Water, Sanitation and Hygiene: Interventions and Diarrhoea - A Systematic Review and Meta-analysis

This paper provides a formal systematic review and meta-analysis examining the evidence of the effectiveness of interventions intended to reduce illness through improvements in drinking water, sanitation facilities and hygiene practices. The comprehensive literature search and bibliographic review shows that in developing countries, water quality interventions, specifically point-of-use treatment, reduced diarrhea illness levels, but this effect was mainly seen with the provision of household connections and use of water without household storage. Hygiene interventions, especially those promoting hand-washing, were effective. Only limited data were available for sanitation interventions, but these suggested effectiveness in reducing diarrhea. Multifactorial interventions consisting of water supply, sanitation and hygiene education acted to reduce diarrhea but were not more effective than individual interventions

Deflection and frequency monitoring of the Forth Road Bridge, Scotland, by GPS

Permission is granted by ICE Publishing to print one copy for personal use. Any other use of these PDF files is subject to reprint fees. Copyright © 2012 Thomas Telford Ltd.The use of carrier phase kinematic GPS (global positioning system) has evolved into a reliable technique to measure both the three-dimensional magnitudes and frequencies of movements of structures. Techniques have been developed that tackle errors caused by multipath, tropospheric delay and issues relating to satellite geometry. GPS-derived movements compare well with data from both design predictions and structural models. Results from field trials carried out on the Forth Road Bridge are presented. This paper brings together key results that outline the procedure as well as a series of new data that indicate other potential applications. GPS data were collected continuously over a period of 46 h at a minimum rate of 10 Hz. During the trials wind speed, wind direction, relative humidity and temperature were also recorded. Frequently there was very heavy traffic flow, and at one point a special load (a 100-t lorry) passed over simultaneously to the heavy daytime flow of traffic. Data from a planned load trial during a brief bridge closure are reported and compared with the limited results available from a finite element model. Measured vibration frequencies are also computed from GPS data and compared with those given in the literature. In addition, results indicating the change in structural characteristics are also presented – in particular changes of mass associated with changes in traffic loading are observed. The results show the performance of GPS as it has developed in recent years, and that it can now reliably be used as a significant part of structural health monitoring schemes, giving both the magnitude of quasi-static deflections in known time periods and hence the frequency of dynamic movements of structures.Forth Estuary Transport Authorit

Incidence and public health burden of sunburn among beachgoers in the United States.

The beach environment creates many barriers to effective sun protection, putting beachgoers at risk for sunburn, a well-established risk factor for skin cancer. Our objective was to estimate incidence of sunburn among beachgoers and evaluate the relationship between sunburn incidence and sun-protective behaviors. A secondary analysis, of prospective cohorts at 12 locations within the U.S. from 2003 to 2009 (n = 75,614), were pooled to evaluate sunburn incidence 10-12 days after the beach visit. Behavioral and environmental conditions were cross-tabulated with sunburn incidence. Multivariable logistic regression was used to estimate the association between new sunburn and sun-protective behaviors. Overall, 13.1% of beachgoers reported sunburn. Those aged 13-18 years (16.5%), whites (16.0%), and those at beach locations along the Eastern Seaboard (16.1%), had the highest incidence of sunburn. For those spending ≥5 h in the sun, the use of multiple types of sun protection reduced odds of sunburn by 55% relative to those who used no sun protection (Odds Ratio = 0.45 (95% Confidence Interval:0.27-0.77)) after adjusting for skin type, age, and race. Acute health effects of sunburn tend to be mild and self-limiting, but potential long-term health consequences are more serious and costly. Efforts to encourage and support proper sun-protective behaviors, and increase access to shade, protective clothing, and sunscreen, can help prevent sunburn and reduce skin cancer risk among beachgoers

Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala

Background The promotion of household water treatment and handwashing with soap has led to large reductions in child diarrhoea in randomized efficacy trials. Currently, we know little about the health effectiveness of behaviour-based water and hygiene interventions after the conclusion of intervention activities. Methods We present an extension of previously published design (propensity score matching) and analysis (targeted maximum likelihood estimation) methods to evaluate the behavioural and health impacts of a pre-existing but non-randomized intervention (a 3-year, combined household water treatment and handwashing campaign in rural Guatemala). Six months after the intervention, we conducted a cross-sectional cohort study in 30 villages (15 intervention and 15 control) that included 600 households, and 929 children <5 years of age. Results The study design created a sample of intervention and control villages that were comparable across more than 30 potentially confounding characteristics. The intervention led to modest gains in confirmed water treatment behaviour [risk difference = 0.05, 95% confidence interval (CI) 0.02-0.09]. We found, however, no difference between the intervention and control villages in self-reported handwashing behaviour, spot-check hygiene conditions, or the prevalence of child diarrhoea, clinical acute lower respiratory infections or child growth. Conclusions To our knowledge this is the first post-intervention follow-up study of a combined household water treatment and handwashing behaviour change intervention, and the first post-intervention follow-up of either intervention type to include child health measurement. The lack of child health impacts is consistent with unsustained behaviour adoption. Our findings highlight the difficulty of implementing behaviour-based household water treatment and handwashing outside of intensive efficacy trial

Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries

objective To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. methods For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. results In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group. conclusions This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene

The Tortoise and the Hare: One Turtle's Journey to Discover the True Nature of Art and Life

Human connection is something we all need in order to live fully, yet we often find ourselves hiding away behind a protective shell. Especially in this day and age, we are usually expected to have it all “figured out” and to present ourselves confidently. This can make it difficult, if not impossible, to reach out. One way we connect is through art, and more specifically, stories. Stories help us to empathize and put ourselves in another’s shoes. The Tortoise and the Hare: One Turtle's Journey to Discover the True Nature of Art and Life is the story of a young man struggling to connect: with his parents, with his friends, and with himself. Through writing this story, for which I drew on personal experiences and feelings, I show how it is possible to express the self through art, and allow others to see it. In conclusion, I have found that this willingness to be take risks and be exposed to others is directly related to a sense of fulfillment and connection.Theatre and Speech Communicatio

Estimating the impact of unsafe water, sanitation and hygiene on the global burden of disease: evolving and alternative methods.

The 2010 global burden of disease (GBD) study represents the latest effort to estimate the global burden of disease and injuries and the associated risk factors. Like previous GBD studies, this latest iteration reflects a continuing evolution in methods, scope and evidence base. Since the first GBD Study in 1990, the burden of diarrhoeal disease and the burden attributable to inadequate water and sanitation have fallen dramatically. While this is consistent with trends in communicable disease and child mortality, the change in attributable risk is also due to new interpretations of the epidemiological evidence from studies of interventions to improve water quality. To provide context for a series of companion papers proposing alternative assumptions and methods concerning the disease burden and risks from inadequate water, sanitation and hygiene, we summarise evolving methods over previous GBD studies. We also describe an alternative approach using population intervention modelling. We conclude by emphasising the important role of GBD studies and the need to ensure that policy on interventions such as water and sanitation be grounded on methods that are transparent, peer-reviewed and widely accepted

Alien Registration- Colford, Arthur (Waterville, Kennebec County)

https://digitalmaine.com/alien_docs/15579/thumbnail.jp

Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh.

We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = -0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.24 SDs (95% CI = -0.63, 0.16) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.33 SDs decrease in HAZ (95% CI = -0.62, -0.05). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy