District Public Health Office Research Articles

What influence mothers’ mental health and health care seeking behaviors for their malnourished children in Nepal: building evidence for a broader perspective

IntroductionImplementing research projects on community-based health care interventions in low-ressource settings is feasible with specific methods and applications. In order to critically understand all ins and outs of influencing factors involved in health care pathways for children and their mothers, we must consider to implement more than one research in the same context.ObjectivesThe objective of this presentation is to showcase the continuum of research projects starting from the assessment of the effectiveness of a combined nutrition and psychosocial intervention and its economic evaluation, and how that led to exploring social representations of malnutrition in order to better understand the link with health care seeking behaviours.MethodsThe FUSAM cluster randomized control trial included 427 were severe acutely malnourished (SAM) children and their mothers. They were divided in two groups receiving the standard nutrition treatment while the intervention group benefited from five psychosocial sessions. A battery of tests for child development and maternal mental health was administered pre and post intervention. For the economic evaluation, a data collection was conducted with 98 community members and District Public Health Office personnel in Saptari and 17 Action contre la Faim and government personnel in Kathmandu. Finally, a mixed-method study comparing social representations of malnutrition included 376 adults in Saptari and Nuwakot district. Data analysis was performed according to the study design: a multivariate model analysis for the CRCT, a micro-costing methodology to cost data collection and analysis was favored. For the mixed-method analysis, descriptive and inductive analysis were performed.ResultsRegarding the child development, children in the intervention group showed higher scores than children in the control group at all time points. And the economic evaluation showed that the costs of adding psychosocial counselling to an existing CMAM program was approximately EUR 28,788 for 6 centers per year. However, referrals of children through the community-based screening were not optimal. The findings related to health seeking behaviors showed that different meaning categories were simultaneously resorted to by community members leading to different representations of SAM children and that relevant health advises were neither systematically nor uniquely associated to medical categories but are linked to different meaning categories depending on the cultural context.ConclusionsMultiplying research projects is crucial to mitigate the limitations of the studies often facing numerous contextual challenges and ultimately to leverage further opportunities.Disclosure of InterestNone Declared

A protocol and a data-based prediction to investigate virus spillover at the wildlife interface in human-dominated and protected habitats in Thailand: The Spillover Interface project.

The Spillover Interface Project aims at assessing the encounter of wildlife, domestic animals, and humans along a landscape gradient from a protected area to a residential community, through areas of reforestation and agricultural land. Here, we present the protocols of the project that combine virus screening in humans, bats, rodents and dogs with camera trapping, land-use characterization, and network analyses. The project is taking place in the sub-district of Saen Thong (Nan Province, Thailand) in collaboration with local communities, the District Public Health Office, and Nanthaburi National Park. To formulate a predictive hypothesis for the Spillover Interface Project, we assess the wildlife diversity and their viral diversity that could be observed in Saen Thong through a data science analysis approach. Potential mammalian species are estimated using data from the International Union for Conservation of Nature (IUCN) and their associated viral diversity from a published open database. A network analysis approach is used to represent and quantify the transmission of the potential viruses hosted by the mammals present in Saen Thong, according to the IUCN. A total of 57 viruses are expected to be found and shared between 43 host species, including the domestic dog and the human species. By following the protocols presented here, the Spillover Interface Project will collect the data and samples needed to test this data-driven prediction.

Internal transcribed spacer 2 (ITS2) based molecular identification of malaria vectors from Bangsring Banyuwangi-Indonesia

Since the malaria outbreak in 2011, the breeding place of Anopheles in Bangsring Village on Banyuwangi District has been monitored by District Public Health Office as part of a vector surveillance program. Morphological identification is still a standard tool to observe Anopheles occurrence and diversity, but the presence of cryptic species made it unreliable. In this study, a molecular approach called DNA barcoding technique was used to assist the morphology-based techniques to identify Anopheles species found in Bangsring. The internal transcribed spacer 2 (ITS2) sequence was used as molecular marker. Based on the morphological features, we were able to identify Anopheles (An.) vagus, An. subpictus, An. sundaicus and An. aconitus. ITS2 sequences from the four identified species were then analyzed simultaneously with eighteen reference sequences from NCBI which had a high similarity of 98-100%. The NJ phylogenetic tree formed three major clades, where the two clades as monophyletic clades were An. vagus and An. aconitus. Another clade was formed as polyphyletic clade containing An. subpictus and An. sundaicus. Although An. subpictus and An. sundaicus were placed in the same clade, seven nucleotide differences were observed in their ITS2 sequence. The intra-specific variation of those two species was 0.08 and 0.49%, respectively, while the interspecific variation was 1.39%. Interspecific variation which was higher than the mean intra-specific variation might indicate that An. sundaicus and An. subpictus were a distantly species. However, the value of interspecific variation lower than 3% might also indicate that those species were classified as a complex species. All ITS2 sequences from morphologically identified species had similar results with molecular-based techniques. This result showed that molecular identification using the ITS2 sequence was reliable in supporting morphological identification among closely related anopheline mosquitoes and gave further information about their evolutionary divergence.

Practices of waste management in health care facilities in Nepal's Biratnagar metropolitan city

Biratnagar is a medical referral centre with tertiary health care in Eastern Nepal. The city population is 202,061, according to the 2011 census. There are 35 Health Care Facilities (HCFs) in the city as of 2014. There are 7 HCFs, 2 non-governmental HCFs, and 26 private HCFs. In 2014, the District Public Health Office Morang, the Biratnagar municipality, and the private sector collaborated to check Biratnagar's health care waste management. Investigators performed a semi-structured questionnaire and checklists while visiting health care sites. According to the survey results, 10% of HCFs use incinerators. 80% of HCFs separate their garbage, 60% use needle destroyer machines, and 50% use coloured dustbins to separate different sorts of medical waste. The bed occupancy rate is 78%. Every day, one sweeper looks for 6.66 beds. Even 10% of HCFs let their waste out in the open. HCFs do not have enough capacity for waste disposal facilities. Thus, HCFs pay the municipality Rs. 1500- 15000 a month to have the facility's waste removed. In the municipality tractor, they are hauling medical garbage and home rubbish. As a result, the city discharges health care waste with household waste in the Singhiaya River. These actions endanger public health. Biratnagar city generates 118 Kgs of hazardous health care waste daily, necessitating immediate treatment. Biratnagar Municipality should collaborate with partners to develop a short and long-term strategy.

Streso įveikos veiksmų planas gerinant Klaipėdos rajono ugdymo organizacijų darbo klimatą

Each responsible personality who seeks productive outcomes in the professional activity tends to experience stress. Stress is an inseparable element of the contemporary professional activity. The analysis of the causes of the experienced stress and an appropriate choice of the stress management techniques enable one to cope with stress and to prevent its negative manifestations in an organization. The aim of the research: after the investigation of the distribution of stress as a psycho-social factor and the ways of coping with it in Klaipeda district educational organizations, to make an action plan for coping with stress with the aim of improving the work climate in organizations. The material and methods. For the research, educational organizations in Klaipėda district were chosen (in accordance with the data of Klaipėda District Municipality of 2011, there were 19 organizations with the staff of 599 at the time). The survey was conducted in September 2011 in collaboration with school public health care specialists from Klaipėda District Public Health Office. 286 questionnaires were handed out, and 246 ones were returned and found appropriate for the investigation. 31 questionnaires did not meet the criterion of representativeness, and 9 people refused to participate. For the statistical processing of the obtained data, the methods of descriptive, comparative, and correlation analysis were applied. The statistical processing of the data was carried out by the SPSS 17.0 software.The outcomes. The stressors characteristic of the staff of Klaipeda district educational organizations were established: responsibility for the future of the staff in the organization; personal skills and abilities completely fail to be realised in the organization; the work is monotonousand full of tension; the necessity to suppress one’s genuine emotions and not to show one’s true feelings; andresponsibility for the actions of other staff members. Statistically significant correlations were established between the coping with stress and the skills of management oriented towards problems and emotions. Conclusions. The staff of Klaipeda district educational organizations tended to belong to Type B personality, i.e. people whose response to stress was rather calm, however, they experienced work-related stress. To reduce the stress or to cope with it, an action plan was recommended. The responsibility for the said plan implementation was to be taken by the head of the institution.

Housing structure including the surrounding environment as a risk factor for visceral leishmaniasis transmission in Nepal.

Visceral leishmaniasis (VL) in Nepal is found in 61 out of 75 districts including areas previously listed as non- endemic. This study focused on the role of housing conditions and its immediate environment in VL transmission, to limit future transmissions, ensure sustainable vector control and support the VL elimination program. The objective was to explore the risk factors in rural housing-and land lot typologies contributing to clinical VL occurrence and transmission. Housing structures and land lots were examined based on characteristics as risk factors of VL transmission in a case-control analysis. VL cases from 2013-2017 were identified based on the existing database from the Epidemiology and Disease Control Division and District Public Health Office from the plain Terai area (Morang, and Saptari districts) and hilly area (Palpa district) of Nepal. Two hundred and three built environments were analyzed (66 cases and 137 controls). Inferential statistics and logistic regression analysis were performed to determine the association of risk factors with VL. The risk factors with the highest odds of VL were: bamboo walls (adjusted odds ratio (AOR)- 8.1, 95% CI 2.40-27.63, p = 0.001), walls made of leaves/branches (AOR- 3.0, 95% CI 0.84-10.93, p = 0.090), cracks in bedroom walls (AOR- 2.9, 95% CI 0.93-9.19, p = 0.065), and placing sacks near sleeping areas (AOR- 19.2, 95% CI 4.06-90.46, p <0.001). Significant outdoor factors were: lots with Kadam trees (AOR- 12.7, 95% CI 3.28-49.09, p <0.001), open ground-outdoor toilets (AOR- 9.3, 95% CI 2.14-369.85, p = 0.003), moisture in outdoor toilet sheds (AOR- 18.09, 95% CI 7.25-451.01, p = 0.002), nearby- open land (AOR- 36.8, 95% CI 3.14-430.98, p = 0.004), moisture inside animal sheds (AOR- 6.9, 95% CI 1.82-26.66, p = 0.005), and surrounding animals/animals wastes particularly goats (AOR- 3.5, 95% CI 1.09-10.94, p = 0.036). Certain housing and surrounding environmental conditions and characteristics are risk factors for VL. Hence, elimination and educational programs should include the focus on housing improvement and avoidance of risk factors. Longitudinal interventional studies are required to document temporal relationships and whether interventions on these factors will have an impact on Leishmania transmission or burden.

Assessment of Learning Organization Practice and Disciplines in Case of Sire District Public Health Office, Arsi Zone, Oromia Region, Ethiopia, 2018

Learning Organizations are organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspirations are set free and where people are continually learning how to learn together. The aim of this study was to assess Learning organization practice and disciplines in case of Sire District Public health office. Learning organization if implemented in the health institutions it enables ignition of newly created more another’s learning organization units moreover, learning organization concept if implemented in the organization it can enables organization to achieve their goal systematically besides this, it also enhance employees their job commitment whereas, the organization not implemented learning organization concept might be opposite of this or vice versa. The study employed qualitative case-study design in sire District public health office. Document review, in depth interview and Focus group discussion with flexible probing techniques were employed to collect the data from 3 key informants and 2 FGD from January 1, 2018 to January 11, 2018. A semi structured interview guide was prepared to explore key informants’ idea about current situation and efforts made to enable organization to be a learning organization and also thematic analyses were used to analyze the findings of the study. The study result revealed that the organization assessed in both parameter of learning organization (five disciplines Peter Senge and Pedler et al criteria of practice of learning organization) the organization was practiced preponderance of learning organization concept was practiced within five disciplines of learning organizations there were implemented in their office. The finding of the study revealed that sire district public health office was practiced learning organization and disciplines in there organization that was exercised as good and the organization also participate entire employees and stakeholders to carry out organizational plan that were align with national strategies of the country moreover, the organization had created enabling learning opportunities to enhance a learning organization among themselves and others.

Study on Occupational Health Status of Secondary Level Teachers Teaching in Government School of Kathmandu District

Introduction: Occupational health hazards of teaching includes ill health, poor physical posture and confusion that plays a vital role in triggering other diseases which are associated with musculoskeletal, cardiovascular, gastrointestinal, vocal cord, skin and other health problems. Most of the teachers develop occupational health problems after being enrolled into this profession, identification of such problems should be carried out in the initial phase of the profession.&#x0D; Objective: To access the health status of teachers in terms of age, gender, health problem and types of health problem. To access the association between gender, years in profession and health problem.&#x0D; Methodology: Cross-sectional study was conducted among teachers of selected secondary level Government school of Kathmandu i.e. 50 schools. Sample size of 270 was calculated. Random sampling was used for school selection. Response rate was 95.5 % i.e. 258 samples were collected.&#x0D; Result: Majority of the teachers i.e. 69% were facing some kind of health problem. Respondents who were above 30 years were found to have different kinds of health problems. Significant association between teaching for more than 10 years and health problem was observed among Males (72.7%, P&lt;0.05) and females (82.5%, P&lt; 0.05).&#x0D; Conclusion: The proportion of health problem was slightly higher among male teachers than in female teachers. It is necessary to improve the work standards and quality of life of teachers, through establishment of routine health checkups and strong coordination between District Education office and District Public Health office.

Drones Optimized Therapy System (DrOTS): Use of Drones for Tuberculosis Diagnosis in Nepal

Over 50% of the total Nepalese population lives in hilly and mountainous areas with extremely poor transportation and access to health care facilities. With advanced health centers concentrated only in urban areas, and diagnostic laboratories not being present in most primary healthcare facilities, majority of people are forced to have to walk by foot, in an average 6-8 hours, to access proper healthcare facilities. Drone Optimized Therapy System, (DrOTS) aims to improve access to healthcare access in rural villages of Nepal. The pilot phase currently involved improving the accessibility of Tuberculosis diagnostic tests by linking communit y health workers (CHWs) with state-of-the-art diagnostic tools (GeneXpert) via drones in two municipalities of Pyuthan district, Nepal. The drones fly from central Hospitals to remote healthcare centers and bring back sputum samples for diagnosis. The purpose of this project is to assist the Ministry of Health and Population (MoHP) and National Tuberculosis Center (NTC) by generating the data necessary to assess the suitability of the drones-based services for nationwide expansion. The aerial distance between any two points being lesser than the actual road distance, drone technology has come out as a very popular tool in transporting medical samples/medicines between health centers. Drones can be used as crucial tools to connect primary healthcare facilities to hospitals by delivering patient information such as blood, urine, sputum, stool etc. samples required for diagnosis from primary facilities to hospitals, and medicines from hospitals to patients in nearby rural locations for treatment. The project team consists of multisector experts; Public Health- Birat Nepal Medical Trust (BNMT), Drones &amp; Tech - WeRobotics, Nepal Flying Labs &amp; DroNepal, Research: The Liverpool School of Tropical Medicine, Govt. stakeholders: MoHP Nepal, the National TB Center and the District Public Health Office (DPHO Pyuthan) is supported by Stony Brook University and the Simons Foundation.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 14

Population Based Survey of Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency among People Living in Terai Districts of Nepal

Objective: This study was carried out to determine the prevalence of Glucose-6-phosphate dehydrogenase (G6PD) deficiency among population of selected malaria endemic districts in central and eastern terai of Nepal.Methods: Six hundred seventy whole blood samples were collected from the indigenous peoples community, identified based on district public health office records for G6PDd in the past from Jhapa, Morang and Dhanusha districts endemic to malaria, during April to June 2013. Collected blood samples were tested on the sites by using BinaxNow G6PD test kit and CareStartTM G6PD test kits.Results: The G6PD deficiency was found to be in 6.1% and 6.3% in BinaxNow and CareStartTM respectively. In 42 G6PD deficient cases number of male to female ratio was almost equal. Higher proportions of deficient cases were from Rajbanshi and Santhal communities than others. Highest number of deficient cases was in Jhapa followed by Morang and Dhanusha districts respectively.Conclusion: G6PD deficiency in indigenous population group in eastern and central terai are heterogenous. So the testing of G6PD before initiation of radical treatment of Plasmodium vivax infection would be important for reducing the risk of hemolysis following Primaquine (PQ) administration. Rational evidence-based PQ administration may be helpful in contributing towards the elimination of malaria from the country.

Spatiotemporal Distribution and Geospatial Diffusion Patterns of 2013 Dengue Outbreak in Jhapa District, Nepal.

This study describes spatiotemporal distribution and geospatial diffusion patterns of dengue outbreak of 2013 in Jhapa district, Nepal. Laboratory-confirmed dengue cases were collected from the District Public Health Office, Government of Nepal. Choropleth mapping technique, Global Moran's Index, SaTScan, and standard deviational ellipse were used to map and quantify the outbreak dynamics. The results revealed heterogeneous distribution and globally autocorrelated patterns. Local clusters were observed in 3 major urban centers. The standard deviational ellipse demonstrated the outbreak occurred from the east and diffused to the west along the east-west highway in different weeks. The results of this study could be useful to public health authorities to plan and execute dengue control strategies.

Surveillance of HIV Infection among Patients with Tuberculosis in Nepal

Introduction: Tuberculosis is one of the most prevalent infectious disease and significant public health problem in Nepal. The importance of HIV surveillance among tuberculosis (TB) patients is increasingly being recognized as the HIV epidemic continues to fuel the global TB epidemic. In many countries the HIV prevalence in TB patients is a sensitive indicator of the spread of HIV into the general population. The aim of this study is to find out the HIV epidemic among TB patients.Methodology: This was a periodic sentinel survey, i.e. cross-sectional HIV Sero-prevalence survey of all newly registered TB cases above 15 year old to provide point estimate. This survey was carried out in six major diagnostic centres of tuberculosis of Nepal from July 2012 to February 2013. The calculated sample size for the surveillance study was 1000. The findings were processed/analyzed using SPSS (version 16) computer software. Descriptive statistics was used to observe the pattern in each variable.Results: The study revealed that four-fifth (80.9%) TB patients investigated were pulmonary positive and one-fifth (19.1%) extra pulmonary. Prevalence of HIV among tested TB patients was 2.4% and prevalence was comparatively more (2.8%) in Male than Female (1.4%). Sentinel site wise prevalence of HIV was higher (6.7%) in United Mission to Nepal (UMN), Palpa followed by 3.1%, 2.9% and 2.7% in District Public Health Office (DPHO), Kanchanpur, International Nepal Fellowship (INF), Nepalgunj and Regional tuberculosis Centre (RTC), Pokhara respectively. Comparatively prevalence was low (1.3%) in National Tuberculosis Centre (NTC), Thimi and not a single case of HIV among tested TB patients was found in Nepal Anti-TB Association (NATA), Biratnagar. Significant proportion (7.8%) of HIV prevalence was found in the age group of 35-39 years followed by 4.6%, 3.6% and 2.8% among the age group of 40-44 years, 50-54 years and 30-34 years age group respectively.Conclusion: Among all TB/HIV co-infected, significant proportion is found in 35-39 years and lowest in 20-24 age groups. Therefore, it is important to implement targeted interventions in the age group between 30-55 years age group. Provider Initiated Testing and Counseling (PITC) in TB clinical setting plays important role to enroll more TB patients for HIV test.SAARC J TUBER LUNG DIS HIV/AIDS, 2015; 12(1), Page: 25-30

Postdisaster epidemiological assessment of Koshi flood 2008, in Nepal

Introduction: Nepal is vulnerable to geological and hydrological natural disasters with vast epidemiological consequences. Objective: This research is focused on the epidemiology of the aftermath of a major flood in Koshi in the eastern part of Nepal in August 2008. Although, direct flood induced mortality was only two, 39 more mortalities were reported within the four months of the disaster event, mostly amongst those living in the rehabilitation camps. Methods and Materials: Data were collected through questionnaire survey and the secondary data from District Public Health Office (DPHO), Sunsari and well as local health centers. Results: The waterborne infectious diseases and mental disorders were found as the major prominent diseases during the post flood period. The infectious diseases increased by 30% in the first year after the disaster whereas the number of mental disorder patients increased immediately and also within one to three years of period from 29.2% to 62.5% during the post disaster phase. Conclusion: The study has found that the effectiveness of epidemiological interventions would be efficient if it continues up to two years after the flood.

Factors associated with neonatal deaths in Chitwan district of Nepal.

BackgroundNeonatal mortality has remained unchanged since 2006 in Nepal. Reducing neonatal mortality is indispensable to reduce child mortality. The objective of this study was to investigate the factors associated with neonatal mortality. This study assesses socio-demographic factors, maternal health care and newborn care practices contributing to neonatal deaths in Chitwan district of Central Nepal.MethodsA case–control study was conducted during April–July 2012. The study used a mixed-method approach, in which records of neonatal deaths were obtained from the District Public Health Office and a comparison group, survivors, was obtained from the same community. A total of 198 mothers (of 99 neonatal deaths and 99 survivor neonates) were included in the survey. Focus group discussions, in-depth interviews and case studies were also conducted. Maternal characteristics were analyzed using descriptive statistics, Mc Nemar’s Chi square test and multivariable backward conditional logistic regression analysis. Qualitative data were analyzed by narrative analysis method.ResultsMore than four-fifth of mothers (86 %) had antenatal check-up (ANC) and the proportion of four or more ANC was 64 %. Similarly, the percentage of mothers having institutional delivery was 62 %, and postnatal check-up was received by 65 % of mothers. In multivariable analysis, low birth weight [adjusted odds ratio: 8.49, 95 % CI (3.21–22.47)], applying nothing on cord [adjusted odds ratio: 5.72, 95 % CI (1.01-32.30)], not wrapping of newborn [adjusted odds ratio: 9.54, 95 % CI (2.03–44.73)], and no schooling of mother [adjusted odds ratio: 2.09, 95 % CI (1.07–4.11)] were significantly associated with an increased likelihood of neonatal mortality after adjusting for other confounding variables. Qualitative findings suggested that bathing newborns after 24 h and wrapping in clean clothes were common newborn care practices. The mothers only attended postnatal care services if health problems appeared either in the mother or in the child.ConclusionResults of this study suggest that the current community based newborn survival intervention should provide an even greater focus to essential newborn care practices, low birth weight newborns, and female education.

The influence of the Great East Japan Earthquake on tuberculosis control in Japan.

WPSAR Vol 6, No 4, 2015 | doi: 10.5365/wpsar.2015.6.2.009 www.wpro.who.int/wpsar 30 a Nishinari District Public Health Offi ce, Osaka City, Japan. b The Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan. Submitted: 4 June 2015; Published: 21 December 2015 doi: 10.5365/wpsar.2015.6.2.009 The Great East Japan Earthquake and subsequent tsunami hit the Pacific Ocean side of north-eastern Japan on 11 March 2011,1 resulting in more than 18 000 deaths and missing people in three prefectures: Iwate, Miyagi and Fukushima.2 Of those deaths, 65% were aged 60 years and older, and more than 90% were caused by drowning.3 The earthquake also destroyed nuclear power plants in Fukushima, causing high levels of radioactive contamination.4 As a result, there were 386 739 evacuees staying in 2182 temporary shelters such as community centres, schools and gymnasiums one week after the disaster.5

Managing Hepatitis Outbreak in Biratnagar Nepal

This is a review article on jaundice outbreak occurred in <i>Biratnagar</i> during April-July 2014. The study reviewed the reports on hepatitis outbreak presented by District Public Health Officer Morang during a seminar organized by Nepal Health Research Council (NHRC), District Disaster Management Committee (DDMC) meetings and HMIS (Health Management Information System) database. District Public Health Office (DPHO) recorded 2,789 Jaundice patients in Morang district including <i>Biratnagar</i> city. Most of the patients (80.67%) recorded from <i>Biratnagar</i>. In the outbreak sex ratio of female to male was 0.56:1. Hepatitis infection was highest among 15-29 age groups and noticed remarkable among 15 to 54 years age groups. District Disaster Management Committee declared the outbreak in <i>Biratnagar</i> on April 28 when 95 jaundice patients recorded in the hospitals. The number reached at peak level 176 patients on May 6 and the trend came downward to normal level on July 8, 2014. Total 12 deaths recorded in the outbreak. Of them 8 deaths recorded from <i>Biratnagar</i>, 3 deaths from <i>Morang</i> district and 1 death from <i>Saptari</i> district. In <i>Biratnagar</i> ward No. 11 listed 5 deaths, ward No. 8 listed 2 deaths and ward No. 3 listed 1 death. Case fatality rate in the <i>Biratnagar</i> outbreak calculated as 0.43%. The causes of hepatitis infection were hepatitis viruses E and A. The transmission of infection in <i>Biratnagar</i> was due to sewage contamination through leaking pipes in water distribution. The level of community awareness on taking safe water observed in the <i>Biratnagar</i>. Before the outbreak, people used to drink tap water without treatment. After the outbreak, people changed their behavior to boil or filter water to drink in houses. Many people started to purchase mineral water in jars and bottles from the market. However, government water supply system in <i>Biratnagar</i> is poor which demands an upgrade to meet WHO standard of drinking water.

Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations.

IntroductionNew York City Article 47 regulations, implemented in 2007, require licensed child care centers to improve the nutrition, physical activity, and television-viewing behaviors of enrolled children. To supplement an evaluation of the Article 47 regulations, we conducted an exploratory ecologic study to examine changes in childhood obesity prevalence among low-income preschool children enrolled in the Nutrition Program for Women, Infants, and Children (WIC) in New York City neighborhoods with or without a district public health office. We conducted the study 3 years before (from 2004 through 2006) and after (from 2008 through 2010) the implementation of the regulations in 2007.MethodsWe used an ecologic, time-trend analysis to compare 3-year cumulative obesity prevalence among WIC-enrolled preschool children during 2004 to 2006 and 2008 to 2010. Outcome data were obtained from the New York State component of the Centers for Disease Control and Prevention’s Pediatric Nutrition Surveillance System.ResultsEarly childhood obesity prevalence declined in all study neighborhoods from 2004–2006 to 2008–2010. The greatest decline occurred in Manhattan high-risk neighborhoods where obesity prevalence decreased from 18.6% in 2004–2006 to 15.3% in 2008–2010. The results showed a narrowing of the gap in obesity prevalence between high-risk and low-risk neighborhoods in Manhattan and the Bronx, but not in Brooklyn.ConclusionThe reductions in early childhood obesity prevalence in some high-risk and low-risk neighborhoods in New York City suggest that progress was made in reducing health disparities during the years just before and after implementation of the 2007 regulations. Future research should consider the built environment and markers of differential exposure to known interventions and policies related to childhood obesity prevention.

Network in Promoting Health Literacy: A Case Study of a School under the Local Administration in Thailand

This research aims to lay a foundation in health literacy for well-informed and inquiring citizens through schooland community networks. A municipal school in Phon district, Khon Kaen province in Thailand was recruited asa case study. The research was a participatory action research. Participants were students, school teachers,administrator, the Mayor of the city, district public health officers, police officers, and parents. Two networkswere established; a strategic network and a procedure network. The strategic network was centered on theoutside organizations, namely the municipality office, district public health office, police station, communityorganizations, and parents. The procedure network was the collaborative work between higher education instituteand school. The two networks also worked collaboratively in order to enhance the promotion of health literacy inthe school. The research instruments included field notes, teachers’ portfolio and lesson plans, interviewing data,and a record of After Action Reflection. The two-year programme revealed that: 1) teachers showed strongcommitment to the continuous promotion of health literacy in school; 2) participating organizations turned out tobe a permanent network with school, and; 3) the concept of health literacy extended throughout the community,from students to their families. The parents and community members showed an awareness and interest inpromoting health literacy practices.

Cholera: Small outbreak in winter season of Eastern Nepal

Dear Editor, The global resurgence of cholera is becoming an increasingly important public-health challenge as the number of countries affected by this infection continues to increase.[1] The current cause of the global cholera pandemic, Vibrio cholerae O1 El Tor (including hybrid strains), has replaced classical biotype organisms around the globe, is associated with prolonged cholera outbreaks, is able to persist in aquatic reservoirs and cause endemic disease, is increasingly resistant to antimicrobials, and is associated with high case-fatality rates.[2] The first report of cholera was officially published in the years 1958-1960 in Kathmandu by a medical doctor visiting Nepal.[3] Other reports of cholera outbreaks in Nepal have been reported in literatures.[3–5] In year 2007, more than 50,000 people of the 54 Village Development Committee (VDC) s in the Saptari district of Eastern Nepal had been in effect of the diarrhea with death toll to 25.[6] After 4 years (November, 2011) in the same district, two people from Tilathi village lost their lives due to diarrheal illness. Upon the request of Ministry of Health, Nepal, a rapid response team comprising of microbiologists and epidemiologists from B.P Koirala Institute of Health Sciences was sent to elucidate the cause of the recent small outbreak of diarrheal illness. After a focus group discussion with the locals of affected village in presence of officials of District Public Health Office, Saptari, clinical and water samples were collected systematically from three wards with active cases of diarrheal illness. Five clinical samples from symptomatic individuals without any antibiotic administration and four water samples (pond and underground) were collected, transported, and investigated microbiologically following Centers for Disease Control Guidelines.[7,8] The causative agent of diarrheal illness was found to be V. cholerae, [O1: El Tor] Ogawa serotype, in three clinical and water samples each. Phenotypically, the isolates from the water samples (pond) were identical to the samples isolated from the patients. This finding suggests that the clinical isolates probably disseminated from pond water. The absence of organism in underground water keeps it safe from pathogenic organisms. In contrast to cotrimoxazole, nalidixic acid, and furazolidone; chloramphenicol and ceftriaxone are sensitive in all the isolates as depicted in Table 1. Ofloxacin, ampicillin, tetracycline, and ciprofloxacin are in decreasing order of susceptibilities. Similarity in the antibiogram among isolates A from clinical sample and E from water sample suggests the presence of same strain in both the samples, reflecting that the same strain of organism can persist in both water and humans. Dissimilar antibiogram among isolates from clinical sample suggests that the different circulating strains were responsible in causing this small outbreak. Dissimilar antibiotic sensitivity pattern among clinical isolates and environmental isolates may have been influenced by host factor, microorganism factor, and environmental factor. Extensive characterization of these strains would definitely bring some conclusion on factors responsible for genotypic variation of isolates within the same epidemic and its probable role in bacterial virulence. Table 1 Antimicrobial susceptibility pattern of Vibrio cholera isolates The villagers had recently celebrated one of their important festivals, chhath; the rituals of which are performed in ponds. Open defecation habit and use of pond water as a major source of water for drinking, cooking, and bathing had a foremost role in the cholera outbreak. The people seemed to be aware of the spread of diarrheal illnesses but were not motivated to use their toilets indeed. Numerous studies have shown that V. cholerae belong to a group of organisms whose major habitats are aquatic ecosystems, and the role of water sources in the spread of cholera has been well documented with a suggestion that environmental concentration of Vibrio species might increase in response to zooplankton or phytoplankton blooms driven by global or local aquatic conditions.[9] Three-dimensional biofilm on surfaces of V. cholerae O1 El Tor and O139 facilitates its persistence within natural aquatic habitats during interepidemic periods,[10] which might be the reason in current case too. This report of a small cholera outbreak occurred in non-summer season. From an applied perspective, clarifying the mechanisms that link seasonal environmental changes to diseases’ dynamics will aid in developing strategies for controlling diseases and improving disease forecast across a range of human and natural systems. We would like to recommend that exploration of presence of these organisms along the year and their molecular epidemiological typing would definitely benefit in tracing the method of spread of cholera in the area. This would also review the role of environmental factors responsible for cholera spread. We would like to acknowledge the support of Prof. SK Bhattacharya, Dr. Rajendra Gurung, Dr. Nimesh Poudyal, Dr. Ratna Baral, Dr. Narayan Raj Bhattarai, and Mr. Tejndra Pandit for their immense support and encouragement. We are greatful to officers of District Public Health Office, Rajbiraj, Nepal.

Surface water quality in Kenya’s urban environment: Githurai Case Study

Safe, clean drinking water and sanitation facilities are key to economic development and public health in Kenya. Rapid urbanization and population growth mean worsening conditions for millions of Kenyans, especially the poorest. Sanitation is one of the greatest problems especially in the informal settlements where 60% of the people in the urban centers reside. In fact, 50% of all preventable illnesses in Kenya are related to water, sanitation and hygiene. This study was done to establish the level of indicator water quality parameters, and establish water borne disease prevalence in Githurai and adjacent communities. Water samples were collected from 6 points distributed uniformly along Kiu River in Githurai. Using standard methods, the samples were analyzed for Dissolved Oxygen (DO), BOD, TSS and TDS in the JKUAT environmental laboratory. A survey was also done in Githurai, Kahawa Sukari and Kahawa Wendani to establish the prevalence of water borne diseases. Data was collected from local medical clinics and Ruiru District Public Health Office. Randomly selected individuals were also interviewed to establish the frequency of visits to health facilities. The study revealed that dissolved oxygen in surface water was between 1.5 and 8.5 mg/L while biochemical oxygen demand (BOD) was between 200 and 400 mg/L. This was much higher than NEMA standards which demands that the BOD of any effluents to be discharged into the environment should be less than 30 mg/L. Total suspended solids (TSS) varied from 900 to 950 mg/L. NEMA allows domestic water not to have TSS of more than 30 mg/L. Total dissolved solids (TDS) were in the range of 3000 to 9000 mg/L compared to a maximum of 1200 mg/L which is allowed by NEMA. Surface water in Githurai is highly polluted and poses public health risks. Some 30-40% of all patients visiting hospitals in the study area suffered from diarrheal diseases and the average resident in Githurai was treated for water borne diseases once every three months. Therefore, an urgent intervention is required to clean up Kiu River and stop further contamination of the river.