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.     

Microcystins (cyanobacterial toxins) in surface waters of rural Bangladesh: pilot study

In Bangladesh the exposure of millions of inhabitants to water from (shallow) tube wells contaminated with high geogenic loads of arsenic is a major concern. As an alternative to the costly drilling of deep wells, the return to the use of surface water as a source of drinking water is considered. In addition to the well-known hazards of water borne infectious diseases associated with the use of surface water, recently the potential public health implications of toxic cyanobacteria have been recognized. As a first step towards a risk assessment for cyanotoxins in Bangladesh surface waters, seston samples of 79 ponds were analysed in late summer 2002 for the presence of cyanobacteria and microcystins (MCYST), the most frequently detected cyanobacterial toxins worldwide. Microcystins could be detected in 39 ponds, mostly together with varying abundance of potentially microcystin-producing genera such as Microcystis, Planktothrix and Anabaena. Total microcystin concentrations ranged between <0.1 and > 1,000 microg l(-1), and more than half of the positive samples contained high concentrations of more than 10 microg l(-1). The results clearly show that concentrations of microcystins well above the provisional WHO guideline value of 1 microg l(-1) MCYST-LR can be frequently detected in Bangladesh ponds. Thus, an increasing use of surface water for human consumption introduces a risk of replacing one health hazard by another and therefore needs to be accompanied by cyanotoxin hazard assessments.     

Natural and anthropogenic radioactivity levels and the associated radiation hazard in the soil of Oodalia Tea Estate in the hilly region of Fatickchari in Chittagong,Bangladesh

Radioactivity in the soil of a tea garden in the Fatickchari area in Chittagong, Bangladesh, was measured using a high-resolution HPGe detector. The soil samples were collected from depths of up to 20 cm beneath the soil surface. The activity concentrations of naturally occurring ²³⁸U and ²³²Th were observed to be in the range of 27 ± 7 to 53 ± 8 Bq kg⁻¹ and 36 ± 11 to 72 ± 11 Bq kg⁻¹, respectively. The activity concentration of ⁴⁰K ranged from 201 ± 78 to 672 ± 81 Bq kg⁻¹, and the highest activity of fallout ¹³⁷Cs observed was 10 ± 1 Bq kg⁻¹. The average activity concentration observed for ²³⁸U was 39 ± 8 Bq kg⁻¹, for ²³²Th was 57 ± 11 Bq kg⁻¹, for ⁴⁰K was 384 ± 79 Bq kg⁻¹ and for ¹³⁷Cs was 5 ± 0.5 Bq kg⁻¹. The radiological hazard parameters (representative level index, radium equivalent activity, outdoor and indoor dose rates, outdoor and indoor annual effective dose equivalents, and radiation hazard index) were calculated from the radioactivity in the soil.     

Estimating the Burden of Maternal and Neonatal Deaths Associated With Jaundice in Bangladesh: Possible Role of Hepatitis E Infection

Objectives. We estimated the population-based incidence of maternal and neonatal mortality associated with hepatitis E virus (HEV) in Bangladesh.Methods. We analyzed verbal autopsy data from 4 population-based studies in Bangladesh to calculate the maternal and neonatal mortality ratios associated with jaundice during pregnancy. We then reviewed the published literature to estimate the proportion of maternal deaths associated with liver disease during pregnancy that were the result of HEV in hospitals.Results. We found that 19% to 25% of all maternal deaths and 7% to 13% of all neonatal deaths in Bangladesh were associated with jaundice in pregnant women. In the published literature, 58% of deaths in pregnant women with acute liver disease in hospitals were associated with HEV.Conclusions. Jaundice is frequently associated with maternal and neonatal deaths in Bangladesh, and the published literature suggests that HEV may cause many of these deaths. HEV is preventable, and studies to estimate the burden of HEV in endemic countries are urgently needed.Hepatitis E virus (HEV) infection is endemic in Asia and many parts of Africa, where it is a leading cause of sporadic and epidemic acute hepatitis.1–3 HEV is primarily transmitted through the fecal–oral route, and outbreaks in endemic areas are typically associated with contaminated drinking water sources.4–13 Clinically, it is indistinguishable from other causes of acute viral hepatitis, and jaundice, the yellowing of the eyes and skin, is the most common clinical feature.14 Jaundice is caused by a buildup of bilirubin, a product of dying red blood cells, in the blood. The healthy liver removes bilirubin from the blood, but when the liver’s ability to process bilirubin is impaired, the buildup occurs. Additional clinical signs and symptoms include anorexia, malaise, fever, dark urine, vomiting, and stomach pain.14 Adults are more likely to have HEV disease and antibodies to HEV than are children in endemic areas, which is unexpected given the young ages at which most people are exposed to other enteric pathogens in low-income countries.15In general, fewer than 1% of patients with clinical HEV die, but case fatality ratios among pregnant women have been reported to be as high as 6% to 20%.12,14,16–18 A high case fatality rate among pregnant women is a characteristic feature of HEV that has not been observed for other etiologies of acute viral hepatitis.19 Pregnant women whose deaths are associated with HEV typically die of hemorrhage or hepatic neuropathy.20,21 The few studies that investigated vertical transmission of HEV noted that neonates born to mothers with HEV infections were frequently infected and often died from complications such as prematurity, liver failure, hypothermia, or hypoglycemia.21–25Hepatitis is not considered to be an important cause of maternal or neonatal mortality globally,26–28 but some data suggest that acute hepatitis might significantly contribute to maternal mortality in HEV endemic countries. A retrospective, community-based study of maternal mortality from southern India reported that 11% of maternal deaths were attributable to infectious hepatitis, resulting in a maternal mortality ratio of 8 per 1000 live births.29 Another record review of maternal mortality from Ethiopia concluded that 15% of maternal deaths were the result of infectious hepatitis.30 An autopsy study from India found that the most common cause of maternal deaths at 1 large hospital was acute viral hepatitis, which accounted for 42% of all maternal deaths.31 Notably, none of these studies provided evidence about the etiology of these hepatitis illnesses, so it is not known if they were caused by HEV. However, given that HEV is a particularly fatal cause of acute hepatitis among pregnant women,19 the possibility that HEV could meaningfully contribute to maternal mortality in these countries should be considered.However, to our knowledge, no studies have attempted to quantify the burden of HEV-associated maternal and neonatal mortality. In low-income countries in Asia and Africa where HEV is commonly found,1–3 population-based estimates of mortality usually come from verbal autopsy studies that use structured questionnaires to interview relatives of the deceased about signs and symptoms of illness before death, and then use coding algorithms to determine cause of death based on the interview data.32 The verbal autopsy questionnaires include questions about new onset of jaundice before death in pregnant women, or new onset of jaundice in the mother as a complication of pregnancy for neonatal deaths. Thus, data from verbal autopsy studies can be used to calculate population-based estimates of maternal and neonatal mortality associated with jaundice. However, the nature of these data precludes conclusions about deaths from specific infectious etiologies, such as HEV. Hospital-based studies can provide important information about etiologic causes of maternal and neonatal deaths associated with jaundice that occur in hospital settings of HEV endemic countries. We investigated the possible contribution of HEV to maternal and neonatal mortality by analyzing data from 4 population-based verbal autopsy studies in Bangladesh and comparing these data with the published literature from hospital-based studies of the etiologic causes of jaundice-associated deaths during pregnancy.     

Recombinant single-chain anti-idiotypic antibody: an effective fungal beta-1,3-glucan synthase inhibitor

Recombinant single-chain fragment variable anti-idiotypic antibodies were produced to represent the internal image of HM-1 killer toxin and were used as novel and effective antifungal agents to inhibit in vitro beta-1,3-glucan synthase and cell growth. The mechanism of cytocidal activity of anti-idiotypic antibodies was investigated and was compared with the actions of aculeacin A and papulacandin B, the most common antibiotics acting as beta-1,3-glucan synthase inhibitors. The degree of inhibition of beta-1,3-glucan synthase by both antibodies and antibiotics were examined for yeasts Saccharomyces cerevisiae A451, Cryptococcus albidus NBRC 0612 and Candida albicans IFM 40215. Although the mechanism of actions of the anti-idiotypic antibodies and antibiotics seems identical, the IC(50) values for the various yeasts used in this study confirmed that anti-idiotypic antibodies could be used as more effective fungal beta-1,3-glucan synthase inhibitors than those of antibiotics.     

Activation of connective tissue-type and mucosal-type mast cells in compound 48/80-induced airway response

The pathology of non-immunological airway contraction is not well understood. To define the activation of different phenotypes of mast cells, a rat non-immunological asthmatic model was prepared. Airway contraction in rats was measured by an unrestrained whole-body plethysmographic system following a 10-min inhalation challenge with a 5% solution of compound 48/80. Histamine, leukotrein C(4) (LTC(4)) and tumor necrosis factor (TNF)-alpha levels in bronchoalveolar lavage fluid, as well as tissue histamine content were quantified. Mast cells and eosinophils were detected by histology. Both the early and late phase of airway responses were induced by inhalation of compound 48/80. Histamine and TNF-alpha levels increased significantly 30 min after challenge, but no increases were detected at either 8 or 24 h after challenge. A high LTC(4) level was detected in 30 min and 8 h after challenge. Tissue histamine content decreased at 30 min after challenge and returned to the unstimulated level by 8 h. Connective tissue mast cells in rat trachea showed a degranulation response. Along with the increase in numbers of mucosal mast cells, rat mast cell protease II at both mRNA and protein levels in the trachea epithelial layer was also increased significantly at 30 min after challenge. We conclude that compound 48/80 inhalation causes both the early and late phase of airway contraction in rats. Mast cell degranulation is responsible for the early phase of airway response, which subsequently triggers the late phase of airway response.     

An outcome evaluation of the implementation of the Outward Bound Singapore five-day “intercept” program

The present study evaluated an Outward Bound Singapore five-day “intercept” program for 136 adolescent participants, aimed at addressing frequent deliberate truancy and absenteeism from school and within-school extracurricular activities using a quasi-experimental design with a matched no-treatment comparison group. Findings suggested that there is some preliminary evidence that such a program could yield positive outcomes in terms of adolescents being more behaviorally engaged in school as demonstrated by improved attendance of both academic and non-academic activities up to 3 months after the conclusion of the intervention program. Goal setting had a short-term positive effect with intervention participants improving significantly more so than comparison participants at 1-month post intervention but not at 3-month follow up. For problem solving, although the intervention group participants improved more than comparison participants at both 1-month post intervention and at 3-month follow up, these effects were not statistically significant. Research and practice implications were discussed.