structured observations were made to collect information on the centres' physical structure, child activities and child care practices. Despite their good infrastructures, hand washing in the centres was infrequent, and nearly 30% of diaper changes were unhygienic. Risk factors for diarrhoea included the presence of flies during meals, infrequent child hand washing before meals, and infrequent child hand washing after defecation, with relative risks of 1.33, 1.73 and 1.63, respectively. There was 33% less diarrhoea in classes where soap was frequently used during diapering. Contrary to our hypotheses, ventilation, group size and child density were not associated with respiratory infections, as was the case for most other factors studied. Only mixing of groups and a larger classroom area were found to be negatively associated with lower and upper respiratory infections, respectively. The results indicate that improving hygiene practices is the only intervention in child care centre characteristics with good potential to reduce diarrhoea among attendees. For respiratory infections, no modifiable characteristic with intervention potential was identified.
Objectives: In response to increasing concerns about respiratory illness in military recruits, a simple handwashing program was developed and evaluated at a large Navy training center.Methods: Clinical records from 1996 through 1998 were reviewed to determine weekly rates of respiratory illness before and after program implementation (1,089,800 person-weeks reviewed). A supplemental survey was given to a sample of recruits to assess self-reported respiratory illness and compliance with the handwashing program.Results: A 45% reduction in total outpatient visits for respiratory illness was observed after implementation of the handwashing program. No change was noted in hospitalization rates for respiratory illness, which remained low during the observation period. Survey data supported clinical observations, as frequent handwashers self-reported fewer respiratory illness episodes when compared to infrequent handwashers. Surveys also revealed challenges with handwashing compliance.Conclusions: Implementation of a handwashing program in this population of healthy young adults was associated with a marked reduction in outpatient visits for respiratory illness. Despite its success, maintenance of the handwashing program has been challenging in the time-constrained setting of military training.
In 1859 a Hungarian obstetrician named Ignaz Semmelweis, reflecting on his years as resident in the Vienna maternity clinic, wrote a graphic account of his attempt to diagnose and eliminate the then epidemic scourge of childbed fever. The resulting Etiology triggered an immediate and international squall of protest from Semmelweisâs colleagues; today it is recognized as a pioneering classic of medical history. Now, for the first time in many years, Codell Carter makes that classic available to the English-speaking reader in this vivid translation of the 1861 original, augmented by footnotes and an explanatory introduction. For students and scholars of medical history and philosophy, obstetrics and womenâs studies, the accessibility of this moving and revolutionary work, important both as an historical document and as a groundbreaking precursor of modern medical theory, is long overdue. Semmelweisâs exposure to the childbed fever was concurrent with his appointment to the Vienna maternity hospital in 1846. Like many similar hospitals and clinics in the major cities of nineteenth-century Europe and America, where death rates from the illness sometimes climbed as high as 40 percent of admitted patients, the Viennese wards were ravaged by the fever. Intensely troubled by the tragic and baffling loss of so many young mothers, Semmelweis sought answers. The Etiology was testimony to his success. Based on overwhelming personal evidence, it constituted a classic description of a disease, its causes, and its prevention. It also allowed a necessary response to the obstetricianâs already vocal, rabid, and perhaps predictable critics. For Semmelweisâs central thesis was a startling one - the fever, he correctly surmised, was caused not by epidemic or endemic influences but by unsterilized and thus often contaminated hands of the attending physicians themselves. Carterâs translation of this radical work, judiciously abridged and extensively footnoted, captures all the drama and impassioned conviction of the original. Complementing this translation is a lucid introduction that places Semmelweisâs Etiology in historical perspective and clarifies its contemporary value. That value, Carter argues, is considerable. Important as a model of clinical analysis and as a chronicle of early nineteenth-century obstetrical practices, the Etiology is also a revolutionary polemic in its innovative doctrine of antisepsis and in its unique etiological explanation of disease. As such its recognition and reclamation allows a crucial understanding, one that clarifies the roots and theory of modern medicine and ultimately redeems and important, resolute, pathfinder.
Recent studies have shown that the spread of infectious nasal secretions from hand-to-hand or hand-to-object, followed by
self-inoculation is an efficient means of viral transmission. The present study was designed to investigate whether self-inoculation
behavior in asthmatic children could be reduced and, if so, whether this reduction would reduce the frequency of infection
and asthma. Sixteen subjects aged 4 to 8, all diagnosed with postinfectious asthma, were assigned to a treatment (differential
reinforcement of other behavior and contingent education) or placebo control condition. Results indicate that self-inoculatory
behavior, infection, and asthma were signjficantly reduced. These findings may indicate an important role for behavioral medicine
inpostinfectious asthma.
A theoretical model is proposed that relates the level of ingestion of diarrhoea-causing pathogens to the frequency of diarrhoea in the community. The implications of this model are that, in poor communities with inadequate water supply and excreta disposal, reducing the level of enteric pathogen ingestion by a given amount will have a greater impact on diarrhoea mortality rates than on morbidity rates, a greater impact on the incidence rate of severe diarrhoea than on that of mild diarrhoea, and a greater impact on diarrhoea caused by pathogens having high infectious doses than on diarrhoea caused by pathogens of a low infectious dose. The impact of water supply and sanitation on diarrhoea, related infections, nutritional status, and mortality is analysed by reviewing 67 studies from 28 countries. The median reductions in diarrhoea morbidity rates are 22% from all studies and 27% from a few better-designed studies. All studies of the impact on total mortality rates show a median reduction of 21%, while the few better-designed studies give a median reduction of 30%. Improvements in water quality have less of an impact than improvements in water availability or excreta disposal.
Stool disposal practices have been shown to be associated with childhood diarrhoea. However, efforts to promote improved hygiene behaviour are hampered by a lack of understanding of what determines those behaviours. Data from 2793 household interviews with mothers of children from the town of Bobo-Dioulasso in Burkina Faso were analyzed to examine what differentiated mothers who reported using safer stool disposal practices from those who did not. Three 'outcomes' were considered: where the child was reported to defaecate; where the mother reported disposing of the child stools; and whether excreta were observed in the compound. Regression models were developed to identify those factors with the strongest independent associations with the outcomes. There was a consistent association between the source of water and the outcomes. Mothers with access to a tap in the yard reported using safe hygiene practices three times more often than mothers using wells outside the compound and twice as often as mothers who used public standpipes or wells within the yard. The source of water showed a similar pattern of association with observations of faecal matter in the environment. Improved sources of water may contribute to safer stool hygiene by reducing the time spent on water collection or by encouraging mothers to conform to higher standards of hygiene. Other factors which played a role in predicting the hygiene behaviour of mothers were the husbands' occupation, the number of health education sessions that she had attended, her zone of residence and family ownership of certain valuable objects. These factors are likely to be related and to be, to some extent, proxies for the real determinants of her behaviour. A model of the cultural, psycho-social and infrastructural proximate determinants of hygiene behaviour is proposed. Data from focus group discussions suggested that the main purpose of hygienic behaviour is to conform to existing norms of social etiquette. Trials of interventions based on changing such norms are needed to test whether this is an effective means of promoting of safer hygiene practices.
This study was designed to explore the physical characteristics and child care practices of child care centres as potential risk factors for respiratory infections and diarrhoea in children 3-35 mo of age. A dynamic cohort averaging 667 children from 40 child care centres in Campinas (Brazil) was followed up for 8 mo. Direct structured observations were made to collect information on the centres' physical structure, child activities and child care practices. Despite their good infrastructures, hand washing in the centres was infrequent, and nearly 30% of diaper changes were unhygienic. Risk factors for diarrhoea included the presence of flies during meals, infrequent child hand washing before meals, and infrequent child hand washing after defecation, with relative risks of 1.33, 1.73 and 1.63, respectively. There was 33% less diarrhoea in classes where soap was frequently used during diapering. Contrary to our hypotheses, ventilation, group size and child density were not associated with respiratory infections, as was the case for most other factors studied. Only mixing of groups and a larger classroom area were found to be negatively associated with lower and upper respiratory infections, respectively. The results indicate that improving hygiene practices is the only intervention in child care centre characteristics with good potential to reduce diarrhoea among attendees. For respiratory infections, no modifiable characteristic with intervention potential was identified.
In response to increasing concerns about respiratory illness in military recruits, a simple handwashing program was developed and evaluated at a large Navy training center.
Clinical records from 1996 through 1998 were reviewed to determine weekly rates of respiratory illness before and after program implementation (1,089,800 person-weeks reviewed). A supplemental survey was given to a sample of recruits to assess self-reported respiratory illness and compliance with the handwashing program.
A 45% reduction in total outpatient visits for respiratory illness was observed after implementation of the handwashing program. No change was noted in hospitalization rates for respiratory illness, which remained low during the observation period. Survey data supported clinical observations, as frequent handwashers self-reported fewer respiratory illness episodes when compared to infrequent handwashers. Surveys also revealed challenges with handwashing compliance.
Implementation of a handwashing program in this population of healthy young adults was associated with a marked reduction in outpatient visits for respiratory illness. Despite its success, maintenance of the handwashing program has been challenging in the time-constrained setting of military training.
We set out to determine the impact of washing hands with soap on the risk of diarrhoeal diseases in the community with a systematic review with random effects meta-analysis. Our data sources were studies linking handwashing with diarrhoeal diseases. Seven intervention studies, six case-control, two cross-sectional, and two cohort studies were located from electronic databases, hand searching, and the authors' collections. The pooled relative risk of diarrhoeal disease associated with not washing hands from the intervention trials was 1.88 (95% CI 1.31-2.68), implying that handwashing could reduce diarrhoea risk by 47%. When all studies, when only those of high quality, and when only those studies specifically mentioning soap were pooled, risk reduction ranged from 42-44%. The risks of severe intestinal infections and of shigellosis were associated with reductions of 48% and 59%, respectively. In the absence of adequate mortality studies, we extrapolate the potential number of diarrhoea deaths that could be averted by handwashing at about a million (1.1 million, lower estimate 0.5 million, upper estimate 1.4 million). Results may be affected by the poor quality of many of the studies and may be inflated by publication bias. On current evidence, washing hands with soap can reduce the risk of diarrhoeal diseases by 42-47% and interventions to promote handwashing might save a million lives. More and better-designed trials are needed to measure the impact of washing hands on diarrhoea and acute respiratory infections in developing countries.
Spread of the Common Cold and Influenza. International Forum on Home Hygiene URL: http://www.ifh-homehygiene.org/2newspage/2new05
- Eccles
- Eccles
A cluster randomised controlled trial to assess the impact of handwashing with soap on diarrhoeal diseases and acute respiratory infections in children in rural Upper Egypt Handwashing and respiratory illness among young adults in military training
- Macleod D Ryan
- Mak
- Christian
Macleod D (2003) Medical Research Council accused of bad management. Guardian, 25 March 2003. Rabie TA (2002) A cluster randomised controlled trial to assess the impact of handwashing with soap on diarrhoeal diseases and acute respiratory infections in children in rural Upper Egypt. MSc Thesis, London School of Hygiene and Tropical Medicine, London. Ryan MAK, Christian R & Wohlrabe J (2001) Handwashing and respiratory illness among young adults in military training. American Journal of Preventive Medicine 21, 79–83.
Fax: 020 7636 7843; E-mail: sandy.cairncross@lshtm.ac.uk Tropical Medicine and International Health
- London Author Sandy Cairncross
- School
- Hygiene
- Keppel Medicine
- Street
- Wc1e London
- Uk 7ht
- Tel
Author
Sandy Cairncross, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Tel.: 020 7927 2211;
Fax: 020 7636 7843; E-mail: sandy.cairncross@lshtm.ac.uk
Tropical Medicine and International Health
volume 8 no 8 pp 677–679 august 2003
Handwashing with soap – a new way to prevent ARIs? Eccles R (2003) Spread of the Common Cold and Influenza. International Forum on Home Hygiene
- S Cairncross
S. Cairncross Handwashing with soap – a new way to prevent ARIs?
Eccles R (2003) Spread of the Common Cold and
Influenza. International Forum on Home Hygiene. URL:
http://www.ifh-homehygiene.org/2newspage/2new05.htm
(accessed on 16/6/03).
Medical Research Council accused of bad management. Guardian
- D Macleod
Macleod D (2003) Medical Research Council accused of bad
management. Guardian, 25 March 2003.
A cluster randomised controlled trial to assess the impact of handwashing with soap on diarrhoeal diseases and acute respiratory infections in children in rural Upper Egypt
- Rabieta
Rabie TA (2002) A cluster randomised controlled trial to assess the
impact of handwashing with soap on diarrhoeal diseases and
acute respiratory infections in children in rural Upper Egypt.
Spread of the Common Cold and Influenza. International Forum on Home Hygiene
- R Eccles
Eccles R (2003) Spread of the Common Cold and
Influenza. International Forum on Home Hygiene. URL:
http://www.ifh-homehygiene.org/2newspage/2new05.htm
(accessed on 16/6/03).
The global burden of diarrhoeal disease
- M Kosek
- C Bern
- R L Guerrant
Kosek M, Bern C & Guerrant RL (2003) The global burden of
diarrhoeal disease, as estimated from studies published between
1992 and 2000. Bulletin of the World Health Organization 81,
197-204.
The World Health Report 2002: Reducing Risks, Promoting Healthy Life. WHO, Geneva. Author Sandy Cairncross, London School of Hygiene and Tropical Medicine
WHO (2002) The World Health Report 2002: Reducing Risks,
Promoting Healthy Life. WHO, Geneva.
Author
Sandy Cairncross, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Tel.: 020 7927 2211;