The household distribution of trachoma in a Tanzanian village: an application of GIS to the study of trachoma

The distribution of active trachoma in Kahe Mpya, Tanzania, an endemic village of approximately 1000 people, was mapped spatially and analysed for associated risk factors and evidence of clustering. An association between distance to water source and active disease was demonstrated, although this was reduced after accounting for the lack of independence between cases in the same household. Significant clustering of active trachoma within households was demonstrated, adding support to the hypothesized importance of intra-familial transmission. The spatial distribution of trachoma was analysed using the spatial scan statistic, and evidence of clustering of active trachoma cases detected. Understanding the distribution of the disease has implications for understanding the dynamics of transmission and therefore appropriate control activities. The demonstrated spatial clustering suggests inter-familial as well as intra-familial transmission of infection may be common in this setting. The association between active trachoma and geographical information system (GIS) measured distance to water may be relevant for planning control measures.     

Relationship between distance to social gathering facilities and risk of trachoma for households in rural Tanzanian communities

Few studies have examined the physical isolation of households with trachoma cases. Thus, in this study, we sought to examine the association between household isolation, as measured by distance to social gathering facilities, and risk of trachoma. We hypothesized that households located closer to such facilities would have a decreased risk of trachoma, due to a variety of social, economic, and cultural reasons. To test this hypothesis we conducted a case-control study of 668 households (93 cases, 575 controls) in eight villages in Kongwa District, Tanzania, in 2007. Case households were defined as having a child aged 1–5 years with clinical signs of trachoma. Distance of household’s place of residence to three main social gathering facilities — bars/cafés, religious establishments, and commercial/government center — was measured with a portable geographic positioning system. Multiple logistic regression analyses, which controlled for potential confounders and accounted for clustering, demonstrated increased risk of trachoma with increasing distance to social gathering facilities. Compared with distances of ≤700 m, odds of trachoma were approximately two-fold higher for households living >1400 m from bars/cafés and from religious establishments, suggesting increased risk of trachoma for households at the fringes of communities. Targeting these isolated households with special programming along with dissemination through trusted social gathering facilities may improve effectiveness of current prevention efforts.     

Assessment of latrine use and quality and association with risk of trachoma in rural Tanzania

The existing evidence regarding latrines and trachoma is inconclusive. Using more precise sanitation measures we examine the association between use and quality of latrines and risk of trachoma. We conducted a case-control study of 678 households (95 cases, 583 controls) in eight villages in Kongwa District, Tanzania. Case households were defined as having a sentinel child with clinical signs of trachoma. A latrine quality score was calculated based on seven indicators and case and control households were compared with respect to use and quality of latrines. Logistic regression analyses controlled for potential confounders. Latrine use was significantly greater in control households than in case households (90.4 vs. 76.8%, P=0.03). The protective effect of latrine use persisted even after controlling for household characteristics significant at P <0.20 (adjusted OR=0.56 [95% CI: 0.32-0.98]). Contrary to expectation, we did not find an inverse association between increasing latrine quality and decreasing odds of trachoma. Although latrine use in the communities was high, latrines, regardless of quality, were significantly associated with decreased risk of trachoma. These findings underscore the importance of achieving 100% latrine use in communities.     

昭通市实验中学学生沙眼患病情况分析

目的了解昭通市实验中学生沙眼的患病现状,揭示其不良影响,使该校加强对沙眼的防治工作。方法把该校学生筛查沙眼所得的资料录入Excel工作表后进行统计和分析。结果共筛查1 379名学生,诊断为沙眼的学生有102名,患病率为7.40%;初中生沙眼的患病率高于高中生,2者患病率差异有统计学意义(χ2=11.54,P<0.01)。结论昭通市实验中学学生中仍有沙眼流行,校方应高度重视,制订防治策略和措施,控制沙眼在该校的流行和传播。     

Active trachoma in children aged three to nine years in rural communities in Ethiopia: prevalence, indicators and risk factors

Trachoma is the most important infectious cause of blindness worldwide. In two rural populations in Ethiopia, a programme of preventative and treatment measures was initiated in May 2002. A baseline survey was conducted to evaluate the effect of this programme on the prevalence of active trachoma. A total of 1960 children aged 3-9 years, from 915 households in 40 communities, were examined for the presence of active trachoma. Demographic and household information was collected using questionnaires and household amenities and environmental conditions were observed. Overall, 72% of children had active trachoma. Twenty percent of children aged nine years had trachomatous scarring. In children, discharge in the eyes and flies on the eyes were significant indicators of trachoma (odds ratio [OR] = 3.0, 95% CI 1.94-4.55 and OR = 3.4, 95% CI 2.37-4.88, respectively). Frequency of washing children, a clean environment and hygienic disposal of excrement were significant preventative factors for active trachoma. Prevalence of active trachoma varies widely between and within districts. Risk factors comprise a mix of individual characteristics and household factors. This study demonstrates the need for broad target interventions and a flexible approach to the prevention of trachoma in high prevalence endemic rural populations.     

Acceptability of azithromycin for the control of trachoma in Northern Tanzania

Trachoma causes blindness; the prevention strategy includes mass antibiotic treatment. In a community in Northern Tanzania offered mass treatment with azithromycin for the control of trachoma, we used focus group discussions, individual interviews, questionnaires and direct observation to quantify, explore and contextualize reasons for acceptance or refusal of the drug. In the village studied, 76% of the population eligible to receive azithromycin were treated. Uptake was significantly higher among women (79% treated) than men (72%). Factors affecting acceptability included: local prevention norms (such as the belief that injections, rather than oral medicine, should be used for prevention); perceptions of drugs in general and azithromycin in particular; perceptions of the distribution team's expertise; witnessing adverse effects in others; and the timing, quality and quantity of information about azithromycin and its availability. Familiarity with trachoma as a blinding disease was significantly associated with uptake. Individuals who refused treatment seemed to be less altruistic than other respondents. Neither socio-economic status nor use of traditional healers was related to uptake. Pre-distribution community assessment and community education, advance notice of the distribution, standardized distribution guidelines and improved distributor training are recommended to maximize acceptance of azithromycin in future campaigns.     

2000年我国中小学生沙眼防治状况分析

目的分析28个省、自治区、直辖市中小学生沙眼防治现状和动态变化,为进一步制定防治策略和措施提供依据。方法分行政区、城乡、学段分析2000年我国各学生群体沙眼防治覆盖率、感染率和治疗接受率。结果城乡学生沙眼感染率分别为7.53%和8.04%,均显著低于1995年的10.57%和13.97%;乡村小学和初中生感染率相对最高,但城乡差异显著缩小;城市小学治疗接受率最低。结论宜推广WHO的SAFE策略,开展“防沙”健康教育工作。     

School water,sanitation, and hygiene inequalities: a bane of sustainable development goal six in Nigeria

ObjectivesThe importance of school water, sanitation, and hygiene (WASH) in achieving the Sustainable Development Goal targets 6.1 and 6.2 in developing countries cannot be overemphasized. However, widespread WASH inequalities remain an impediment to achieving the targets by 2030. Hence, this study was conducted to examine current school-WASH disparities among public and private schools in a low-income Nigerian community using mixed methods.MethodsThe cross-sectional survey utilized multi-stage sampling to select 400 students from five public and five private schools in Akinyele, Ibadan. Semi-structured questionnaires and observational checklists were used to obtain data. Inferential statistics were measured at a 95% confidence interval. Independent variables like the students’ sociodemographic characteristics, school type, and available WASH facilities were associated with dependent variables like respondents’ hand hygiene and sanitation practices and WASH-associated knowledge and attitude to examine existing inequalities.ResultsClassifying the available WASH facilities based on the WHO/UNICEF Joint Monitoring Programme, none of the public schools provided any sanitation and hygiene service, while all the private schools provided both services. Furthermore, the private-school students had significantly better WASH knowledge (p<0.001; Ƞ²_p=0.152) and attitude (p<0.001; Ƞ²_p=0.036) compared with the public-school students. Also, a significantly higher portion of public-school students practiced open defecation at school (p<0.001; odds ratio (OR)=7.4; confidence interval (CI)=4.1–13.5) and at home (p<0.001; OR=7.8; CI=3.7–16.7).ConclusionWASH disparities among socioeconomic groups remain a persistent challenge. Sole reliance on the Government to narrow the inequalities has persistently proven unfruitful. There is a need to empower local community stakeholders to facilitate sustainable school-WASH interventions.     

The relationship between rainfall and well water pollution in a West African (Gambian) village.

Water pollution was monitored in six Gambian village wells over a period of 8 months spanning the 5-month monomodal rains and the pre- and post-rains dry periods. Faecal coliform (FC) and faecal streptococci (FS) counts were high throughout and there was a massive increase associated with the onset of the rains, maximum counts exceeding 5 x 10(5)/100 ml. This pattern was largely sustained throughout the rainy season. Some individual variations in patterns of pollution could be ascribed to well design, in particular lining of the shaft, but no well was protected from the seasonal increase in faecal pollution. The source of the increased pollution appeared to be a flushing in of faecal material of indeterminate or mixed human and animal origin, probably over considerable distances. Peaks of pollution not associated with rainfall episodes could have resulted from the practice of communal laundering in the near vicinity of the wells. Specific pathogens including Salmonella spp. were isolated only intermittently. Attention has been drawn to a problem complicating the standard method for assessing FC counts.     

大连市63家游泳场(馆)水质卫生状况调查

目的了解大连市游泳场(馆)水质卫生状况。方法通过现场调查、现场采样、现场检测、实验室检测对63家游泳场(馆)进行水质综合分析。结果所检测的63家游泳场(馆)的148份游泳池水样品中,浑浊度的合格率为100%,尿素合格率为95%,细菌总数合格率为91%,大肠菌群合格率为100%。检测游离性余氯样品142份,合格率仅为65%;浸脚池水游离性余氯样品89份,合格率为28%。结论大连市游泳场(馆)卫生管理状况不容乐观,游泳场(馆)水质有待进一步提高。     

The relationship between local availability and first-time use of specialists in an arthritis population

OBJECTIVE: To determine what health area characteristics, in particular local availability of specialists, were associated with the age-sex adjusted ambulatory utilization rate of musculoskeletal (MSK) specialists (i.e., rheumatologists, orthopaedic surgeons and general internists) in an arthritis and rheumatism (A&R) cohort. METHODS: The cohort was composed of respondents aged 15+ from the 1996/97 Ontario Health Survey who self-reported A&R and/or had a primary care encounter for A&R during the two years preceding the survey, as determined by their billings in the Ontario Health Insurance Plan. Respondents with prior exposure to MSK specialists were excluded. The outcome of an encounter with a MSK specialist for A&R was determined during the three-year period after the survey. RESULTS: The A&R cohort was composed of 5,052 respondents, of whom 11% had an A&R encounter with a MSK specialist in the three-year post-survey period. There was area variation in the age-sex adjusted ambulatory utilization rate of MSK specialists in the A&R cohort. The backwards stepping linear regression to examine predictors for seeing MSK specialists found a positive association with local availability of rheumatologists, a negative association with the proportion of high school graduates in the health area and a negative association with the proportion of people aged 65 years and older. DISCUSSION: At the health area level, we found that the local availability of rheumatologists was an important factor associated with utilizing MSK specialists for A&R-related conditions in a cohort of respondents who have not been previously exposed to MSK specialists for musculoskeletal-related conditions.     

奉贤区外来务工子弟学校学生沙眼现状及干预效果

分析奉贤区外来务工子弟学校学生沙眼患病现状,为开展相应的干预措施提供参考依据.方法 选取奉贤区16所外来务工子弟学校2011年全体在校学生共12 710名,实际检查12 619名,采用免疫学法(胶体金法)检测沙眼衣原体.干预措施为对沙眼患者采取眼局部药物治疗和健康宣教.结果 12 619名受检学生中,检出沙眼患者397名,沙眼患病率为3.15%.受检女生沙眼患病率为3.80%,高于男生(2.65%) (x2=13.448,P=0.000);各年龄组间沙眼患病率差异无统计学意义(x2=2.660,P=0.616).不同分期沙眼的患病率分别为滤泡性沙眼(2.67%)、浸润性沙眼(0.19%)、疤痕性沙眼(0.29%),差异有统计学意义(x2=480.387,P=0.000).对397名沙眼患者实施药物治疗和健康宣教,6个月后治愈率为90.10%.结论 奉贤区外来务工子弟学校学生的沙眼患病率较高.实施SAFE策略能有效控制沙眼的发展.     

家用净水设备微生物污染及评价指标研究现状

随着我国经济的不断发展,人们对饮用水的需求日渐增强.因此很多人已经开始使用家用净水设备来提高饮用水的质量.据统计某些发达国家的家用净水设备的普及率为70％以上,我国经济发达地区的家用净水设备的普及率也达20％.但是考虑到我国供水方式及净水技术功能等特点,家用净水设备的细菌污染也成为人们关注的焦点.本文通过近年来国内外文...     

2014年北京市石景山区游泳池水质卫生监测分析

目的了解北京市石景山区游泳场所水质卫生状况,保护游泳者的身体健康,为行政监管提供科学依据。方法 2014年1月、5~10月,对石景山区全部游泳场所进行监测,每月监测1次,每次采集3件池水样品,监测项目为水温、游离性余氯、浑浊度、p H值、尿素、细菌总数、大肠菌群共计7项指标,检测依据为GB 18204-2000和GB/T 5749-2006。结果 2014年共监测水样255件,合格率为7.06%;主要不合格项目为游离性余氯、水温、尿素,其合格率分别为18.82%、48.63%、57.25%,细菌总数、p H值的合格率分别为96.86%、98.82%,浑浊度和大肠菌群100%合格。学校内设游泳池的游离性余氯、尿素和全项的合格率高于独立游泳馆和宾馆内设游泳池,但差异无统计学意义。不同月份的游离性余氯、尿素合格率变化不大(50.00%~58.33%);水温合格率6—8月较低(27.78%~35.71%),1、5、9月次低(54.54%~58.33%),10月最高为100%,经χ2检验各月份合格率差异有统计学意义(χ2=49.372,P0.01)。结论该区游泳场所卫生状况欠佳,需加强卫生管理,确保各项指标值维持在标准范围内。     

Sustainability and acceptability of latrine provision in The Gambia

All households in 32 villages were provided with improved pit latrines as part of a trachoma control programme in a rural part of The Gambia. Latrine provision was externally driven and was not in response to a request from the communities involved. Materials were provided for free and labour was paid for. To assess durability and acceptability we conducted a follow-up study 25-47 months after construction. Before the intervention only 32% of households in these villages had access to any type of latrine; at follow-up this had risen to 95%. On visual inspection 585/666 latrines (87.3%) were usable and 510 (87.2% of those usable) were currently used. During interviews 566/637 latrine owners (89%) said they were either happy or very happy with their latrines, and 620 (97.3%) reported that they would make a new latrine of some kind when the current one was full or unusable. We interpret these data to suggest that externally driven latrine provision, without additional health education, to an area with poor latrine coverage can result in high, sustainable levels of uptake and generate future demand for sanitation.     

咸宁温泉地区环境辐射水平及放射卫生学评价

目的　对温泉地区环境辐射水平作放射卫生学评价。方法　用FD -3 0 13数字式γ辐射仪测定温泉周边环境γ辐射剂量率 ;用电离室法、CR -3 9径迹法、双滤膜法、Markov快速潜能法和闪烁室法分别测定了咸宁两处 [咸宁 (A)、蒲圻 (B) ]富镭温泉旁室内、外空气中氡及子体浓度 ,以及温泉水中2 2 6 Ra和2 2 2 Rn的含量 ,对洗浴者及工作人员进行了剂量估算 ;用电离室法测定了温泉旁土壤中氡浓度面析出率 ;测定了在该泉水中养殖的鱼类及用该泉水灌溉生长的农作物和其他有关环境生物样品中天然放射性物质的含量。结果　温泉周边环境γ辐射剂量率明显高于它处。A、B两处富镭温泉水中2 2 6 Ra和2 2 2 Rn含量分别为 (1 65± 0 0 3 )Bq·L- 1 ;(1 62± 0 0 2 )Bq·L- 1 和 (2 3 1 2 0± 12 12 )Bq·L- 1 ;(2 3 0 40± 13 0 2 )Bq·L- 1 ,该泉水2 2 6 Ra含量平均测出值为 (1 62± 0 0 2 )Bq·L- 1 ,已超过国家饮用水允许标准 ,A、B两温泉浴室空气中2 2 2 Rn及子体潜能浓度均值为 (3 0 8 60± 15 2 0 )Bq·m- 3;(2 10 2 0± 12 60 )Bq·m- 3和 (3 8 5 0± 1 60 )mWL ,(2 8 0 0± 1 40 )mWL ,根据UNSCEAR 1993年报告推荐的剂量转换系数计算A、B两温泉水浴室工作人员年有效剂量当量分别为 8 42mSv和 5 76mSv。温     

Interim evaluation of a large scale sanitation, hygiene and water improvement programme on childhood diarrhea and respiratory disease in rural Bangladesh

Started in 2007, the Sanitation Hygiene Education and Water Supply in Bangladesh (SHEWA-B) project aims to improve the hygiene, sanitation and water supply for 20 million people in Bangladesh, and thus reduce disease among this population. This paper assesses the effectiveness of SHEWA-B on changing behaviors and reducing diarrhea and respiratory illness among children < 5 years of age. We assessed behaviors at baseline in 2007 and after 6 months and 18 months by conducting structured observation of handwashing behavior in 500 intervention and 500 control households. In addition we conducted spot checks of water and sanitation facilities in 850 intervention and 850 control households. We also collected monthly data on diarrhea and respiratory illness from 500 intervention and 500 control households from October 2007 to September 2009. Participants washed their hands with soap < 3% of the time around food related events in both intervention and control households at baseline and after 18 months. Washing both hands with soap or ash after cleaning a child's anus increased from 22% to 36%, and no access to a latrine decreased from 10% to 6.8% from baseline to 18 months. The prevalence of diarrhea and respiratory illness, among children <5 years of age were similar in intervention and control communities throughout the study. This large scale sanitation, hygiene and water improvement programme resulted in improvements in a few of its targeted behaviors, but these modest behavior changes have not yet resulted in a measurable reduction in childhood diarrhea and respiratory illness.     

The relationship between snack intake and its availability of 4th-6th graders in Taiwan

The purpose of this study was to examine the relationship between the snack intake and snack availability of elementary school children. Data analyzed were from 722 4th to 6th graders' food availability and food intake questionnaires collected in the Nutrition and Health Survey in Taiwan Elementary School Children 2001-2002. The snacks commonly eaten were divided into two groups. Healthy snacks included dairy products, 100% fruit juice and fresh fruits. Unhealthy snacks included high fat/sugar snacks, cookies, candy, carbonated/sugared beverages and fast food. Structural equating modeling was used to test the models that describe the availability and intake of two snack groups. Results indicated that parents' intake and children's preference were major predictors of children intake of both healthy and unhealthy snacks. Other than that, the intake of unhealthy snacks was positively associated with "purchase by children themselves" but not the intake of healthy snacks, which was influenced predominantly by "present in home". The results support the perception that a positive family food environment is important for improving children's diet quality. To build a healthy family food environment, parents have to not only provide healthy snacks but also limit the unhealthy snacks in home. In addition to that, the role modeling of parents as eating healthy snacks instead of unhealthy snacks themselves may help children to develop similar behaviors.