Inadequate Sanitation Facilities Research Articles

Recurrence of cholera epidemics in South Africa: inadequate sanitary facilities, poor environmental monitoring practices, and climate change as possible contributing factors

Cholera is an acute infectious disease caused by two toxin-producing strains, namely Vibrio cholerae O1, and Vibrio cholerae O139. Its recorded history stretches as far back as 1817, in Bengal, India, yet it continues to be a public health threat to this present day. Although cholera epidemics are now a relatively rare phenomenon in developed countries, frequent epidemics continue to be experienced in sub-Saharan Africa. Africa accounted for 63.33% of the 223 370 cases of and 4 159 deaths from cholera that were reported globally in 2020. Furthermore, of the 342 900 cholera cases and 3 304 cholera deaths reported globally in 2022, 40.28% of the cases and 77.85% of the deaths were in Africa. Inadequate sanitation infrastructure as well as inadequate provision of quality, safe drinking water in South Africa still creates conducive conditions for the transmission of cholera. In addition, climate change is increasingly becoming a risk factor towards the spread of V. cholerae pathogens in inland regions. To make recommendations on how South Africa, and potentially the Southern African region as a whole, can minimise the resurgence of cholera, this review addressed the following questions: Does South Africa have adequate sanitation infrastructure to curb the spread of cholera? Is there enough intentional surveillance of environmental water sources for vibrios as a cholera outbreak predictive tool? What is the impact of climate change on the resurgence of cholera in South Africa? And, what needs to be done to curb the resurgence of cholera in South Africa?

Sanitation Control of Ferry Ports in Tanjung Harapan Harbor

Environmental sanitation is an activity to create healthy environmental conditions in the port area. Good sanitation conditions can prevent disease transmission. Sanitary conditions in the Port of Tanjung Harapan Selat Panjang are not good enough, characterized by rat catching which increases every year, poor drainage conditions, and inadequate sanitation facilities. The purpose of this study is to evaluate the management of sanitation at Tanjung Harapan Harbor in Selat Panjang to become input material to make it better in the future. This research uses a qualitative method with a system approach based on input, process and output where the data collected comes from interviews, observation and documentation and is analyzed using triangulation. Sanitary management of the Port of Tanjung Harapan Selat Panjang is managed by port management and supervised by the Port Health Office. Sanitary management at the Port of Tanjung Harapan Selat Panjang is already running but not optimal, there are still obstacles from the aspects of human resources, large financing and inadequate infrastructure such as the unavailability of TPS and WWTP for waste management. Port sanitation management must be maintained to prevent the development of disease vectors and transmission of various types of diseases. The need for good cooperation between the manager and the Port Health Office to create a healthy port.

Evaluation of Sanitation Technologies Across Sanitation Service Chain in Kericho Town, Kenya

In 2020, over half of the world's population resided in cities, with projections indicating that by 2050, this figure will rise to 70%. Providing adequate sanitation services in urban and peri-urban areas presents significant challenges due to the dense concentration of people, particularly in low- and middle-income countries. Poor sanitation practices in these areas can lead to the spread of diseases with high morbidity and mortality rates. The focus of the study was on Kericho town, Kenya, facing a notable sanitation challenge due to dilapidated sewer system and inadequate sanitation facilities . The aim of this study was to evaluate the safety of sanitation technologies used in Kericho Town. Descriptive study design was adopted. Data collection methods included surveys, interviews, and observations, with a sample size of 409 households. The findings revealed that 66.5% of the population relies on pit latrines with slabs, 13.69% use pour/manual flush systems, 11.49% have ventilated improved pit latrines, 8.07% employ automatic cistern flush, and a minimal 0.24% practice open defecation. 25% of population discharged waste directly into the sewerage system whereby 5% were considered safely managed. Additionally, 4% of waste from user interfaces was discharged directly into open ground or open drains. 2% of population used septic tanks connected to soak pits, whereas 6% of population used septic tanks connected to open ground. Sludge from septic tanks, comprising 20%, was delivered to the WWTP by exhausters for further treatment, of which only 20% underwent treatment, with the remainder released untreated into the environment. 49% of the population used lined pits, while 14% used unlined pits. Approximately 20% of faecal sludge from the pits was exhausted, with only 20% of it considered safely treated, and the remainder released into the environment. Notably, open defecation accounted for less than 1% based on the survey findings. Consequently, the current trend in faecal sludge management in Kericho Town posed potential health hazards to the community unless measures such as rehabilitating the existing wastewater treatment plant are implemented.

The level of implementation of water, sanitation, and hygiene (WASH) practices among the public basic schools in Ghana

ABSTRACT Water, sanitation and hygiene practices (WASH) have been a major challenge facing many basic schools in Ghana for many decades. The school authority have made a number of complaints to the Ghana government through the Ministry of Education in relation to the inadequate potable water, sanitation facilities and hygiene practices in basic schools which the government has remained silent on. The aim of this study was to assess the level of implementation of Water, sanitation and hygiene practices in basic schools in the Sunyani East Education Directorate. Both qualitative and quantitative data were collected using questionnaires and interviews. The results indicate that hygiene and sanitation facilities available in schools under study included urinals, toilets, handwashing materials and solid waste disposal facilities. It was revealed that wooden slap pit latrine toilet was present in all schools except Methodist school which has cemented slaps. There were absence of toilet rolls, tap facilities and hand washing soap in all schools visited. The pupils fetched water from neighbouring houses and used it. The study recommends that the Parent-Teacher Association, School Management Committee, District Education Directorate and Ghana Education Service should team up to provide these essential facilities to basic schools in Sunyani East.

Behavioral Predisposing Factors in Mothers of Toddlers Affecting the Risk of Stunting Among Toddlers in Dairi Regency

Stunting a significant public health issue worldwide, particularly in low- and middle-income countries where access to adequate nutrition and healthcare is limited. This condition affects not only physical growth but also cognitive development and well-being. The study aimed to explore the impact of maternal behavioral factors, including nutrition, breastfeeding practices, and health-seeking behaviors, on the risk of stunting among toddlers. Method It is a cross sectional study with retrospective case control approach. A total of 120 mothers who had toddlers aged 6-24 months involved recruited from Puskesmas Pegagan Julu, Dairi District. Variables collected were knowledge, attitude and action of mothers, weight, height, age of children and exclusive breastfeeding consumption. Analyzed was performed through bivariate and multivariate logistic regression. Results a total 28.60% of toddlers were stunted, with significant links found between maternal nutritional knowledge (OR = 0.45, p < 0.05), exclusive breastfeeding for six months (OR = 0.60, p < 0.05), and regular health-seeking behavior (OR = 0.32, p < 0.01), and reduced stunting risk. Conversely, inadequate sanitation facilities were associated with increased stunting prevalence (OR = 2.76, p < 0.01).

Water Stress: Between Farmers' Needs and Public Policies the Case of Smallholder Farmers in the Villages of Nabatieh Governorate

Water scarcity is a paramount developmental and livelihood issue globally, posing life-threatening challenges in the Arab world and the Eastern Mediterranean. This scarcity manifests in two forms: physical scarcity, due to insufficient water resulting from local environmental conditions, and economic scarcity, characterized by inadequate water infrastructure. When these forms of scarcity converge, they lead to severe water stress, exemplified by regions experiencing both low rainfall and inadequate water storage and sanitation facilities. In Lebanon, state policies, or the lack thereof, have significantly exacerbated water scarcity. Governmental negligence and mismanagement of water resources, compounded by insufficient investment in infrastructure, have intensified both physical and economic water scarcities. The lack of effective water conservation policies, poor maintenance of existing water facilities, and failure to develop new water projects have led to severe water stress, hindering developmental progress and threatening the livelihoods and health of the population. The combined effect of environmental challenges and governmental inaction has made water scarcity a critical issue, necessitating immediate and comprehensive interventions to ensure sustainable water management and availability for the future.

Integrated public health and migration policy: Crafting effective responses to migrant crises

The intersection of public health and migration policy presents complex challenges in the context of migrant crises. This abstract provides an overview of the policy analysis on integrated public health and migration policy, focusing on the crafting of effective responses to migrant crises. By examining key findings and implications, it highlights the critical importance of addressing public health needs within migration policy frameworks. The analysis reveals that migrant crises often exacerbate existing public health vulnerabilities, including limited access to healthcare, inadequate sanitation facilities, and heightened risks of infectious diseases. Integrated approaches that prioritize the health needs of migrants are essential for mitigating these challenges and ensuring the well-being of both migrant populations and host communities. Key findings underscore the importance of adopting a comprehensive and rights-based approach to addressing public health in migration policy. This involves recognizing migrants' right to health and ensuring equitable access to healthcare services, regardless of legal status or nationality. Furthermore, it requires addressing the social determinants of health, such as poverty, discrimination, and social exclusion, which disproportionately affect migrant populations. Implications for future research and policy development include the need for greater collaboration and coordination among stakeholders, including government agencies, civil society organizations, and international partners. Research gaps identified underscore the importance of further investigation into the health needs of specific migrant groups, such as refugees, asylum seekers, and undocumented migrants, as well as the effectiveness of different policy interventions in meeting these needs. In conclusion, integrated public health and migration policy is essential for crafting effective responses to migrant crises. By prioritizing the health needs of migrants and adopting a rights-based approach, policymakers can mitigate the negative health impacts of migration and promote the well-being of all individuals affected by migrant crises. This abstract highlights the urgency of addressing public health within migration policy frameworks and calls for greater commitment to integrated approaches that prioritize health equity and human rights.

Research on the Implementation Plan of Urban and Rural Sanitation Integration in County Towns in China

This paper deeply discusses the implementation plan of the integration of urban and rural sanitation in county towns in China. First of all, the main problems facing urban and rural sanitation in the county are analyzed, including inadequate sanitation facilities, scattered management and low efficiency of resource utilization. Then, it puts forward the necessity and importance of urban and rural sanitation integration, pointing out that it helps to improve the county's environmental health level, promote resource conservation and recycling, and promote the coordinated development of urban and rural areas. In the implementation of the program, this paper puts forward a series of concrete measures. It includes strengthening the construction of sanitation infrastructure, improving the system of garbage collection, transfer and treatment; Promoting the reform of the environmental sanitation management system to realize the unification and coordination of urban and rural sanitation management; Strengthen environmental sanitation technology innovation and personnel training, improve the quality and efficiency of environmental sanitation services; At the same time, pay attention to the combination of policy guidance and market mechanism to attract social capital to participate in the cause of environmental sanitation. Through this study, the aim is to provide a scientific implementation plan and reference for the integration of urban and rural environmental sanitation in the county, and promote the healthy development of environmental health undertakings in the county.

The Environmental Health Risk Analysis regarding Hepatitis A Transmission among Street Food Vendor in Indonesia

This study aimed to conduct hazard identification and risk assessment for the transmission of hepatitis A among street food vendors (SFVs), whereas risk management was generated. This observational analytic study was conducted in Jember Regency - Indonesia. Cluster random sampling was employed, wherein five distinct locus were selected representing SFVs in campus area and local market area. A total of 100 SFVs in Jember participated in this study. Data was collected using a questionnaire. The risk assessment was measured by multiplying the likelihood and consequence. Additionally, the data was subjected to descriptive analysis. This study found the identification of hazards among SFVs was found inadequate sanitation facilities, poor food processing practice (improper handling of raw ,- cooked ingredients, and poor food serving), limited availability of clean water,substandard building and layout were observed as potential hazards for the transmission of hepatitis A. The risk assessment found inadequate sanitation facilities (18 point), negative attitude (18 point), poor quality assurance (16 point), and food contamination (14 point) have high scores. The risk management including: a) location and building: providing specific location, and maintaining cleanliness of the furniture and equipment on a regular basis, b) sanitation facility: provision of sanitary waste bin, communal toilet and wastewater drainage system; fly control measures, and using piped water supply, c) food processing: increasing food handler personal hygiene, and standard food handling process.In conclusion, the risk of Hepatitis A transmission among street vendors remains high and poses a threat in Jember, indicating the need for health education for the street vendors. Additionally, the author recommends policymakers to implement regular monitoring or inspection of the food quality and the necessity of providing clean water facilities or other fundamental facilities to SFVs.

Assessment of Informal Settlement in Central Kandahar: A Case Study of Area Within Four Historic Gateways

Afghanistan's post-war recovery, commencing in 2001 following the cessation of hostilities, precipitated rapid urbanization, notably witnessed by a substantial proliferation of informal settlements, primarily concentrated in Kandahar Province. This phenomenon, exacerbated by significant rural-to-urban migration and population expansion, has emphasized the imperative for exhaustive research aimed at comprehensively understanding its definitions, associated types and potential impacts of informal settlement. The proliferation of informal settlements in Kandahar's historic gateways presents a complex challenge necessitating meticulous and nuanced analysis. The research endeavors to undertake a comprehensive exploration of the definitional constructs of informal settlements, encompassing diverse typologies and their ramifications on urban settings. Central to this endeavor are key objectives aimed at scrutinizing squatter settlements, discerning their typologies, including Spontaneous Sheltering, Homeless Encampments, Nomadic Tents, Refugee Camps, Carts and Wagons, Squatter Settlements, Slums, Self-Help Housing, Shantytowns, Informal Subdivisions and Tenement Housing. Furthermore, the research aims to assess the effects associated with informal supplementary settlements, which encompass a broad spectrum of socioeconomic and environmental ramifications, such as Overcrowding, Poor Living Conditions, High Levels of Poverty, Limited Basic Services, Social Marginalization, Health Risks, Inadequate Sanitation Facilities and Vulnerability. Employing a mixed-methods approach integrating field observations, surveys, Case Studies and literature review, the research seeks to comprehensively understand the complexities of informal settlement dynamics, thus providing insights for informed policy formulation and interventions in urban planning.

Human-animal entanglements in bushmeat trading in Sierra Leone: An ethnographic assessment of a potential zoonotic interface.

'Bushmeat' markets are often portrayed as chaotic spaces where exotic wild animals are sold. They are hypothesized to be important sites for zoonotic disease transmission, given the prolonged and intense nature of the cross-species encounters that occur within them. Whilst such markets have received some attention from researchers, rich qualitative descriptions of everyday practices in these markets are rare. Depictions of wild animal markets as sites for potential viral amplification often rely on exoticizing assumptions and narratives rather than actual evidence, and in some cases are based more on ideology than on science. We provide an in-depth ethnographic account of two bushmeat markets in Bo, Sierra Leone. Our analysis goes beyond common assumptions that zoonotic risk is located solely in the knowledge and behaviours of traders. Our account sheds light on the modes of touch, closeness and contact that shape this hypothesised zoonotic interface, outlining the possible risks to different people who use and spend time in the market. We found that inadequate infrastructure and sanitation facilities created risks of zoonotic disease transmission for diverse actors including traders, customers, children, and the wider public. Butchering and trading practices frequently resulted in people directly and indirectly encountering animal fluids. We also discuss how public health management of these markets focused on individual behaviours rather than on improving conditions. Urgent sanitary reform and infrastructure upgrades in these sites that support the economic needs of traders could encourage voluntary compliance with biosafety measures amongst traders seeking to balance responsibilities to family and public health. Our study reveals the value of moving beyond exoticized narratives about bushmeat markets to yield situated insights for reducing risk at this interface.

Is Africa Ready to Use Phycoremediation to Treat Domestic Wastewater as an Alternative Natural Base Solution? A Case Study

This review outlines the potential of phycoremediation as a natural, cost-effective solution for domestic wastewater treatment in Africa, particularly focusing on its application in less densely populated and rural areas. The urgency of improving sanitation access, a key objective in both the Millennium Development Goals (2000–2015) and the Sustainable Development Goals (2015–2030), is underscored by the fact that half of Africa’s population suffers from diseases linked to inadequate water and sanitation facilities. South Africa, a focal point of this study, faces significant challenges in wastewater management. These include the limited capacity of wastewater treatment plants to handle the burgeoning wastewater volumes due to population growth, unregulated discharges causing fluctuating pollution levels, and high operational costs leading to improper sludge disposal and odor issues. Compounding these problems are frequent power outages, financial constraints impacting wastewater treatment plant operations and maintenance across Africa, and a lack of skilled personnel to manage these facilities.

A qualitative study on menstrual health and hygiene management among adolescent schoolgirls in peri-urban Lusaka, Zambia

Abstract Menstrual Health and Hygiene (MHH) require adequate sanitary facilities, clean water, product access, privacy and safety, and disposal. MHH can significantly influence girls' health and educational achievements. However, schools in some developing countries lack proper Water, Sanitation and Hygiene (WASH) amenities to manage healthy menstruation. Therefore, it is crucial to enhance WASH services to tackle menstrual-related difficulties effectively. Zambian government schools struggle with insufficient WASH infrastructures. Hence, it is imperative to reveal the status of WASH services for policy progress and to promote girls' optimal menstrual health. We conducted observations and a qualitative study to evaluate the school's WASH facilities, investigate the sociocultural factors impacting MHH, and examine coping mechanisms to manage menstruation. Thirty adolescent schoolgirls, aged 14–19, residing in Lusaka peri-urban areas, participated in five focus group discussions. Insufficient school security, inadequate sanitary facilities, absence of clean water, and limited access to menstrual materials presented notable challenges. Culturally, there was an expectation for girls to swiftly embrace womanhood despite being unprepared for the natural biological process it entailed. Girls formulated strategies for managing challenges associated with MHH. The fundamental needs of menstruating girls include a sufficient supply of menstrual materials, improved WASH services, increased safety, and enhanced privacy.

Estimation of the Parasitic Burden of Soil-Transmitted Helminths Among Pregnant Women in the Maharashtra State of India Using qPCR: A Community-Based Study.

Soil-transmitted helminth (STH) infections are widespread in developing countries with inadequate sanitation facilities. These infections can lead to malnutrition, anemia, and other complications that can negatively impact both the mother's and fetus's health during pregnancy. This study aimed to estimate the burden of STH by Kato-Katz microscopy and quantitative polymerase chain reaction (qPCR) in pregnant women from rural India. The diagnostic accuracy of these two methods was also compared. A community-based cross-sectional study was conducted in rural areas of Wardha district of Maharashtra state. We randomly selected and interviewed 688 pregnant women. A total of 534 (77.61%) participants gave stool samples. Two containers (60 mL) labeled with a unique identification number were given to pregnant women to collect stool samples for Kato-Katz microscopy and qPCR. Stool specimens were transported to an accredited lab and examined within 24 hours. Suitable examinations were conducted to compare sensitivity between two tests. The results are presented for 534 participants who gave stool samples. The prevalence of any STH by Kato-Katz stool microscopy was 6.55% (95%CI 4.46-12.19), and that by qPCR was 20.41 (95%CI 17.53-29.40). The sensitivity of Kato-Katz microscopy was 29.17% compared to sensitivity of 90.83% by qPCR (P = 0.001). Pregnant women with STH infection have a significantly lower weight gain during pregnancy, and the majority were either mild or moderate anemic compared to those without STH. The study highlighted significant differences in prevalence of STH among pregnant women by Kato-Katz microscopy and qPCR. The sensitivity of qPCR for detecting STH was higher than that of Kato-Katz microscopy.

A pilot survey of students' menstrual attitudes, experiences, and needs on an urban university campus.

In the United States, many menstruators face barriers to period management, such as period poverty, or the lack of access to relevant knowledge and affordable menstrual products. Our current understanding of the social, emotional, and physical impacts of period poverty on students in post-secondary institutions is largely limited. The purpose of this pilot study is to assess period poverty, period-related class disruption, and avoidance of menstrual hygiene management on campus among students and to identify recommendations for action at the University of Illinois Chicago and other urban universities. An online cross-sectional study from February to May 2023. Enrolled students who were at least 18 years old completed an anonymous, self-administered online survey. Through descriptive statistics and chi-square tests in SAS version 9.4, we analyzed the sociodemographic, academic, and menstrual characteristics of those who had a period in the past 12 months. We also performed a thematic analysis of students' open-ended responses regarding their menstrual experiences on campus. Of our sample (N = 106), 17.1% of students have faced period poverty, 55.8% experienced period-related class disruption, and 47.5% avoided changing their menstrual products on campus. The relationships between the three menstrual experiences were statistically significant. In the open responses, students reported that their personal experiences with menstruation were largely painful and disruptive. We identified the following themes: (1) inadequate water, sanitation, and hygiene facilities; (2) understocked, empty, or non-existent menstrual product dispensers; (3) a desire for additional resources for menstruation; and (4) the unpredictability of menstruation. Our findings indicate that students continue to face obstacles to menstruation management due to inadequate support related to menstrual infrastructure, products, and pain. We outline several recommendations for university/college institutions to prioritize a more inclusive and supportive educational environment for all students.

Occupational hazards and risks among the women in fisher communities in Cox's Bazar and Chattogram, Bangladesh.

Women in the fisher communities in coastal regions of Bangladesh are engaged in a wide range of fishery activities. However, there is limited evidence available on the occupational hazards and risks experienced by them. The study was conducted among fishing colonies in Cox's Bazar and Chattogram districts in Bangladesh. This was a cross-sectional study blending qualitative and quantitative approaches. The qualitative component comprised five focus group discussions to understand the occupational context, hazards, and risks faced by the fisherwomen, informing the questionnaire design for the subsequent survey. The quantitative survey involved a sample of 207 women from fisher communities, gathering socio-demographic information, occupational hazards, risks, and health and safety practices. The study found a high occurrence of occupational hazards, health risks and limited availability of preventive measures among the women in fisher communities. Occupational hazards include physical safety hazards such as slippery surfaces and fish cutting instruments, and physical hazards like prolonged sun exposure and noise. Chemical hazards like pesticides and saltwater, ergonomic hazards such as prolonged uncomfortable posture and heavy lifting, and biological hazards including inadequate sanitation facilities were prevalent. The study also identified the potential occupational risks, and the outcomes resulting from the hazards, including injuries (87.44%), musculoskeletal conditions (69.08%), skin diseases/conditions (56.52%), eye complaints (33.82%), severe respiratory distress (24.15%) and high incidence of self-reported communicable diseases. Most women (78.26%) did not use personal protective equipment, and the majority (93.72%) lacked a workplace first aid kit. The study revealed a high prevalence of occupational hazards and health risks, including injuries and diseases, among Bangladeshi women in fisher communities with insufficient safety measures. Collaboration among government, NGOs, development partners, fisheries stakeholders, and the community is imperative for targeted training, innovative procedures, ergonomic solutions, provision of protective equipment, and advocacy to enhance the well-being of these women.

Escherichia coli in Food and Hands of Handlers in Catering service Group A1 and A2

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p class="Default"><em>Food hygiene was a controlling factor for food contamination that can cause foodborne diseases such as diphtheria, diarrhea, typhoid, and food poisoning. Several types of microbes that can cause food poisoning, one of which is Escherichia Coli. The purpose of this study was to analyze the relationship between personal hygiene, food hygiene, sanitation facilities, with Escherichia Coli food and hands of handlers in catering services of groups A1 and A2. This research method uses Cross Sectional study, sampling techniques in research using Accidental Sampling in catering service groups A1 and A2 in the Banyudono District. This research was carried out from May to June 2022, the research location was in catering service in the Banyudono district area. This sample in this study was 25 food handlers.The data analysis was done by Chi Square test. The results showed that the handlers had good personal hygiene by 52%, good food hygiene 72%, inadequate sanitation facilities 52%, Escherichia coli in food 56%, and Escherichia coli in hands 84%. There was no relationship between personal hygiene (p-value = 0.302) and food hygiene (p-value = 0.177) with the content of Escherichia coli in food. There was a relationship between sanitation facilities (p-value = 0.000) and the content of Escherichia coli in food. There was no relationship between personal hygiene (p-value = 0.096), food hygiene (p-value = 0.548) and sanitation facilities (p-value = 0.322) with Escherichia Coli on hands. Food service handlers already have personal hygiene and apply good food hygiene, but Escherichia coli is still found in the food and handlers hands. Sanitation facilities still do not meet the requirements, so it is necessary to utilize available sanitation facilities to reduce Escherichia coli contamination. </em></p></td></tr></tbody></table></div><strong><em>Keyword: Personal hygiene, Hygiene, Sanitation, </em> <em>Escherichia coli</em></strong>

International law for public health in aviation: the challenges of harmonisation

International laws for commercial aviation have achieved an exceptional degree of harmonisation and greatly improved passenger safety. Yet, despite much international guidance, enforceable laws for public health protection in aviation are mainly the responsibility of national authorities. As a result, public health laws may be incoherent, in conflict with other countries and/or based on disputed scientific evidence. The COVID-19 pandemic has highlighted the responsibility of airlines and regulatory authorities to protect not only air passengers but also populations in destination countries. While the greatest risk to global public health is the potential spread of disease by infected passengers or vectors, lesser-known risks include food contamination, inadequate sanitary facilities and poor air quality within the cabin. In preparedness for inevitable future disease outbreaks and pandemics, an urgent review of international law as it applies to public health in commercial aviation is needed, with greater investment in scientific research to enable more accurate and effective risk assessment and management, supported by enforceable laws and clear responsibility.

Microsporidial keratoconjunctivitis - first outbreak in Japan.

Most cases of microsporidial keratoconjunctivitis are found in the Southern hemisphere. Our purpose was to investigate the first outbreak of microsporidial keratoconjunctivitis in Japan among healthy, immunocompetent soccer players from the same team during a 1-month period. This study is an observational case series. The medical records were analyzed for five cases with microsporidial keratoconjunctivitis who presented within September 2022. All five cases were males between 28 and 36 years old. These previously healthy individuals belonged to the same football team. Their eyes were considered susceptible to contaminated water or dirt from the turf at game and practice sites. All cases involved unilateral conjunctivitis, with scattered round white lesions that showed positive fluorescein staining in the corneal epithelium. All cases experienced diminution of vision in the affected eye. In three cases, direct smears showed spores of approximately 2-3μm in diameter. Polymerase chain reaction (PCR) analysis of corneal scrapes revealed partial amplification of microsporidial 18S ribosomal RNA gene in four cases. Sequences of PCR products from all four cases showed 100% identity with strains of Vittaforma corneae previously reported from an outbreak in Singapore. All cases were treated with topical therapy, including voriconazole, fluorometholone, and levofloxacin. Four eyes underwent corneal scraping. After treatment, all eyes healed without residual opacities. Only a few sporadic case reports of this disease have previously been reported in Japan. We detected V. corneae in our case series, representing what appears to be the first outbreak of microsporidial keratoconjunctivitis in Japan. Exposure to contaminated water or soil, in addition to inadequate sanitary facilities, represents a potential source of infection. Further investigations to clarify the characteristics of microsporidia seem warranted.

The status of water access, sanitation, and hygiene in schools: A cross sectional survey to identify capacities and assess coverage in Garoua, North Cameroon

There has been an increasing global interest in understanding, documenting, and monitoring water, sanitation, and hygiene (WASH) services in schools. This study is the first to identify existing WASH-in-school capacities and understand the magnitude of the gaps in WASH coverage in schools in the Northern Cameroon, a region of the country marked by recurrent sanitary emergencies, the highest prevalence of acute malnutrition, and representing the largest and heaviest focus of food and water insecurity. Using a cross-sectional design, relevant authorities of 176 schools in Garoua, were interviewed. The survey guide included core questions for monitoring WASH in schools from recommended guidelines. Eleven indicators-related variables were extracted from data to calculate the WASH-in-school indicators composite score, which could be used as a more reliable and useful tool for comparison across settings and can contribute to harmonize data with WASH in schools related indicators applied in national surveys. The results of this research showed suboptimal drinking water supply systems and sanitation facilities whereas most schools had hand washing points available. However, activities that aimed to promote and sustain a WASH positive environment among children still need to be put in place. The WASH-in-school indicators composite score predictive value corroborated the disparities related to WASH access in schools located in Garoua. This score hence provides an assessment of the spatial dimensions of reduced access to water in schools, improper hygiene practices, and inadequate sanitation facilities. Such a score could be used to identify hotspots lacking WASH infrastructural facilities and strategize optimal interventions to reduce the incidence of WASH related diseases in schools.