Estimation of Underreported Cases of Infections and Deaths from COVID-19 for Countries with Limited and Scarce Data: Examples from Nepal

COVID-19 pandemic has overburdened the public healthcare system around the world. Further, lockdown imposed to curb the spread of pandemic has shown to have an adverse effect on economic and health status of an individual. It has also compelled us to switch from the physical world to virtual world, thus depriving us of benefits of person-to-person direct contact. People from developing countries are specially affected. An average person here lacks basic skills needed to survive in the digital world. Due to limited COVID-19 testing capacities in such countries, there is also less testing. Less testing means less contact tracing, underreported cases, and rapid spread of disease. In this paper, the underreported cases of daily infections and daily deaths are predicted using mathematical models. This is based on daily data published by the Government of Nepal. Here, Kathmandu valley is taken as a model area for estimation of underreporting. The behavior of probability of infection, probability of recovery, and probability of deaths is also mathematically analyzed. A time-dependent susceptible infected and recovered model is also proposed. Here, the second wave of COVID-19 is analyzed in detail from 1 Feb 2021 to 1 June 2021. The effect of lockdown on the psychology of people is also modeled with principal components analysis. The inherent and latent factors affecting the people in lockdown are identified. This is based on detailed primary data collected from a survey of 277 households.

Removal of Pathogens from Domestic Wastewater Using Small-Scale Gradual Hydroponics Planted with Duranta erecta, Addis Ababa, Ethiopia

This study aimed to evaluate the treatment potential of gradual hydroponics planted with Duranta erecta in the removal of pathogens from domestic wastewater. Two experimental and control units were configured in series. Each unit contains three bioreactors and was arranged in a cascaded configuration. The two experimental units used both plant and media, but the two control units used only media to treat the wastewater. Gravel and polyester sponge were used as media. Experimental unit 1 and control unit 1 used gravel as media; however, experimental unit 2 and control unit 2 used polyester sponges as media. The experiment was operated at hydraulic retention times of 1, 3, 5, and 7 days in a continuous mode. The performance of the hydroponic system was evaluated by characterizing the influent and effluent quality using standard methods. At optimum hydraulic retention time (7 days), the average removal of experimental units 1 and 2 was 98.7% and 89.8% for heterotrophic bacteria, 96.2% and 86.8% for total coliform, and 92.9% and 84.0% for fecal coliform, respectively. Analysis of variance showed that there was a significant difference P < 0.05 between the two experimental and control units in removing pathogens, but no significant difference P > 0.05 was observed between the two experimental units and between the two control units. Heterotrophic bacteria and coliforms were satisfactorily removed from domestic wastewater via a gradual hydroponic system. Hence, the hydroponic treatment system planted with Duranta erecta has a promising potential in the removal of pathogens from domestic wastewater in developing countries including Ethiopia.

Occupational Exposure of Health-Care Workers to Blood and Body Fluids in West Shewa Zone, Ethiopia, 2018: A Cross-Sectional Study

Background. Health-care workers are susceptible to acquiring blood and body fluids borne infections due to their occupations involving contact with patients and their body fluids, although studies conducted in Ethiopia are scarce. Therefore, the aim of this study was to investigate the magnitude of exposure to blood and body fluids among health-care workers in governmental health facilities in West Shewa Zone, Ethiopia. Materials and Methods. A facility-based cross-sectional study was conducted from May 19 to June 25, 2018. A total of 381 health-care workers were selected by simple random sampling from 31 sampled governmental health facilities using proportional to size allocation. Data were collected through self-administered questionnaires, entered into Epi Info version 7, and analyzed by SPSS version 21. Adjusted odds ratio (AOR) with 95% confidence intervals (CI) calculated for variables retained in the multivariable logistic regression and significance declared at p < 0.05 . Results. Of 377 health-care workers who participated, the study found that 233 (61.2%) were exposed to blood and body fluids in their lifetime. Previous needlestick injury (AOR = 0.30; 95% CI: 0.12–0.75), type of health facility (AOR = 0.42; 95% CI: 0.26–0.68), handwashing practice (AOR = 0.15; 95% CI: 0.07, 0.31), and perceiving at risk (AOR = 0.16; 95% CI: 0.03, 0.98) were protective factors, whereas long work experience (AOR = 1.47; 95% CI: 1.13–1.93) was a risk factor for the exposure. Conclusions. Exposures to blood and body fluids during patient care were common among health-care workers in the study area. Therefore, health-care workers especially those newly hired and working in hospitals should pay due attention to their occupation’s safety and regularly practice handwashing during critical times.

Prevalence and Determinants of Occupational Injuries among Solid Waste Collectors of Zoomlion Ghana Limited

Background. Globally, occupational injuries account for 15% of the mortalities associated with occupational accidents. The work of the solid waste collectors exposes them to numerous occupational hazards, which results in injuries. Increasing rates of occupational injuries from 43.7% to 63.9% among solid waste collectors in sub-Saharan Africa opens room for more research to be done. The study assessed the magnitude of occupational injuries and associated factors among solid waste collectors of Zoomlion Ghana Limited in the Accra Metropolis. Methods. A cross-sectional quantitative study was carried out among the solid waste collectors. The occupational injuries and their associated factors among the solid waste collectors were assessed using questionnaires. Multistage sampling approach was used to select study respondents. Data were collected through the administration of questionnaires. Bivariate and multivariable logistic regression was used to assess the association between the dependent and independent variables. Results. In this study, 21.79% (78/358) with 95% CI (0.1749, 0.2608) among the solid waste collectors reported having at least one work-related injury in the last 6 months. The factors that were significantly associated with at least one occupational injury among the solid waste collectors in the Accra Metropolis were work duty (collection and transportation), the zone of assignment for respondents, and lack of personal protective equipment (PPE). Conclusion. This study showed that the prevalence of occupational injuries among municipal solid waste collectors in the Accra Metropolis was lower as compared to similar research conducted in Ethiopia, Egypt, and India. Working in the collection and transportation category and lack of PPE for use at work were significantly and positively associated with occupational injury among the solid waste collectors. Again, working in the La Dade Kotopon zone had reduced odds of sustaining injuries as compared to those in the Ablekuma South zone. The result of the study demonstrated that cuts/puncture was the injury that was mostly sustained by the municipal solid waste workers, while the leg was the body part that was mostly injured followed by the hands. Public health education in the municipality should target solid waste collectors with the aim of improving their health-seeking behaviour.

Knowledge, Attitude, and Practices of Unused Medications Disposal among Patients Visiting Public Health Centers in Gondar Town, Ethiopia: A Cross-Sectional Study

Background. The improvement of healthcare systems has brought the subsequent increase in people access to medications. The consumers are not able to use all the dispensed medications because of various reasons. The improper disposal of these unused medicines has led to environmental contamination to an alarming extent. Therefore, the study was conducted to assess the knowledge, attitude, and practice of unused medications disposal among patients visiting public health centers in Gondar town, Ethiopia. Methods. A descriptive cross-sectional study was conducted among 404 patients visiting public health centers in Gondar town, Ethiopia, from August to September 2021, by using standardized and a locally translated semistructured questionnaire. The data were entered and analyzed by using the SPSS version of 21.0. The variable of interest was described in the form of statements and tables. Result. Out of 404 respondents included in the study, 221 (54.7%) of them were female. More than half (226 (55.9%)) of the respondents had unused medicine at home. The common methods of disposal practice were throwing into a household garbage (150 (31.4%)), followed by flushed into toilet/sinks (88 (21.8%)). More than half (286 (70.8%)) of the respondents knew about medication waste and 239 (59.2%) of them checked their medication expiry date. More than half (215 (53.5%)) of the participants strongly agreed that unused medicine can cause potential risk at home and 279 (69.1%) of study participants strongly agreed that children are more vulnerable to the potential risk of unused medicine at home. Conclusion. There was a high practice of keeping medication at home, and most disposal approach indicated by the participants was not recommended methods. Awareness about the proper disposal of unused medicines among the public should be created. Guidelines on safe disposal are required, and an organized method of collecting unused and expired pharmaceuticals needs to be introduced.

Association of Acute Respiratory Infections with Indoor Air Pollution from Biomass Fuel Exposure among Under-Five Children in Jimma Town, Southwestern Ethiopia

Background. Most of the households in developing countries burn biomass fuel in traditional stoves with incomplete combustion that leads to high indoor air pollution and acute respiratory infections. Acute respiratory infection is the most common cause of under-five morbidity and mortality accounting for 2 million deaths worldwide and responsible for 18% of deaths among under-five children in Ethiopia. Although studies were done on acute respiratory infections, the majority of studies neither clinically diagnose respiratory infections nor use instant measurement of particulate matter. Methods. The community-based cross-sectional study design was employed among under-five children in Jimma town from May 21 to June 7, 2020. A total of 265 children through systematic random sampling were included in the study. The data were collected using a pretested semistructured questionnaire and laser pm 2.5 meter for indoor particulate matter concentration. Associations among factors were assessed through correlation analysis, and binary logistic regression was done to predict childhood acute respiratory infections. Variables with p -value less than 0.25 in bivariate regression were the candidate for the final multivariate logistic regression. Two independent sample t-tests were done to compare significant mean difference between concentrations of particulate matter. Results. Among 265 under-five children who were involved in the study, 179 (67.5%) were living in households that predominantly use biomass fuel. Prevalence of acute respiratory infections in the study area was 16%. Children living in households that use biomass fuel were four times more likely to develop acute respiratory infections than their counterparts (AOR: 4.348; 95% CI: 1.632, 11.580). The size of household was significantly associated with the prevalence of acute respiratory infections. Under-five children living in households that have a family size of six and greater had odds of 1.7 increased risk of developing acute respiratory infections than their counterparts (AOR: 1.7; 95% CI: 1.299, 2.212). The other factor associated with acute respiratory infection was separate kitchen; children living in households in which there were no separate kitchen were four times at increased risk of developing acute respiratory infection than children living in households which have separate kitchen (AOR: 4.591; 95% CI: 1.849, 11.402). The concentration of indoor particulate matter was higher in households using biomass fuel than clean fuel. There was statistically higher particulate matter concentration in the kitchen than living rooms (t = 4.509, p ≤ 0.001 ). Particulate matter 2.5 concentrations (μg/m3) of the households that had parental smoking were significantly higher than their counterparts (AOR: 20.224; 95% CI: 1.72, 12.58). Conclusion. There is an association between acute respiratory infections and biomass fuel usage among under-five children. Focusing on improved energy sources is essential to reduce the burden and assure the safety of children.

Food Safety Practices and Associated Factors among Food Handlers of Fiche Town, North Shewa Zone, Ethiopia

Background. Foodborne diseases remain a major public health problem globally, but the problem is severe in developing countries like Ethiopia. The objective of this study was to assess food safety practices and associated factors among food handlers of Fiche town. Methods. A cross-sectional study was conducted among 422 food handlers working in food and drink establishments. The data were collected using a structured questionnaire and observational checklist. Data were entered and coded into SPSS for analysis. Multivariable logistic regression was used to identify the predictor variables associated with the practice of food handlers ( p < 0.05 ). Result. 61.6% of food handlers knew the potential risk of contaminating food with dirty hands, and 70% washed hands with soap before working with food. 52.8% of food handlers covered the hair with restraints. 66.8% of food handlers used outer garments, and the majority of food handlers (71.1%) had a trimmed fingernail. Two hundred thirteen (50.5%) of food handlers had good food handling practices. Medical checkup (AOR = 3.16; 95% CI 1.89, 5.26), sanitary inspection (AOR = 1.76; 95% CI 1.16, 2.69), knowledge (AOR = 2.31; 95% CI 1.53, 3.48), service year (AOR = 3.11; 95% CI 1.53, 6.31), and educational status (AOR = 3.42, 95% CI 1.29, 9.04) were found to be significantly associated with food handling practices. Conclusion. The food handlers should take various training concerning food hygiene and safety to enhance their knowledge and practice. Regular sanitary inspection of food and drink establishments is recommended.

Hepatitis B and Asymptomatic Malaria Infection among Pregnant Women in a Semiurban Community of North-Central Nigeria

Background. The overlap of malaria and Hepatitis B Virus (HBV) infections present a major threat to public health throughout endemic countries of tropical and sub-Saharan Africa. There is a paucity of data on the prevalence and associated factors of malaria and HBV infections among pregnant women in Ejule, a semiurban area of Nigeria. Therefore, the current study was designed to assess the seroprevalence of malaria and HBV among pregnant women attending antenatal clinics in Ejule Metropolis. Materials and Methods. In a hospital-based cross-sectional study, blood samples collected from 200 apparently healthy pregnant women at the Ilemona Clinic were screened for Plasmodium falciparum (P. falciparum) and HBsAg using histidine-rich protein 2 (HRP2) and hepatitis B surface antigen (HBsAg) rapid diagnostic tests (RDTs), respectively. Relevant sociodemographic and putative risk factor information was obtained with structured questionnaires. Results. The prevalence of the infections was 44 (22%), 5 (2.5%), and 1 (0.5%) for P. falciparum monoinfection and HBV monoinfection and coinfection, respectively. Single and concurrent infections peaked at ages 31–40 years but decreased with older ages. High P. falciparum, 31 (59.62%), and HBV 2 (3.85%) infection were observed among those without formal education. Contrary to ages, occupation, and knowledge of infection, malaria parasitemia differed significantly with lower educational qualification ( p ≤ 0.001 ), being single ( p = 0.001 ), and inconsistent use of insecticide-treated bed nets (ITNs) ( p = 0.04 , OR = 5, CI: 0.10–0.47). History of blood donation (OR = 5, p = 0.04 , CI: 1.10–32.80) and multiple sex partners (OR = 11.9, p = 0.01 , CI: 0.01–0.93) were found to be significantly associated with hepatitis B surface antigenemia rate during pregnancy. No evidence of HBV infection was observed in women with a history of HBV vaccination. Conclusions. Malaria is still highly prevalent among pregnant women due to high illiteracy and noncompliance to using ITNs. Therefore, routine screening and educating pregnant mothers are crucial in eliminating malaria in endemic settings. The low rate of hepatitis B and coinfection with malaria shows that further improvement in HBV vaccination could considerably reduce the disease burden among pregnant women.

Effectiveness of a Participatory Program on Pesticide Use Behavior and Blood Cholinesterase Levels in Chiang Mai Province, Northern Thailand

This quasiexperimental study was designed to determine the effectiveness of a participatory program on pesticide use behavior and blood cholinesterase levels. The participants were 18–60 years old, living in Thung Satok subdistrict, San Pa Tong District, Chiang Mai Province. Eighty subjects, including 32 farmers and 48 consumers, were recruited to participate in the study voluntarily by a purposive sampling technique. Data concerning each individual’s behaviors were collected using questionnaires, and blood cholinesterase levels were obtained from whole blood finger, providing whole blood pre and postexperiment. The data were analyzed using Fishers’ exact and paired t-tests, for the problem situations were independently analyzed. The results show that the participatory process made it possible to improve methods for the prevention of the unhealthy effects of pesticides. After participating in the activities, both groups showed significantly higher scores in before and after knowledge ( P < 0.05 ) and a decrease in pesticide contamination in their bodies as a result of the measurement of average cholinesterase which increased significantly ( P < 0.001 ). In conclusion, the participatory program was applied to solve health problems from chemical hazards. The program can raise awareness about chemical toxicity, leading to the modification of the related behavior toward chemicals and reduction of the contamination of chemicals in the body. Therefore, the adoption of participatory processes can effectively solve problems related to chemical hazards that affect health.

Spatial Extent and Distribution of Ambient Airborne Particulate Matter (PM2.5) in Selected Land Use Sites in Nairobi, Kenya

Air pollution is one of the most important environmental and public health concerns worldwide. Urban air pollution has been increasing since the industrial revolution due to rapid industrialization, mushrooming of cities, and greater dependence on fossil fuels in urban centers. Particulate matter (PM) is considered to be one of the main aerosol pollutants that causes a significant adverse impact on human health. Low-cost air quality sensors have attracted attention recently to curb the lack of air quality data which is essential in assessing the health impacts of air pollutants and evaluating land use policies. This is mainly due to their lower cost in comparison to the conventional methods. The aim of this study was to assess the spatial extent and distribution of ambient airborne particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) in Nairobi City County. Seven sites were selected for monitoring based on the land use type: high- and low-density residential, industrial, agricultural, commercial, road transport, and forest reserve areas. Calibrated low-cost sensors and cyclone samplers were used to monitor PM2.5 concentration levels and gravimetric measurements for elemental composition of PM2.5, respectively. The sensor percentage accuracy for calibration ranged from 81.47% to 98.60%. The highest 24-hour average concentration of PM2.5 was observed in Viwandani, an industrial area (111.87 μg/m³), and the lowest concentration at Karura (21.25 μg/m³), a forested area. The results showed a daily variation in PM2.5 concentration levels with the peaks occurring in the morning and the evening due to variation in anthropogenic activities and the depth of the atmospheric boundary layer. Therefore, the study suggests that residents in different selected land use sites are exposed to varying levels of PM2.5 pollution on a regular basis, hence increasing the potential of causing long-term health effects.