Enabling the sustainable Faecal Sludge Management service delivery chain—A case study of dense settlements in Kigali,Rwanda

The lack of access to basic sanitation is a global concern and alarmingly prevalent in low- and middle- income countries. In the densely populated settlements of these countries, on-site sanitation systems are usually the only feasible option because dwellers there have no sewers in place to connect to. Using on-site sanitation facilities results in an accumulation of faecal sludge which needs to be properly managed to ensure the well-being of the users as well as the surrounding environment. Unfortunately, often the conditions for faecal sludge management (FSM) within dense settlements are adverse and thus hamper sustainable FSM. We use the normative framework of the FSM enabling environment to gather empirical evidence from densely populated settlements of Kigali city in Rwanda to examine current FSM practices and the extent to which these are being influenced and affected by the setting within which they are taking place. The analysis of the study findings confirms that the existing conditions for FSM in these settlements are inadequate. The specific constraints that hinder the achievement of sustainable FSM include limited government focus on the sanitation sector, high turnover of staff in relevant government institutions, pit sludge management is not placed on the sanitation projects agenda, the existing relevant bylaws are not pro-poor oriented, a lack of clear responsibilities, a lack of relevant local professional training opportunities, unaffordability of FSM services and an inhibition to discuss FSM. Drawing on the involved stakeholders’ own perceptions and suggestions, we identify possible approaches to overcome the identified constraints and to allow all actors in the FSM chain to contribute effectively to the management of faecal sludge in densely populated low-income urban settlements. Finally, our study also presents a contribution to the theoretical conceptualisation of the enabling environment for sustainable FSM.     

Propositions de structuration des commissions de menus en établissements d’hébergement pour personnes âgées dépendantes

Menu Committees (MC) are frequently present in French geriatric institutions like nursing homes, but with variable functioning conditions. Their aims are theoretically to favour communication about food, and to validate menus in each institution. However, statutory frame and bibliography on MC are poor and consequently pragmatic propositions based on daily practice can be made. They give optimal aims of MC, its composition including which role each participant plays and the functioning conditions before, during and after MC. A better satisfaction of residents, medical practitioners and employees, combined with surveys showing improvements in food supply could be signs of a good efficiency for MC.     

COPD patients with and without metabolic syndrome: clinical and functional differences

Chronic obstructive pulmonary disease (COPD) and the metabolic syndrome (MetS) are considered public health challenges of the 21st century. The coexistence of MetS in COPD patients and any clinical differences between COPD patients with and without MetS have not been extensively studied. We aimed to describe the clinical characteristics of patients with MetS and COPD. An observational, multicenter study of 375 patients hospitalized for a COPD exacerbation with spirometric confirmation was performed. We measured the components of the MetS and collected comorbidity information using the Charlson index and other conditions. Dyspnea, use of steroids, exacerbations, and hospitalizations were also investigated. The overall prevalence of MetS in COPD patients was 42.9 %, was more frequent in women (59.5 %) than men (40.8 %), p = 0.02, but with no differences in age and smoking history. COPD patients with MetS had greater % predicted FEV₁, more dyspnea, and more comorbidity and used more inhaled steroids (all p < 0.05). Diabetes, osteoporosis, coronary artery disease, and heart failure were more frequent in patients with MetS. They had been hospitalized more frequently for any cause but not for COPD. In multivariate analysis, the presence of MetS was independently associated with greater FEV₁, inhaled steroids use, osteoporosis, diabetes, and heart failure. MetS is a frequent condition in COPD patients, and it is associated with greater FEV₁, more dyspnea, and more comorbidities.