A community-based approach to promote household water treatment in Rwanda

Treatment of drinking water at the household level is one of the most effective preventive interventions against diarrhea, a leading cause of illness and death among children in developing countries. A pilot project in two districts in Rwanda aimed to increase use of S?r'Eau, a chlorine solution for drinking water treatment, through a partnership between community-based health insurance schemes and community health workers who promoted and distributed the product. Evaluation of the pilot, drawing on a difference-in-differences design and data from pre- and post-pilot household surveys of 4,780 households, showed that after 18 months of pilot implementation, knowledge and use of the product increased significantly in two pilot districts, but remained unchanged in a control district. The pilot was associated with a 40-42 percentage point increase in ever use, and 8-9 percentage points increase in use of S?r'Eau at time of the survey (self-reported measures). Our data suggest that exposure to inter-personal communication on S?r'Eau and hearing about the product at community meetings and health centers were associated with an increase in use.     

Changing community behaviour: experience from three African countries

In the developing world, more than 1 billion people lack access to safe water. To address this problem, the US Centers for Disease Control and Prevention developed the Safe Water System (SWS), a household-based intervention with three elements: water disinfection, safe storage and behaviour change techniques, and tested these in three countries. In Zambia, social marketing (SM) was used to implement the SWS, and 100 randomly selected households also received motivational interviewing (MI). In Madagascar, the SWS was implemented using SM and community mobilisation (CM). In rural Western Kenya, the SWS was also implemented with SM and CM. In Zambia, 3 months after the SM project launch, 14% of households in the SM-only group had adopted the disinfectant compared with 78% of households in the SM plus MI group. Through SM, over 1 million bottles of disinfectant were sold in 3 years in Zambia. In Antananarivo, Madagascar, 6 months after launch of the water disinfectant, 8% of households in an early stage of the CM process were using the disinfectant compared with 20% in households at a late stage of the CM process. In 1 year, over 500,000 bottles of disinfectant were sold in Madagascar. In Kenya, adoption of the water disinfectant exceeded 60% in intervention households and diarrhoea rates decreased by 58% in children < 5 years. Social marketing permits widespread dissemination of interventions, but may have limited penetration into economically disadvantaged communities. Additional, targeted interventions, such as MI and CM, can increase product adoption. A combination of behaviour change interventions can increase project impact.     

Access to and perceptions towards water,sanitation and hygiene: a case of HIV/AIDS affected and non-affected households in rural Uganda

Aim

To explore the water, sanitation and hygiene (WASH) access and perceptions among households with people living with HIV/AIDS (affected households) as compared to households without people living with HIV/AIDS (non-affected households).

Methods

This was a cross-sectional study that was conducted in the rural districts of Mpigi and Gomba. The study used a sample of 450 respondents with 222 from HIV/AIDS affected and 228 from HIV/AIDS non-affected households.

Results

Majority of respondents had improved water sources although most of these sources were beyond 2 km from households. Respondents from HIV/AIDS-affected households were four times more likely to have ever used a chemical water disinfectant locally known as “water guard”. Additionally, affected households were twice more likely to mention having clean containers for storing drinking water and twice more likely to report boiling water for drinking. No significant differences in presence of latrines for affected and non-affected households were reported. Households with a perception that fetching water takes a lot of time were more likely to buy water from vendors.

Conclusions

Access to improved water sources in short distances with a round trip water collection time of 30 min as recommended by WHO/UNICEF is still a challenge in this region. Good water practices were reported more in HIV/AIDS-affected households. A perception that fetching water takes a lot of time is significantly associated with buying water from vendors. Sleeping in own house is significantly associated with household presence of latrines.     

Household Transmission of SARS-CoV-2 from Humans to Pets,Washington and Idaho,USA

SARS-CoV-2 likely emerged from an animal reservoir. However, the frequency of and risk factors for interspecies transmission remain unclear. We conducted a community-based study in Idaho, USA, of pets in households that had >1 confirmed SARS-CoV-2 infections in humans. Among 119 dogs and 57 cats, clinical signs consistent with SARS-CoV-2 were reported for 20 dogs (21%) and 19 cats (39%). Of 81 dogs and 32 cats sampled, 40% of dogs and 43% of cats were seropositive, and 5% of dogs and 8% of cats were PCR positive. This discordance might be caused by delays in sampling. Respondents commonly reported close human‒animal contact and willingness to take measures to prevent transmission to their pets. Reported preventive measures showed a slightly protective but nonsignificant trend for both illness and seropositivity in pets. Sharing of beds and bowls had slight harmful effects, reaching statistical significance for sharing bowls and seropositivity.     

Use of a Unique Farmers’ Market Program Targeting Lower-Income Community Members

We examined use of a farmers’ market that leverages community partnerships to provide free produce to lower-income persons. Participants (n?=?422) were asked to complete a questionnaire and given an ID number, which was used to track market use from 2014 to 2015. Chi square tests were used to examine associations between 2014/2015 market use and reasons for market use, financial support received, and how attendees had learned about the market. Ordinal regression was used to identify household characteristics associated with increased market attendance. Although the proportion of lower-income attendees declined over the study period, a substantial proportion of households in 2014 (69.1%) and 2015 (54.6%) were below the poverty threshold. We identified significant differences in attendees’ reasons for market use and ways attendees heard about the market from 2014 to 2015. The most frequently reported reason for 2014 market use was retirement/fixed income (P?<?0.001) and in 2015 was low-income (P?<?0.001). Most attendees heard about the market through flyers (P?<?0.001) and word of mouth (P?≤?0.001) in 2014 and through local, non-profit services (P?<?0.001) in 2015. In the ordinal regression, households with an older person registering the household for the market used the market more times per year (P?<?0.001). Impoverished households (P?=?0.020) and households receiving more financial support services (P?<?0.001) used the market fewer times per year. While a substantial proportion of lower-income persons used the free-produce market, frequency of use was still lowest among this group indicating a need to address barriers beyond produce cost.     

Cost and financial sustainability of a household-based water treatment and storage intervention in Zambia

Providing safe water to >1 billion people in need is a major challenge. To address this need, the Safe Water System (SWS) - household water treatment with dilute bleach, safe water storage, and behavior change - has been implemented in >20 countries. To assess the potential sustainability of the SWS, we analyzed costs in Zambia of "Clorin" brand product sold in bottles sufficient for a month of water treatment at a price of $0.09. We analyzed production, marketing, distribution, and overhead costs of Clorin before and after sales reached nationwide scale, and analyzed Clorin sales revenue. The average cost per bottle of Clorin production, marketing and distribution at start-up in 1999 was $1.88 but decreased by 82% to $0.33 in 2003, when >1.7 million bottles were sold. The financial loss per bottle decreased from $1.72 in 1999 to $0.24 in 2003. Net program costs in 2003 were $428,984, or only $0.04 per person-month of protection. A sensitivity analysis showed that if the bottle price increased to $0.18, the project would be self-sustaining at maximum capacity. This analysis demonstrated that efficiencies in the SWS supply chain can be achieved through social marketing. Even with a subsidy, overall program costs per beneficiary are low.     

Drinking water intake and source patterns within a US–Mexico border population

This study was undertaken to identify water intake and source patterns among a population that resides in a hot, arid region on the US–Mexico border. A cross-sectional community-based survey was conducted among households in the neighbouring cities of El Paso, TX, USA and Ciudad Juárez, Chihuahua, Mexico to obtain data on the quantity and source of water consumed. The study was also designed to identify factors that impact water consumption patterns, including gender, demographics, socio-economic status, cultural characteristics, health status, types of occupations and residences, available water sources and outdoor temperature, among many others. Of all factors studied, outdoor air temperature was found to have the strongest impact upon water intake quantity. Specifically, among the survey participants, when the outdoor air temperature exceeded 90?°F, water consumption increased by 28?%. Additionally, it was found that participants in this region consumed approximately 50?% more water than the values reported in previous studies.     

A comparison of different approaches to promote community-wide dietary change

BACKGROUND: Because public health education funds are limited, it is important to determine which methods are most effective for promoting healthy lifestyles to communities. We conducted interventions in two communities to further examine the effectiveness of various educational approaches for communicating the "1% Or Less" message to switch from high-fat (whole or 2%) to low-fat (1% or fat-free) milk. METHODS: One intervention used public relations and community-based educational activities in supermarkets, schools, worksites, and other community settings. The other used paid advertising in the absence of other programming. We used telephone surveys and supermarket milk sales data, collected before and after each campaign and in a comparison community, to determine changes in milk-usage patterns. RESULTS: After the campaign of community-based educational programs and public relations activities, the proportion of high-fat milk drinkers who reported drinking low-fat milk was 19.6% compared with 6.8% for the comparison city (p<0.0001). After the advertising-only campaign, 12.8% of high-fat milk drinkers reported drinking low-fat milk (p<0.01). Although supermarkets experienced increases in low-fat milk sales after both campaigns, the results were not statistically significant. CONCLUSIONS: The results show how well-designed public relations activities can attract news coverage and provide further evidence that such coverage can be an important component of health-promotion campaigns. Although the use of paid advertising in the absence of other media or programming appeared to change milk-drinking habits, the results were not sustained after the ads stopped airing.     

Altruistic willingness to pay in community-based sales of insecticide-treated nets exists in Nigeria

The objective of this study was to determine whether households who are willing to pay for insecticide-treated nets (ITNs) for themselves are prepared to contribute for the ITNs to be purchased for the indigent community members who cannot afford the nets. This was in the framework of community-based and directed sales for ITNs. The study was conducted in four malaria holoendemic communities in south-eastern Nigeria. Contingent valuation method was used to determine the altruistic willingness to pay (WTP) from randomly selected household heads or their representatives, which was elicited using an open-ended question. Theoretical validity was assessed using the Tobit model. Median altruistic WTP ranged from $0.11 to $0.21 across the four communities (95 Naira = $1). However, using a pooled data from the four communities, the mean was $0.34. In Tobit estimation, altruistic WTP varied significantly with two of the communities; the respondents were resident in, sex, marital status and the amount of savings of the respondent. It also varied significantly with the respondents' WTP for their own ITNs and average monthly household expenditures to treat malaria (p<0.05). Altruistic WTP will exist in community-based and directed sales of ITNs. Thus there can be intra-community subsidisation by the rich for the poor who may not be able to pay for the nets. Community mobilisation and sensitisation should be used to encourage able households to actually pay at least the amounts they have stated.     

Cost and financial sustainability of a household-based water treatment and storage intervention in Zambia

Providing safe water to >1 billion people in need is a major challenge. To address this need, the Safe Water System (SWS) - household water treatment with dilute bleach, safe water storage, and behavior change - has been implemented in >20 countries. To assess the potential sustainability of the SWS, we analyzed costs in Zambia of “Clorin” brand product sold in bottles sufficient for a month of water treatment at a price of $0.09. We analyzed production, marketing, distribution, and overhead costs of Clorin before and after sales reached nationwide scale, and analyzed Clorin sales revenue. The average cost per bottle of Clorin production, marketing and distribution at start-up in 1999 was $1.88 but decreased by 82% to $0.33 in 2003, when >1.7 million bottles were sold. The financial loss per bottle decreased from $1.72 in 1999 to $0.24 in 2003. Net program costs in 2003 were $428,984, or only $0.04 per person-month of protection. A sensitivity analysis showed that if the bottle price increased to $0.18, the project would be self-sustaining at maximum capacity. This analysis demonstrated that efficiencies in the SWS supply chain can be achieved through social marketing. Even with a subsidy, overall program costs per beneficiary are low.     

Professional Expertise of Community-Based Occupational Therapists

SUMMARY

As the health care system changes, it is increasingly important to define the roles and contributions of individual professions. The goal of this study was to identify job roles, job skills, and professional expertise of community-based therapists. The Community Practice Project survey was mailed to 200 AOTA registered community-based therapists. There were 84 (42%) surveys returned. The results provided a profile of community-based therapists. Principal roles, job skills, and areas of professional expertise were identified. Educational preparation was assessed. Respondents reported that they were not prepared to use the skills of networking, consulting, and communication. They were not prepared in expertise areas such as community resources, self-directed learning, and client-centered approach to practice. Overall, therapists expressed satisfaction with work in community-based positions.     

History of childhood candy cigarette use is associated with tobacco smoking by adults

OBJECTIVE: We examined whether childhood candy cigarette use was associated with adult tobacco smoking. METHODS: 25,887 U.S. adults from the Harris Poll Online (HPOL) were surveyed about current smoking status from November 2005 to May 2006. Respondents were randomly assigned to a yes/no item or a dose-response scale to assess candy cigarette use. Data were weighted to reflect the U.S. adult population. RESULTS: 26.4% of respondents reported current smoking and 29.4% reported former smoking. Candy cigarette use was reported by 88% of both current and former smokers and 78% of never smokers (p相似文献   

After the flood: an evaluation of in-home drinking water treatment with combined flocculent-disinfectant following Tropical Storm Jeanne -- Gonaives, Haiti, 2004

Tropical Storm Jeanne struck Haiti in September 2004, causing widespread flooding which contaminated water sources, displaced thousands of families and killed approximately 2,800 people. Local leaders distributed PūR, a flocculent-disinfectant product for household water treatment, to affected populations. We evaluated knowledge, attitudes, practices, and drinking water quality among a sample of PūR recipients. We interviewed representatives of 100 households in three rural communities who received PūR and PūR-related education. Water sources were tested for fecal contamination and turbidity; stored household water was tested for residual chlorine. All households relied on untreated water sources (springs [66%], wells [15%], community taps [13%], and rivers [6%]). After distribution, PūR was the most common in-home treatment method (58%) followed by chlorination (30%), plant-based flocculation (6%), boiling (5%), and filtration (1%). Seventy-eight percent of respondents correctly answered five questions about how to use PūR; 81% reported PūR easy to use; and 97% reported that PūR-treated water appears, tastes, and smells better than untreated water. Although water sources tested appeared clear, fecal coliform bacteria were detected in all sources (range 1 - >200 cfu/100 ml). Chlorine was present in 10 (45%) of 22 stored drinking water samples in households using PūR. PūR was well-accepted and properly used in remote communities where local leaders helped with distribution and education. This highly effective water purification method can help protect disaster-affected communities from waterborne disease.     

Shifts in purchasing patterns of non-alcoholic, water-based beverages in Australia, 1997–2006

Aim: To describe trends in purchasing patterns of non‐alcoholic, water‐based beverages (WBBs) in Australia, 1997–2006. Methods: Trends in volume sales of WBBs were determined from data supplied by the Australian beverage industry, not including fruit juice or milk‐based drinks. Change was calculated as per cent difference between 1997 and 2006, volume share by proportion of total sales in the category and per capita consumption by dividing total volume sales by population estimate for that year. Sugar supply from WBBs was calculated by multiplying sales by sugar content. Demographic trends from AC Nielsen surveys were shown as per cent households purchasing beverages and as volume share by age and sex. Results: Total volume sales of WBBs increased by 13% from 1997 to 2006, largely accounted for by increases in sales of plain still water and non‐sugar carbonated soft drink (CSD). Sales in the CSD category saw a shift away from sugar‐sweetened to non‐sugar. There was a concomitant increase in sales of sugar‐sweetened sports and energy drinks, and iced tea. Younger people and high‐income households were the major purchasers of CSDs, and for sports and energy drinks, it was young males. Conclusion: The increased sales of beverages by 2006 appear to reflect a greater trend towards purchasing fluids, particularly increases in bottled water and non‐sugar CSDs. Sugar supply from beverages has declined, mostly because of decreasing sales of sugar‐sweetened CSDs since 2002. Industry‐generated data proved useful in forming a picture of apparent non‐alcoholic, WBB consumption patterns in Australia.     

West Nile Virus: the buzz on Ottawa residents' awareness, attitudes and practices

BACKGROUND: In 2002, the City of Ottawa was interested in the public perception of West Nile Virus (WNV) and mosquito control. Their objectives were to assess: awareness of WNV, practices to reduce mosquito sources, personal protective measures, and attitudes towards community-based insecticide programs. METHODS: In July 2002, we administered a telephone survey to a random, stratified sample of urban, suburban and rural Ottawa households. RESULTS: Surveys were completed for 491 households. Most (77.2%) respondents reported they had heard of WNV, and of these, 58.3% reported WNV was an important health issue. Mosquito repellent was the most common personal protective measure, reported among 72.5% of respondents, of whom 76.9% used DEET products. Multivariate regression analyses showed that age was a significant predictor of repellent use, with respondents aged less than 51 years more likely to use repellent than older respondents (ORadj =2.0; 95% CI: 1.2-2.3). This age group was also more likely to use at least one personal protective behaviour (ORadj = 2.5; 95% CI: 1.4-4.5). Of 315 people selecting a justified time to larvicide, 4.8% chose "larvicides should never be used in Ottawa"; 33.4% stated that larviciding would be appropriate "when WNV was detected in birds or mosquitoes"; one third "needed more information" on the health and environmental effects of insecticides, prior to selecting a response. CONCLUSIONS: Our findings highlight the need for public education reinforcing WNV importance, emphasizing the health and environmental effects of insecticides as well as appropriate personal protective behaviours. Such messages should target older and urban residents.     

2012-2018年北京市抗结核药物使用趋势分析

目的分析北京市2012-2018年抗结核药物的使用情况与变化趋势,为北京市进一步规范及修改结核药物的使用策略提供数据参考。方法对2012-2018年北京市46家医院J04A类抗结核药物的销售金额、用药频度(Defined daily doses,DDDs)、药品限定日费用(Defined daily cost,DDC)等指标进行统计分析与评价。采用SPSS 22.0线性回归分析,判断变化趋势。结果 2012-2018年抗结核药销售金额逐年上升,而销售量在2016年到达高峰后缓慢下降;2012年和2018年相比抗结核的药物种类构成变动不大,各类药物销售金额构成变化较大;抗结核药物以一线、口服为主,二线、注射为辅,且二线用药的销售金额、DDDs和注射用药的销售金额有上升的趋势(P均<0.05);抗生素销售单价以注射类经济负担最重,且2018年较2012年,大部分种类药物都有不同程度的价格增长。结论抗结核药物的DDDs在2012-2018年间保持平稳,但大部分种类抗结核药物的DDC均出现上升趋势,患者经济负担增大,且抗结核药物使用存在用药集中的现象,带来的耐药风险不容忽视。     

Variability of Criteria for Pasteurized Donor Human Milk Use

Background: Use of donor human milk (DHM) is increasing, but criteria for its use are not well defined. Materials and Methods: We conducted a 34‐question Internet‐based survey of medical directors of U.S. level 3 and level 4 neonatal intensive care units (NICUs), with the goal of describing specifics of policies developed to guide DHM use in U.S. NICUs. Respondents reported NICU characteristics and details of policies concerning DHM use. Policy‐specified criteria for DHM use, if any, were described. Bivariate and multivariate analyses were used to identify NICU characteristics associated with DHM use. Results: Respondents returned 153 (33%) surveys, with use of DHM reported by 91 (59%). Donor human milk use was more likely with more than 100 annual admissions <1500 g at birth (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1–4.7) and with Vermont‐Oxford Network participants (OR, 4.6; 95% CI, 1.8–11.6). Among 72 NICUs reporting a written policy, criteria for providing DHM required birth weights varying from <1000 to <1800 g and/or gestational ages from <28 to <34 completed weeks, but criteria were reportedly waived in many circumstances. Policies regarding duration of DHM therapy were similarly varied. Conclusions: Criteria for initiating and continuing DHM vary widely among U.S. level 3 and level 4 NICUs. Donor human milk use is more frequent in NICUs with many very low‐birth‐weight admissions and among Vermont‐Oxford Network participants. Further research is needed to define short‐ and long‐term outcomes and cost benefits of DHM use in subgroups of NICU patients, particularly for uses other than necrotizing enterocolitis prevention.     

Use and misuse of a discount voucher scheme as a subsidy for insecticide-treated nets for malaria control in southern Tanzania

Since 1997, discount vouchers for insecticide-treated nets (ITNs) have been used in two rural districts of southern Tanzania as a way to target subsidies to children under 5 years and pregnant women. We assessed appropriate use and misuse of discount vouchers through a follow-up study of 104 randomly selected vouchers. We traced these vouchers from their original issue in mother-and-child health (MCH) clinics through to being redeemed at a sales agent. We found that all vouchers that reached the target population (100%, 56/56) were used to buy an ITN. Moreover, 94% of the ITNs bought with vouchers were used by those intended, women and children under 5 years. However, up to 48% (50/104) of the vouchers had been misused at the clinics that issued them. Nevertheless, large-scale misuse occurred only at three of 21 clinics. Although most women slept under a net while pregnant, the use of voucher-subsidized ITNs during pregnancy was low despite widespread knowledge of the scheme. Parents had apparently decided to buy the subsidized ITNs once the child was born and not during pregnancy. Importantly, in 20% of households the only existing net had been bought with a voucher. Our findings suggest that vouchers are properly used by the target population, and that to minimize voucher leakage, control measures are needed at MCH clinics and to a certain extent for commercial sales agents. Increased awareness among the whole community on the right to receive a discount voucher may also help to control misuse at health facilities.     

Appropriate household water treatment methods in Ethiopia: household use and associated factors based on 2005, 2011, and 2016 EDHS data

Background

Diarrheal disease attributable to water and sanitation can be prevented using point-of-use water treatment. In Ethiopia, a small number of households treat water at point-of-use with appropriate methods. However, evidence on factors associated with household use of these treatment methods is scarce. Therefore, this study is intended to explore the household use of appropriate point-of-use water treatment and associated factors in Ethiopia.

Methods

The data of 2005, 2011, and 2016 Ethiopian demographic and health surveys were used for analysis. Households reportedly treating water with bleach, boiling, filtration, and solar disinfection in each survey are considered as treating with appropriate treatment methods. Household water treatment with these treatment methods and factors associated was assessed using bivariate and multivariable regression. In addition, a region level difference in the treatment use was assessed by using multilevel modeling.

Results

The number of households that reported treating water with appropriate water treatment methods was 3.0%, 8.2%, and 6.5% respectively in 2005, 2011, and 2016. Household heads with higher education had 5.99 (95% CI?=?3.48, 10.33), 3.61 (95% CI?=?2.56, 5.07), and 3.43 (95% CI?=?2.19, 6.37) times higher odds of using the treatment methods respectively in 2005, 2011, and 2016 compared to household heads who had no education. There was a significantly high number of households that used appropriate water treatment methods in 2011 (AOR?=?2.78, 95% CI?=?2.16, 3.57) and 2016 (AOR?=?2.18, 95% CI?=?1.64, 3.89) compared to 2005 data. In pooled data analysis, the reported use of the treatment methods is associated with household head education, residency, drinking water sources, and owning radio and television. From a multilevel modeling, within-region variation is higher than between-region variations in the use of treatment methods in each survey.

Conclusions

Below 10% of households reportedly treating water at point-of-use in each survey attributable to different factors. Designing intervention strategies for wide-scale use of treatment methods at the country level is fundamental.

     

Use,microbiological effectiveness and health impact of a household water filter intervention in rural Rwanda—A matched cohort study

Unsafe drinking water is a substantial health risk contributing to child diarrhoea. We investigated impacts of a program that provided a water filter to households in rural Rwandan villages. We assessed drinking water quality and reported diarrhoea 12–24 months after intervention delivery among 269 households in the poorest tertile with a child under 5 from 9 intervention villages and 9 matched control villages. We also documented filter coverage and use. In Round 1 (12–18 months after delivery), 97.4% of intervention households reported receiving the filter, 84.5% were working, and 86.0% of working filters contained water. Sensors confirmed half of households with working filters filled them at least once every other day on average. Coverage and usage was similar in Round 2 (19–24 months after delivery). The odds of detecting faecal indicator bacteria in drinking water were 78% lower in the intervention arm than the control arm (odds ratio (OR) 0.22, 95% credible interval (CrI) 0.10–0.39, p < 0.001). The intervention arm also had 50% lower odds of reported diarrhoea among children <5 than the control arm (OR = 0.50, 95% CrI 0.23–0.90, p = 0.03). The protective effect of the filter is also suggested by reduced odds of reported diarrhoea-related visits to community health workers or clinics, although these did not reach statistical significance.