Evaluation of impact of long-lasting insecticide-treated bed nets and point-of-use water filters on HIV-1 disease

March 12, 2013 · 0 comments

AIDS. 2013 Jan 16.

Evaluation of impact of long-lasting insecticide-treated bed nets and point-of-use water filters on HIV-1 disease progression in Kenya.

Walson JL, Sangaré LR, Singa BO, Naulikha JM, Piper BK, Yuhas K, Onchiri FM, Otieno PA, Mermin J, Zeh C, Richardson BA, John-Stewart G.

OBJECTIVES:: Among HIV-1 infected individuals in Africa, co-infection with malaria and diarrheal disease may be associated with more rapid HIV-1 disease progression. We sought to determine whether the use of long-lasting insecticide-treated bed nets and simple point-of-use water filters can delay HIV-1 disease progression.

DESIGN:: Prospective cohort study.

SETTING:: Two HIV Care Sites in Kenya. PARTICIPANTS:: HIV-1 infected adults not yet meeting criteria for antiretroviral therapy.

INTERVENTIONS:: One group received the standard of care, while the other received long-lasting insecticide-treated bed nets and water filters. Individuals were followed for up to 24 months.

MAIN OUTCOME MEASURES:: The primary outcome measures were time to CD4 count <350 cells/mm and a composite endpoint of time to CD4 <350 cells/mm and non-traumatic death. Time to disease progression was compared using Cox proportional hazards regression. RESULTS:: Of 589 individuals included, 361 received the intervention and 228 served as controls. Median baseline CD4 counts were similar (p = 0.36). After controlling for baseline CD4 count, individuals receiving the intervention were 27% less likely to reach the endpoint of a CD4 count <350 cells/mm (HR: 0.73; 95% CI: 0.57-0.95). CD4 decline was also significantly less in the intervention group (-54 vs. -70 cells/mm/year, p = 0.03). In addition, the incidence of malaria and diarrhea were significantly lower in the intervention group.

CONCLUSIONS:: Provision of a long-lasting insecticide-treated bed net and water filter was associated with a delay in CD4 decline and may be a simple, practical, and cost-effective strategy to delay HIV-1 progression in many resource-limited settings.

Effect of recent diarrhoeal episodes on risk of pneumonia in children

March 12, 2013 · 0 comments

Int J Epidemiol. 2013 Feb 1.

Effect of recent diarrhoeal episodes on risk of pneumonia in children under the age of 5 years in Karachi, Pakistan.

Ashraf S, Huque MH, Kenah E, Agboatwalla M, Luby SP.

Water Sanitation and Hygiene Research Group, Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh Department of Biostatistics, University of Florida, Gainesville, GA, USA Health Oriented Preventive Education, Karachi, Pakistan and Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

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BACKGROUND: We assessed the association between the duration of diarrhoea and the risk ofpneumonia incidence among children <5 years of age.

METHODS: We analysed data from a cluster randomized controlled trial in Karachi, Pakistan, which assessed the effect of promoting hand washing with soap (antibacterial and plain) on child health. Field workers visited households with children <5 years of age weekly and asked primary caregivers if their child had diarrhoea, cough or difficulty breathing in the preceding week. We used the WHO clinical case definitions for diarrhoea and pneumonia.We used adjusted time-to-event analyses with cumulative diarrhoea prevalence over the previous 2 and 4 weeks as exposure and pneumonia as outcome. We calculated the attributable risk of pneumonia due to recent diarrhoea across the intervention groups.

RESULTS: 873 households with children <5 years were visited. Children had an increased risk of pneumonia for every additional day of diarrhoea in the 2 weeks (1.06, 95% CI: 1.03-1.09) and 4 weeks (1.04, 95% CI: 1.03-1.06) prior to the week of pneumonia onset. The attributable risk of pneumonia cases due to recent exposure to diarrhoea was 6%. A lower associated pneumonia risk following diarrhoea was found in the control group: (3%) compared with soap groups (6% in antibacterial soap, 9% in plain soap).

CONCLUSION: Children <5 years of age are at an increased risk of pneumonia following recent diarrhoeal illness. Public health programmes that prevent diarrhoea may also reduce the burden of respiratory illnesses.

Seasonality, disease and behavior: Using multiple methods to explore socio-environmental health risks

March 12, 2013 · 0 comments

Soc Sci Med. 2013 Mar;80:1-9. doi: 10.1016/j.socscimed.2012.12.027.

Seasonality, disease and behavior: Using multiple methods to explore socio-environmental health risks in the Mekong Delta.

Few R, Lake I, Hunter PR, Tran PG.
School of International Development, University of East Anglia (UEA), Norwich NR4 7TJ, United Kingdom. Electronic address: r.few@uea.ac.uk.

Any analysis of how changing environmental hazards impact on public health is fundamentally constrained unless it recognizes the centrality of the social and behavioral dimensions of risk. This paper reports on a research project conducted among low-income peri-urban households in the Mekong Delta of Vietnam. The research was based on cross-disciplinary inputs to develop a multi-layered understanding of the implications of a dynamic seasonal environment for diarrheal disease risk.

It is a widely held assumption that the major changes in the abundance of surface water between the flood and dry seasons in the Mekong Delta are likely to be reflected in the changing patterns of disease risk, especially for poorer households that tend to rely heavily on river water for domestic water use. Therefore, this study investigated seasonal patterns in the contamination of environmental water, incidences of diarrheal illnesses, water use and hygiene behavior, together with perceptions of health risks and seasonality. During the period of October 2007 to October 2008, the UK and Vietnamese research team worked with a total of 120 households in four low-income sites around the city of Long Xuyen to conduct water testing; administer questionnaires on self-reported health, risk perceptions and behavior; and conduct semi-structured interviews.

The research team found no overall evidence of a systematic seasonal risk pattern. At the population level, marginal temporal variations in water quality in the environment failed to translate into health outcomes. A complex risk narrative emerged from the interweaving data elements, demonstrating major inter- and intra-household variations in risk perceptions, hygiene behavior, seasonal behavior and other risk factors. It is suggested that these complexities of human behavior and transmission routes challenge simplistic assumptions about change in health outcomes as a result of seasonal environmental changes. These findings demonstrate the key role social science can play in a holistic and critical analysis of environment and health interactions.

Application of solar disinfection for treatment of contaminated public water supply

March 12, 2013 · 0 comments

J Water Health. 2013 Mar;11(1):135-45. doi: 10.2166/wh.2012.119.

Application of solar disinfection for treatment of contaminated public water supply in a developing country: field observations.

Mustafa A, Scholz M, Khan S, Ghaffar A.
Department of Environmental Engineering, NED University of Engineering and Technology, Karachi 75270, Sindh, Pakistan E-mail: atifm@neduet.edu.pk.

A sustainable and low-cost point-of-use household drinking water solar disinfection (SODIS) technology was successfully applied to treat microbiologically contaminated water. Field experiments were conducted to determine the efficiency of SODIS and evaluate the potential benefits and limitations of SODIS under local climatic conditions in Karachi, Pakistan. In order to enhance the efficiency of SODIS, the application of physical interventions were also investigated.

Twenty per cent of the total samples met drinking water guidelines under strong sunlight weather conditions, showing that SODIS is effective for complete disinfection under specific conditions. Physical interventions, including black-backed and reflecting rear surfaces in the batch reactors, enhanced SODIS performance. Microbial regrowth was also investigated and found to be more controlled in reactors with reflective and black-backed surfaces. The transfer of plasticizer di(2-ethylhexyl)phthalate (DEHP) released from the bottle material polyethylene terephthalate (PET) under SODIS conditions was also investigated.

The maximum DEHP concentration in SODIS-treated water was 0.38 μg/L less than the value of 0.71 μg/L reported in a previous study and well below the WHO drinking-quality guideline value. Thus SODIS-treated water can successfully be used by the people living in squatter settlements of mega-cities, such as Karachi, with some limitations.

Comparison of the burden of diarrhoeal illness among individuals with and without household cisterns

March 7, 2013 · 0 comments

Comparison of the burden of diarrhoeal illness among individuals with and without household cisterns in northeast Brazil. BMC Infectious Diseases 2013, 13:65

Pasha B Marcynuk, et al.

Background: Lack of access to safe and secure water is an international issue recognized by the United Nations. To address this problem, the One Million Cisterns Project was initiated in 2001 in Brazil’s semi-arid region to provide a sustainable source of water to households. The objectives of this study were to determine the 30-day period prevalence of diarrhoea in individuals with and without cisterns and determine symptomology, duration of illness and type of health care sought among those with diarrhoea. A subgroup analysis was also conducted among children less than five years old.

Methods: A face-to-face survey was conducted between August 20th and September 20th, 2007 in the Agreste Central Region of Pernambuco State, Brazil. Households with and without a cistern that had at least one child under the age of five years were selected using systematic convenient sampling. Differences in health outcomes between groups were assessed using Pearson’s Chi-squared and two-way t-tests. Demographic variables were tested for univariable associations with diarrhoea using logistic regression with random effects. P-values of 0.05 or less were considered statistically significant.

Results: A total of 3679 people from 774 households were included in the analysis (1863 people from 377 households with cisterns and 1816 people from 397 households without cisterns). People from households with a cistern had a significantly lower 30-day period prevalence of diarrhoea (prevalence = 11.0%; 95% CI 9.5-12.4) than people from households without a cistern (prevalence = 18.2%; 95% CI 16.4-20.0). This significant difference was also found in a subgroup analysis of children under five years old; those children with a cistern had a 30-day period prevalence of 15.6% (95% CI 12.3-18.9) versus 26.7% (95% CI 22.8-30.6) in children without a cistern. There were no significant differences between those people with and without cisterns in terms of the types of symptoms, duration of illness and health care sought for diarrhoea.

Conclusions: Our results indicate that the use of cisterns for drinking water is associated with a decreased occurrence of diarrhoea in this study population. Further research accounting for additional risk factors and preventative factors should be conducted.

Nudging to Use:Achieving Safe Water Behaviors in Kenya and Bangladesh

March 7, 2013 · 0 comments

Nudging to Use:Achieving Safe Water Behaviors in Kenya and Bangladesh.

J Luoto, et al.

Convincing people to adopt preventive health behaviors consistently is difficult, yet many lives could be saved if we understood better how to do so. For example, low‐cost point‐of‐use (POU) technologies such as chlorine and filters can substantially reduce diarrheal disease, responsible for nearly 1.7 million child deaths each year. Nonetheless, these products are not consistently used anywhere in the developing world, even when available and heavily subsidized. We ran complementary randomized field studies in rural western Kenya and urban Dhaka, Bangladesh in which households received free trials of POU products to test the role of marketing on usage of these preventive health goods.

Ryan Rowe – Ghana National Strategy for Household Water Treatment

March 1, 2013 · 1 comment

Ghana National Strategy for Household Water Treatment by Ryan Rowe | Source-Feb 28, 2013 |

Good news from West Africa! The Government of Ghana is making further progress on its “National Strategy on Household Water Treatment and Safe Storage”. This follows a series of efforts since 2010, which included an assessment commissioned by UNICEF, an initial draft to kick off the strategy development process, and several stakeholder consultations, including one in June 2012. This is an important step to empowering households to improve the quality of their drinking water, in a country where as many as 5 million people are at risk of water-related diseases from the simple act of quenching their thirst. Now, the government plans another regional workshop and is seeking additional input to make the strategy as focused and effective as possible. As part of my work with the International Network on Household Water Treatment and Safe Storage, I’ll have an opportunity to provide input to their plans over the next few months. 

For those unfamiliar with the practice, household [or, point-of-use] water treatment and safe storage (HWTS) involves the application of technologies or techniques to improve the quality of drinking water in the home, or other places where water is consumed, such as schools and health clinics. Many may think of boiling when they think of water purification. Although boiling is effective if done properly, but it can also be expensive and sometimes causes other health problems, such as injuries from burns, or lead to respiratory infections if the water is boiled over an open (and smoky) fire inside the home. Other popular techniques of water purification include adding chlorine, using a filter and even solar disinfection. The “safe storage” part of HWTS comes from keeping water in clean, covered containers to makes sure it stays safe and does not get re-contaminated by dirty flies or fingers in places they shouldn’t be.

Many firms (for-profit, non-profit and social enterprise) around the world have come up with solutions to purify dirty drinking water. Some such companies include Procter & Gamble (P&G Purifier of Water),Vestergaard-Frandsen (the LifeStraw), Basic Water Needs (the Tulip Filter) and Ecofiltro.

In countries where not everyone has access to tap water, there are real concerns about the quality of drinking water. For example, in Ghana, about 9% of people living in cities draw water from surface sources such as lakes, ponds or unprotected wells or boreholes (JMP, 2012). In rural areas, it is much worse: about 31% of people draw water from such sources (JMP, 2012). Nationwide, that means about 5 million people (20% of the population) drink water from sources considered unsafe.

Drinking contaminated water often leads to killer diseases, the brunt of which is borne by children. In Ghana, about 7% of all deaths in children under five years old are due to diarrhoea (A Promise Renewed, 2012). Published research has shown that HWTS can reduce the incidence of diarrhoea by up to 47% (Fewtrell et al, 2005; Clasen et al, 2006; Waddington et al, 2009). Although child mortality in many Sub-Saharan African countries has declined in recent years, it remains too high.

When I first began learning more about the water crisis years ago, it struck me as incredible that hundreds of thousands (at least) of children die every year from preventable diarrhoea. Working on improving child survival has become one of my life’s passions and was the reason for why I re-focused my career on learning about and supporting efforts to increase access to safe water through methods such as HWTS.

Stay tuned to this page for more updates on Ghana’s progress in the coming months!

Leveraging carbon financing to enable accountable water treatment programs

March 1, 2013 · 1 comment

Leveraging carbon financing to enable accountable water treatment programs | Source: Global Water Forum, Sept 2013 |

Dr. Evan Alexander Thomas, Portland State University, Portland.

International carbon credit markets are designed to encourage sustainable, clean development around the world, while reducing current and projected emissions. The United Nations Clean Development Mechanism (CDM) has created a worldwide market for carbon credits from clean projects. However, few of those programs are active in truly developing countries – less than 2% of the projects are registered in African Nations,1 even while the impacts of climate change are expected to be severe in these regions.2

Firewood collection

In 2010, a social enterprise I co-founded, Manna Energy Limited, was the first to successfully register a UN CDM program combining drinking water treatment with carbon financing. We are able to earn UN carbon credits for treating drinking water in rural Rwanda. The premise of our carbon credits is that of the methods currently available to rural residents, one prevailing practice is to boil their water with non-renewable wood. When we install a water treatment system that treats water to World Health Organization standards3 for microbiological contamination, we are providing a clean alternative to these baseline practices.

Many people in Rwanda and elsewhere do boil their water.4 Some use alternatives such as chlorination or solar distillation, while many consume untreated water and often suffer the health consequences.

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Measuring Sustainability

March 1, 2013 · 0 comments

Measuring Sustainability By Evan Thomas | Source: Solutions |

The World Health Organization estimates that 884 million people do not have access to safe sources of drinking water. Meanwhile, about half of the world’s population continues to use unsustainable, biomass-based energy sources for indoor fuel, leading to extensive deforestation, harmful indoor air emissions, and in many cases upper respiratory disease and high commodity costs for impoverished families. Exacerbating these problems are the international effects of climate change, expected to significantly impact developing countries by changing water and energy quality and availability.

International development organizations work tirelessly to address these challenges. However, many efforts struggle with achieving long-term sustainability; many well-intentioned programs fail when their ambition is not matched by the financial sustainability and objective performance of data collection. Our team is studying these gaps, and we have proposed several concepts that seek to provide built-in accountability and sustainability mechanisms.

Where Is the Accountability?

The majority of international development programs self-report project outcomes. Evaluations by outside experts are expensive and infrequent. When programs self-report, they tend to show success, even while broader surveys indicate ongoing challenges in the sector. As a result, the often rural, impoverished citizens who use these programs continue to suffer from significant public health and livelihood challenges, even as their communities are advertised to donors as success stories.1

SWEETLab/Portland State University The author tests remote monitoring equipment for cookstoves in the Portland State University SWEETLab. This inexpensive technology could dramatically increase the accountability and effectiveness of development projects worldwide.

Many development organizations are now recognizing the problem: a lack of objective data on program performance is contributing to a subsequent lack of accountability and misappropriation of resources. For example, in the water sector, the World Health Organization and UNICEF Joint Monitoring Program (JMP) for Water Supply and Sanitation recently reported on their Rapid Assessment of Drinking Water Quality program, and stated that “reporting use is based on household surveys,” and that the global monitoring of drinking-water quality is “complex and it is expensive” at approximately US$50 per sample. The JMP stated that “data comparability is a big challenge,” and there is a “need for a wider and integrated approach to link to the national monitoring systems.”2

Is There a Way to Help Aid Organizations Achieve Success?

Electronic sensors can help development organizations remotely monitor their own performances, similar to many engineered water and energy projects around the world. Organizations can use data to understand programmatic, social, economic, and seasonal changes that may influence the quality of a program. In addition, they can study behavioral patterns to better understand how and when the water and energy technologies are being used. It is also possible to evaluate how the sponsors of the intervention respond to the data and adjust their implementation programs.

In order to help aid organizations improve their evaluation methods, our research team has engineered a twist on data collection for international development—automated, remote monitoring. The Sustainable Water, Energy, and Environmental Technologies Laboratory (SWEETLab) at Portland State University is working with partners to demonstrate this concept across several applications and countries. This concept can provide objective, qualitative, and continuous operational data on the usage and performance of programs across a range of sectors and communities, thereby dramatically improving accountability and sustainability of water, sanitation, and energy programs around the world.

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Assessing an intermittently operated household scale slow sand filter paired with household bleach

March 1, 2013 · 0 comments

Assessing an intermittently operated household scale slow sand filter paired with household bleach for the removal of endocrine disrupting compounds. J Environ Sci Health A Tox Hazard Subst Environ Eng. 2013;48(7):753-9. doi: 10.1080/10934529.2013.744616.

Kennedy TJ, Anderson TA, Hernandez EA, Morse AN. Department of Civil and Environmental Engineering , Texas Tech University , Lubbock , Texas , USA.

Endocrine disrupting compounds (EDCs) are a contaminant of emerging concern throughout the world, including developing countries where centralized water and wastewater treatment plants are not common. In developing countries, household scale water treatment technologies such as the biosand filter (BSF) are used to improve drinking water quality. No studies currently exist on the ability of the BSF to remove EDCs.

In this experiment, the BSF was evaluated for the removal of three EDCs, estrone (E1), estriol (E3), and 17α-ethinyl estradiol (EE2). Removal results were compared to the slow sand filter (SSF) from the literature, which is similar to the BSF in principal but comparisons have revealed differences in removal of other water quality parameters between SSF and BSF.

In general, the BSF minimally removed the compounds from spiked lake water as removal was less than 15% for all three compounds, though mass removal much higher than other studies in which the SSF was used. Household bleach was added to the rate was BSF effluent as suggested in order to achieve different Cl- concentrations (0.67, 2.0, 5.0, and 10.0 mg/L) and subsequent removal of EDCs by oxidation was examined.

Concentrations were reduced > 98% for all compounds when the Cl- concentration was greater than 5 mg/L. Removal efficiency was > 50% at the 0.67 mg/L Cl- concentration, while almost 70% removal was observed for all compounds at the 2.0 mg/L Cl- concentration.

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