Role of sanitation in preventing faecal contamination of the domestic environment and protecting health: An observational study.

This thesis assesses the potential public health significance of, sanitation quality and coverage by using microbiological indicator and secondary health outcome data. Sanitation was categorised using The Millennium Development Goal (MDG) definition of improved (private pit latrine with a slab or better) and unimproved (toilets connected to open, pit latrine without a slab, hanging toilet, shared toilets). A spot check of sanitation facilities was conducted in 460 target houses and 1,784 neighbouring houses. Faecal contamination of the household environment was assessed by looking for evidence of contamination with faecal coliforms on children’s hands and on ‘sentinel’ toys (standardised toy balls provided by the study). An analysis of secondary data was conducted on sanitation and reported diarrhoea among children <5 years of age that had been collected as part of an impact evaluation. Households with private improved sanitation had lower faecal coliform contamination than households with unimproved sanitation [difference in means: -0.31 log10 colony forming units (CFU)/toy ball; 95% CI: -0.61, -0.01]. Access to 100% private improved sanitation coverage in the neighbourhood was associated with a small but statistically insignificant difference in contamination of sentinel toys (difference in means: -0.09 log10 CFU/toy; 95% CI: -0.56, 0.38). Other household sanitary practices such as cleanliness of latrine, wastewater disposal and disposal of animal faeces were important and statistically significant (P value ≤0.06) determinants of household faecal contamination. Children from households with access to private improved sanitation had a similar prevalence of diarrhoea to those with unimproved sanitation (Prevalence Ratio [PR] =1.00; 95% CI: 0.89, 1.13). Children from households with appropriate solid waste disposal systems had lower prevalence of diarrhoea compared to those without (PR=0.78; 95% CI: 0.65, 0.95). 4 Improved sanitation infrastructure quality and coverage may have limited roles in preventing transmission of diarrhoea causing enteric pathogens in the study context in which diarrhoea is endemic. Although in this study, private use and cleanliness of latrine were associated reduction in faecal contamination, but these factors were not associated with reduced diarrhoea prevalence. This may be because, firstly data were collected from slightly different contexts and time, secondly indicator organisms are only weakly associated presence of enteric pathogens and thirdly the population in this study context may have developed some degree of immunity to common circulating pathogens. Findings from this observational studies presented in this thesis adds to the evidence base, which do not support the inclusion of shared facilities as improved. There may be other more important source of children’s exposure to enteric pathogens that onsite sanitation access cannot prevent. Other sanitation related factors like maintenance of sanitation facility, use by all household members including children and faecal sludge management should be considered while defining improved sanitation for international monitoring. We also need to increase research efforts to integrate sanitation, water quality, handwashing and nutritional interventions and to understand better ways to monitor the impact of these interventions

HUBUNGAN KECERDASAN EMOSIONAL DENGAN PRESTASI BELAJAR MATEMATIKA SISWA DI SEKOLAH MENENGAH PERTAMA NEGERI 16 KOTA JAMBI

Skripsi ini membahas tentang Hubungan Kecerdasan Emosional Dengan Prestasi Belajar Siswa Matematika kelas VII di SMP N 16 Kota Jambi. Penelitian ini merupakan penelitian kuantitatif dengan menggunakan Desain Penelitian Kuantitatif Survey. Pengumpulan data dilakukan dengan angket dan dokumentasi. Subjek penelitian adalah siswa kelas VII C berjumlah 34 orang siswa. Data hasil penelitian di peroleh skor tertinggi adalah 97 dan skor terendah 70. Skor hasil prestasi belajar matematika diperoleh skor tertinggi adalah 100 dan skor terendah adalah 60. Berdasarkan perhitungan menggunakan Korelasi Pearson Product Moment menggunakan SPSS 16.0 diperoleh rhitung= 0,709 dan pada taraf signifikan 5% diperoleh rtabel = 0,334 dengan demikian Sehingga Ha diterima, artinya bahwa terdapat hubungan yang signifikan antara Kecerdasan Emosional Dengan Prestasi Belajar Matematika Siswa Di Sekolah Menengah Pertama Negeri 16 Kota Jambi

The Involvement of Bangladeshi Girls and Women in Sex Work: Sex Trafficking, Victimhood, and Agency

In Bangladesh, traffickers have trapped socially and economically marginalised girls and women and sold them into sex work. Furthermore, multiple sociocultural factors shape women’s forced and voluntary movement into sex work. However, there are limited peer-reviewed studies of how sex work operators and sociocultural and economic factors shape women’s forced and voluntary engagement in sex work in Bangladesh and worldwide. This study examines how sex work operators and various factors shape Bangladeshi women’s forced and voluntary involvement in sex work. This study used a qualitative approach by employing in-depth interviews with 10 female sex workers (FSWs) and 8 other stakeholders who work in a Bangladeshi brothel context. This study also used field notes to document how sex work operators and various factors shape women’s engagement in sex work. The interview transcripts and field notes were coded and analysed thematically. Participants’ accounts reveal two key themes about how sex work operators and sociocultural factors shape women’s engagement in sex work. Findings suggest that sex work operators (e.g., traffickers, pimps, madams, house owners) forced girls and women into sex work by putting them in situations in which they had limited power. Furthermore, various economic (poverty, limited employment opportunities) and sociocultural (rape, harassment, exploitation, divorce, limited support from family members and friends, feeling of disempowerment, desire to be autonomous) factors shaped their voluntary engagement in sex work by creating a condition of victimhood in which women felt limited agency and obligated to work for madams as bonded sex workers. However, some women supported by an FSW-led organisation had more agency than others to work and earn in the brothel area. We suggest three important strategies that are likely to benefit brothel-based women and their families, children, and the wider community

Prevalence and Demographic, Socioeconomic, and Behavioral Risk Factors of Self-Reported Symptoms of Sexually Transmitted Infections (STIs) among Ever-Married Women: Evidence from Nationally Representative Surveys in Bangladesh

Sexually transmitted infections (STI) symptoms (e.g., abnormal genital discharge and genital sores/ulcers) are a major public health concern in Bangladesh because the symptoms can indicate an STI and cause sexual and reproductive health complications in women of reproductive age. To our knowledge, no study examined the prevalence and risk factors of STI symptoms using a nationally representative sample. This study investigates the prevalence of STI symptoms among ever-married women in Bangladesh and the associations of STI symptoms with various demographic, socioeconomic, and behavioral risk factors using the most recent available data (2007, 2011, and 2014) of the Bangladesh Demographic and Health Surveys (BDHS). The BDHS employs a two-stage stratified sampling technique. The analytic sample comprised 41,777 women of reproductive age (15–49 years). Outcome variables included STI symptoms: abnormal genital discharge and genital sores/ulcers. Multivariate logistic regression was employed to find the adjusted odds ratio with a 95% confidence interval to assess the associations of outcome measures with explanatory variables. The study found that the prevalence of abnormal genital discharge and genital sores/ulcers among ever-married women aged 15–49 years was 10% and 6%, respectively. Multi-variable analysis revealed that for women aged 25–34 years, those who used contraceptives and married earlier had an increased likelihood of STI symptoms. Furthermore, women from the wealthiest wealth quintile and couple’s joint decision-making were less likely to have STI symptoms. Findings have implications for interventions efforts aiming to improve women’s sexual and reproductive health in Bangladesh

Coronary Computed Tomographic Angiography at 80 kVp and Knowledge-Based Iterative Model Reconstruction Is Non-Inferior to that at 100 kVp with Iterative Reconstruction

The aims of this study were to compare the image noise and quality of coronary computed tomographic angiography (CCTA) at 80 kVp with knowledge-based iterative model reconstruction (IMR) to those of CCTA at 100 kVp with hybrid iterative reconstruction (IR), and to evaluate the feasibility of a low-dose radiation protocol with IMR. Thirty subjects who underwent prospective electrocardiogram-gating CCTA at 80 kVp, 150 mAs, and IMR (Group A), and 30 subjects with 100 kVp, 150 mAs, and hybrid IR (Group B) were retrospectively enrolled after sample-size calculation. A BMI of less than 25 kg/m2 was required for inclusion. The attenuation value and image noise of CCTA were measured and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated at the proximal right coronary artery and left main coronary artery. The image noise was analyzed using a non-inferiority test. The CCTA images were qualitatively evaluated using a four-point scale. The radiation dose was significantly lower in Group A than Group B (0.69 ± 0.08 mSv vs. 1.39 ± 0.15 mSv, p < 0.001). The attenuation values were higher in Group A than Group B (p < 0.001). The SNR and CNR in Group A were higher than those of Group B. The image noise of Group A was non-inferior to that of Group B. Qualitative image quality of Group A was better than that of Group B (3.6 vs. 3.4, p = 0.017). CCTA at 80 kVp with IMR could reduce the radiation dose by about 50%, with non-inferior image noise and image quality than those of CCTA at 100 kVp with hybrid IR

Antimicrobial Resistance, Virulence Factors and Genetic Diversity of Escherichia coli Isolates from Household Water Supply in Dhaka, Bangladesh

Background: Unsafe water supplies continue to raise public health concerns, especially in urban areas in low resource countries. To understand the extent of public health risk attributed to supply water in Dhaka city, Bangladesh, Escherichia coli isolated from tap water samples collected from different locations of the city were characterized for their antibiotic resistance, pathogenic properties and genetic diversity. Methodology/Principal Findings: A total of 233 E. coli isolates obtained from 175 tap water samples were analysed for susceptibility to 16 different antibiotics and for the presence of genes associated with virulence and antibiotic resistance. Nearly 36% (n = 84) of the isolates were multi-drug(≥3 classes of antibiotics) resistant (MDR) and 26% (n = 22) of these were positive for extended spectrum β-lactamase (ESBL). Of the 22 ESBL-producers, 20 were positive for blaCTX-M-15, 7 for blaOXA-1-group(all had blaOXA-47) and 2 for blaCMY-2. Quinolone resistance genes, qnrS and qnrB were detected in 6 and 2 isolates, respectively. Around 7% (n = 16) of the isolates carried virulence gene(s) characteristic of pathogenic E. coli; 11 of these contained lt and/or st and thus belonged to enterotoxigenic E. coli and 5 contained bfp and eae and thus belonged to enteropathogenic E. coli. All MDR isolates carried multiple plasmids (2 to 8) of varying sizes ranging from 1.2 to >120 MDa. Ampicillin and ceftriaxone resistance were co-transferred in conjugative plasmids of 70 to 100 MDa in size, while ampicillin, trimethoprim-sulfamethoxazole and tetracycline resistance were co-transferred in conjugative plasmids of 50 to 90 MDa. Pulsed-field gel electrophoresis analysis revealed diverse genetic fingerprints of pathogenic isolates. Significance: Multi-drug resistant E. coli are wide spread in public water supply in Dhaka city, Bangladesh. Transmission of resistant bacteria and plasmids through supply water pose serious threats to public health in urban areas

Shonjibon cash and counselling: a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh.

BackgroundUndernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months.MethodThe study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child's age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Household food security (10) Number of events for child suffering from diarrhoea, acute respiratory illness and fever (11) Average costs of mobile phone BCC and cash transfer, and benefit-cost ratio for primary and secondary outcomes.DiscussionThe proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh.Trial registrationThe study has been registered in the Australian New Zealand Clinical Trials Registry ( ACTRN12618001975280 )

Impaired Executive Function Mediates the Association between Maternal Pre-Pregnancy Body Mass Index and Child ADHD Symptoms

Increasing evidence suggests exposure to adverse conditions in intrauterine life may increase the risk of developing attention-deficit/hyperactivity disorder (ADHD) in childhood. High maternal pre-pregnancy body mass index (BMI) has been shown to predict child ADHD symptoms, however the neurocognitive processes underlying this relationship are not known. The aim of the present study was to test the hypothesis that this association is mediated by alterations in child executive function.A population-based cohort of 174 children (mean age = 7.3 ± 0.9 (SD) yrs, 55% girls) was evaluated for ADHD symptoms using the Child Behavior Checklist, and for neurocognitive function using the Go/No-go task. This cohort had been followed prospectively from early gestation and birth through infancy and childhood with serial measures of maternal and child prenatal and postnatal factors. Maternal pre-pregnancy BMI was a significant predictor of child ADHD symptoms (F((1,158)) = 4.80, p = 0.03) and of child performance on the Go/No-go task (F((1,157)) = 8.37, p = 0.004) after controlling for key potential confounding variables. A test of the mediation model revealed that the association between higher maternal pre-pregnancy BMI and child ADHD symptoms was mediated by impaired executive function (inefficient/less attentive processing; Sobel Test: t = 2.39 (± 0.002, SEM), p = 0.02).To the best of our knowledge this is the first study to report that maternal pre-pregnancy BMI-related alterations in child neurocognitive function may mediate its effects on ADHD risk. The finding is clinically significant and may extrapolate to an approximately 2.8-fold increase in the prevalence of ADHD among children of obese compared to those of non-obese mothers. These results add further evidence to the growing awareness that neurodevelopmental disorders such as ADHD may have their foundations very early in life

Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial

Background: The increased prevalence of obesity in pregnant women in Australia and other developed countries is a significant public health concern. Obese women are at increased risk of serious perinatal complications and guidelines recommend weight gain restriction and additional care. There is limited evidence to support the effectiveness of dietary and physical activity lifestyle interventions in preventing adverse perinatal outcomes and new strategies need to be evaluated. The primary aim of this project is to evaluate the effect of continuity of midwifery care on restricting gestational weight gain in obese women to the recommended range. The secondary aims of the study are to assess the impact of continuity of midwifery care on: women&rsquo;s experience of pregnancy care; women&rsquo;s satisfaction with care and a range of psychological factors.Methods/Design: A two arm randomised controlled trial (RCT) will be conducted with primigravid women recruited from maternity services in Victoria, Australia. Participants will be primigravid women, with a BMI&ge;30 who are less than 17 weeks gestation. Women allocated to the intervention arm will be cared for in a midwifery continuity of care model and receive an informational leaflet on managing weight gain in pregnancy. Women allocated to the control group will receive routine care in addition to the same informational leaflet. Weight gain during pregnancy, standards of care, medical and obstetric information will be extracted from medical records. Data collected at recruitment (self administered survey) and at 36 weeks by postal survey will include sociodemographic information and the use of validated scales to measure secondary outcomes.Discussion: Continuity of midwifery care models are well aligned with current Victorian, Australian and many international government policies on maternity care. Increasingly, midwifery continuity models of care are being introduced in low risk maternity care, and information on their application in high risk populations is required. There is an identified need to trial alternative antenatal interventions to reduce perinatal risk factors for women who are obese and the findings from this project may have application in other maternity services. In addition this study will inform a larger trial that will focus on birth and postnatal outcomes.<br /

Vaccination against GIP for the treatment of obesity.

BACKGROUND: According to the WHO, more than 1 billion people worldwide are overweight and at risk of developing chronic illnesses, including cardiovascular disease, type 2 diabetes, hypertension and stroke. Current therapies show limited efficacy and are often associated with unpleasant side-effect profiles, hence there is a medical need for new therapeutic interventions in the field of obesity. Gastric inhibitory peptide (GIP, also known as glucose-dependent insulinotropic polypeptide) has recently been postulated to link over-nutrition with obesity. In fact GIP receptor-deficient mice (GIPR(-/-)) were shown to be completely protected from diet-induced obesity. Thus, disrupting GIP signaling represents a promising novel therapeutic strategy for the treatment of obesity. METHODOLOGY/PRINCIPAL FINDINGS: In order to block GIP signaling we chose an active vaccination approach using GIP peptides covalently attached to virus-like particles (VLP-GIP). Vaccination of mice with VLP-GIP induced high titers of specific antibodies and efficiently reduced body weight gain in animals fed a high fat diet. The reduction in body weight gain could be attributed to reduced accumulation of fat. Moreover, increased weight loss was observed in obese mice vaccinated with VLP-GIP. Importantly, despite the incretin action of GIP, VLP-GIP-treated mice did not show signs of glucose intolerance. CONCLUSIONS/SIGNIFICANCE: This study shows that vaccination against GIP was safe and effective. Thus active vaccination may represent a novel, long-lasting treatment for obesity. However further preclinical safety/toxicology studies will be required before the therapeutic concept can be addressed in humans