scholarly journals Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Jessica Y. H. Aw ◽  
Naomi E. Clarke ◽  
James S. McCarthy ◽  
Rebecca J. Traub ◽  
Salvador Amaral ◽  
...  
Keyword(s):  
Low Income ◽  
Large Scale ◽  
Giardia Duodenalis ◽  
Community Level ◽  
Trial Registration ◽  
Low Income Countries ◽  
Secondary Outcome ◽  
Sanitation And Hygiene ◽  
Timor Leste ◽  
The Impact

Abstract Background Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis. Methods The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires. Results There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95% CI: 0.72–1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95% CI: 1.04–1.75), living in a household with more than six people (aOR: 1.32, 95% CI: 1.02–1.72), and sampling during the rainy season (aOR: 1.23, 95% CI: 1.04–1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95% CI: 0.57–0.88). Conclusions Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12614000680662. Registered 27 June 2014, retrospectively registered. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366540.

scholarly journals Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact

2019 ◽  
Vol 16 (3) ◽  
pp. 359 ◽  
Author(s):  
Celia McMichael
Keyword(s):  
Low Income ◽  
Library Science ◽  
Low Income Countries ◽  
Cochrane Library ◽  
Publication Date ◽  
Program Fidelity ◽  
School Based ◽  
Sanitation And Hygiene ◽  
Hygiene Promotion ◽  
The Impact

Many schools in low-income countries have inadequate access to water facilities, sanitation and hygiene promotion. A systematic review of literature was carried out that aimed to identify and analyse the impact of water, sanitation and hygiene interventions (WASH) in schools in low-income countries. Published peer reviewed literature was systematically screened during March to June 2018 using the databases PubMed, Embase, Web of Science, the Cochrane Library, Science Direct, and Google Scholar. There were no publication date restrictions. Thirty-eight peer reviewed papers were identified that met the inclusion criteria. The papers were analysed in groups, based on four categories of reported outcomes: (i) reduction of diarrhoeal disease and other hygiene-related diseases in school students; (ii) improved WASH knowledge, attitudes and hygiene behaviours among students; (iii) reduced disease burden and improved hygiene behaviours in students’ households and communities; (iv) improved student enrolment and attendance. The typically unmeasured and unreported ‘output’ and/or ‘exposure’ of program fidelity and adherence was also examined. Several studies provide evidence of positive disease-related outcomes among students, yet other assessments did not find statistically significant differences in health or indicated that outcomes are dependent on the nature and context of interventions. Thirteen studies provide evidence of changes in WASH knowledge, attitudes and behaviours, such as hand-washing with soap. Further research is required to understand whether and how school-based WASH interventions might improve hygiene habits and health among wider family and community members. Evidence of the impact of school-based WASH programs in reducing student absence from school was mixed. Ensuring access to safe and sufficient water and sanitation and hygiene promotion in schools has great potential to improve health and education and to contribute to inclusion and equity, yet delivering school-based WASH intervention does not guarantee good outcomes. While further rigorous research will be of value, political will and effective interventions with high program fidelity are also key.

More than poverty

2016 ◽  
Vol 40 (6) ◽  
pp. 536-543 ◽  
Author(s):  
Theodore D. Wachs ◽  
Santiago Cueto ◽  
Haogen Yao
Keyword(s):  
Low Income ◽  
Large Scale ◽  
Cumulative Risk ◽  
Low Income Countries ◽  
Data Set ◽  
Middle Income ◽  
Middle Income Countries ◽  
Developmental Risks ◽  
The Impact ◽  
Low And Middle Income

Studies from both high and low-middle income (LAMI) countries have documented how being reared in poverty is linked to compromised child development. Links between poverty and development are mediated by the timing and extent of exposure to both risk factors nested under poverty and to protective influences which can attenuate the impact of risk. While children from high-, middle-, and low-income countries are exposed to similar types of developmental risks, children from low- and middle-income countries are exposed to a greater number, more varied and more intense risks. Given these contextual differences, cumulative risk models may provide a better fit than mediated models for understanding the nature of pathways linking economic insufficiency and developmental inequality in low- and middle-income countries, and for designing interventions to promote development of children from these countries. New evidence from a large scale UNICEF data set illustrates the application of a cumulative risk/protective perspective in low- and middle-income countries.

scholarly journals Omitting edema measurement: how much acute malnutrition are we missing?

2015 ◽  
Vol 102 (5) ◽  
pp. 1176-1181 ◽  
Author(s):  
Severine Frison ◽  
Francesco Checchi ◽  
Marko Kerac
Keyword(s):  
Low Income ◽  
Large Scale ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Low Income Countries ◽  
Public Health Issue ◽  
Data Sets ◽  
Cross Sectional Survey ◽  
Prevalence Estimates ◽  
The Impact

ABSTRACT Background: Acute malnutrition is a major public health issue in low-income countries. It includes both wasting and edematous malnutrition, but the terms wasting and acute malnutrition are often used interchangeably. Little is known about the burden of edematous malnutrition, and few large-scale surveys measure it. Objective: Most acute malnutrition might be captured by the measurement of wasting alone, but this is unknown. This article aims to fill this gap. Design: This article presents a secondary data analysis of 852 nutrition cross-sectional survey data sets of children aged 6–59 mo. The data sets assembled included surveys from East, West, South, and Central Africa; the Caribbean; and Asia. The overlap between edematous malnutrition and wasting was assessed, and the impact of including/excluding edema on acute malnutrition prevalence estimates was evaluated. Results: The prevalence of edematous malnutrition varied from 0% to 32.9%, and children were more likely to have bilateral edema in Central and South Africa (OR: 4; 95% CI: 2.8, 5.6). A large proportion of children with edematous malnutrition were not wasted [62% and 66% based on midupper arm circumference (MUAC) and weight-for-height (WFH), respectively], and most were not severely wasted (83% and 86% based on MUAC and WFH, respectively). When wasting and global acute malnutrition prevalence estimates as well as severe wasting and severe acute malnutrition prevalence estimates overall were compared, the differences between estimates were small (median of 0.0% and mean of 0.3% based on WFH and MUAC for global estimates and slightly higher median of 0.1% and mean of 0.4% based on MUAC and WFH, respectively, for the severe forms), but the picture was different at the regional level. Conclusions: The terms acute malnutrition and wasting should not be used interchangeably. The omission of the measurement of edema can have important repercussions, especially at the nutrition program level.

scholarly journals Constraints on foreign aid effectiveness in the water, sanitation, and hygiene (WaSH) sector

2017 ◽  
Vol 8 (1) ◽  
pp. 44-52 ◽  
Author(s):  
Joshua Wayland
Keyword(s):  
Foreign Aid ◽  
International Development ◽  
Low Income ◽  
Aid Effectiveness ◽  
Low Income Countries ◽  
Middle Income ◽  
Instrumental Variable Regression ◽  
Sanitation And Hygiene ◽  
Political Economic ◽  
The Impact

Abstract Numerous studies have sought to empirically test the effectiveness of foreign aid as a tool for international development, with often inconsistent or contradictory results. New sources of disaggregated aid data now allow researchers to test the impact of individual sectors of aid on sector-specific outcomes. The paper investigates the effectiveness of foreign aid in the water, sanitation, and hygiene (WaSH) sector and seeks to identify constraints on WaSH aid effectiveness in recipient countries. Multilevel latent growth, dynamic panel, and instrumental variable regression models were estimated on a panel dataset comprising 125 recipient countries over 20 years. WaSH aid was consistently associated with improved health outcomes in middle-income countries; no effect on those outcomes was observed in low-income countries. Potential constraints on the effectiveness of WaSH aid – including political, economic, institutional, and technical constraints – were examined using subgroup analysis. The effectiveness of WaSH aid was found to have been constrained by government ineffectiveness and regulatory quality in recipient countries. Countries with large rural populations also appear to have benefitted less from WaSH aid than more urbanized recipient countries.

scholarly journals COVID-19 pandemic: Water, sanitation and hygiene (WASH) as a critical control measure remains a major challenge in low-income countries

2021 ◽  
Vol 191 ◽  
pp. 116793
Author(s):  
Oscar Omondi Donde ◽  
Evans Atoni ◽  
Anastasia Wairimu Muia ◽  
Paul T. Yillia
Keyword(s):  
Low Income ◽  
Control Measure ◽  
Low Income Countries ◽  
Sanitation And Hygiene

scholarly journals Psychological distress during COVID-19 pandemic in low-income and middle-income countries: a cross-sectional study of older persons in Thailand

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e047650
Author(s):  
Wiraporn Pothisiri ◽  
Paolo Miguel Manalang Vicerra
Keyword(s):  
Psychological Distress ◽  
Low Income ◽  
Older Persons ◽  
Online Survey ◽  
Well Being ◽  
Secondary Outcome ◽  
Ageing Society ◽  
Psychological Well Being ◽  
Middle Income ◽  
The Impact

ObjectiveThe COVID-19 situation in Thailand was controlled with various social measures. Much of the information covered in the media and in studies focused on the public health and economic aspects of the pandemic. This study aimed to explore the psychological well-being of older people, which is important especially in an ageing society categorised as low income or middle income due to the limits of economic and healthcare resources.SettingThe impact of COVID-19 on older persons in Thailand, an online survey, taken across nine provinces within the five regions of the country.ParticipantsInformation was collected from 1230 adults aged at least 60 years old.If an older person was illiterate, unable to access the internet or had a disability preventing them from responding to the survey, an intermediary residing in the community conducted the survey interview.Primary and secondary outcome measuresThe analysis focused on the worries of older adults and the factors associated with psychological distress experienced during the pandemic using logistic regression analysis.ResultsThe majority of people aged at least 60 years old experienced psychological distress during COVID-19. Employment loss (OR 1.08, 95% CI 0.78 to 1.38), inadequate income (OR 1.77, 95% CI 1.28 to 2.44) and debt incursion (OR 2.74, 95% CI 1.57 to 4.80) were detrimental to psychological well-being. The negative changes in the perception of their health status (OR 1.92, 95% CI 1.23 to 2.99) and decreased life satisfaction (OR 1.49, 95% CI 0.45 to 1.87) also weighed on older Thais. The protective factors for psychological well-being were residing in rural areas (OR 0.46, 95% CI 0.35 to 0.61) and being married (OR 0.75, 95% CI 0.55 to 1.01).ConclusionObserving the concerns of the older population is important for introducing policies that can alleviate their precarious financial and health statuses.

scholarly journals Evaluation of a Low-Cost Commercial Actigraph and Its Potential Use in Detecting Cultural Variations in Physical Activity and Sleep

Sensors ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 3774
Author(s):  
Pavlos Topalidis ◽  
Cristina Florea ◽  
Esther-Sevil Eigl ◽  
Anton Kurapov ◽  
Carlos Alberto Beltran Leon ◽  
...  
Keyword(s):  
Physical Activity ◽  
Low Income ◽  
Large Scale ◽  
Low Cost ◽  
Low Income Countries ◽  
Time Data ◽  
Cultural Variations ◽  
Step Counts ◽  
Scale Step ◽  
Potential Use

The purpose of the present study was to evaluate the performance of a low-cost commercial smartwatch, the Xiaomi Mi Band (MB), in extracting physical activity and sleep-related measures and show its potential use in addressing questions that require large-scale real-time data and/or intercultural data including low-income countries. We evaluated physical activity and sleep-related measures and discussed the potential application of such devices for large-scale step and sleep data acquisition. To that end, we conducted two separate studies. In Study 1, we evaluated the performance of MB by comparing it to the GT3X (ActiGraph, wGT3X-BT), a scientific actigraph used in research, as well as subjective sleep reports. In Study 2, we distributed the MB across four countries (Austria, Germany, Cuba, and Ukraine) and investigated physical activity and sleep among these countries. The results of Study 1 indicated that MB step counts correlated highly with the scientific GT3X device, but did display biases. In addition, the MB-derived wake-up and total-sleep-times showed high agreement with subjective reports, but partly deviated from GT3X predictions. Study 2 revealed similar MB step counts across countries, but significant later wake-up and bedtimes for Ukraine than the other countries. We hope that our studies will stimulate future large-scale sensor-based physical activity and sleep research studies, including various cultures.

scholarly journals The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Giorgia Gon ◽  
Abdunoor M. Kabanywanyi ◽  
Petri Blinkhoff ◽  
Simon Cousens ◽  
Stephanie J. Dancer ◽  
...  
Keyword(s):  
Pilot Study ◽  
Study Design ◽  
Low Income ◽  
High Volume ◽  
Surface Cleaning ◽  
Low Income Countries ◽  
Training Period ◽  
Future Research ◽  
Environmental Hygiene ◽  
The Impact

Abstract Background Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. Methods This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. Results Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11–1.60), and by 1.08 (CI = 1.03–1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. Conclusions The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design.

scholarly journals COVID-19 in children treated with immunosuppressive medication for kidney diseases

2020 ◽  
pp. archdischild-2020-320616
Author(s):  
Matko Marlais ◽  
Tanja Wlodkowski ◽  
Samhar Al-Akash ◽  
Petr Ananin ◽  
Varun Kumar Bandi ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Immunosuppressive Therapy ◽  
Low Income ◽  
Kidney Diseases ◽  
Low Income Countries ◽  
Reference Network ◽  
Immunosuppressive Medication ◽  
Immunosuppressive Medications ◽  
Significant Difference ◽  
The Impact

BackgroundChildren are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity.MethodsCross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19.Results113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications.ConclusionsThis global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.

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