Incidence Of Diarrheal Disease Research Articles

Cholera and diarrheal diseases in Cuamba District, Niassa Province, Mozambique: Systematic healthcare facility-based surveillance strengthening, characteristics of suspected cholera and diarrheal patients, and incidence of diarrheal diseases.

Mozambique is one of the countries in Africa that is continuously at risk of cholera outbreaks due to poor sanitation, hygiene, and limited access to potable water in some districts. The Mozambique Cholera Prevention and Surveillance (MOCA) project was implemented in Cuamba District, Niassa Province to prevent and control cholera outbreaks through a preemptive cholera vaccination, strengthened surveillance system for cholera and diarrheal diseases, and better understanding of cholera-related healthcare seeking behavior of local populations, which may further guide the national cholera control and prevention strategies. This article presents the surveillance component of the MOCA project. A prospective healthcare facility (HCF)-based surveillance of cholera and diarrheal disease was conducted in six HCFs in the District of Cuamba from March 2019 to December 2020. A systematic surveillance procedure has been put in place with capacity building in selected sentinel HCFs and a basic microbiology laboratory established on-site. Patients presenting with suspected cholera or other diarrheal symptoms were eligible for enrollment. Clinical data and rectal swab samples were collected for laboratory confirmation of Vibrio Cholerae and other pathogens. A total of 419 eligible patients from six HCFs were enrolled. The median age was 19.8 years with a similar age distribution between sentinel sites. The majority were patients who exhibited diarrhea symptoms not suspected of cholera (88.8%; n = 410). Among those, 59.2% (210/397) were female and 59.9% (235/392) were 15 years and above. There were 2 cholera cases, coming outside of the catchment area. The incidence of diarrheal diseases ranged from 40-103 per 100,000 population. No Vibrio cholerae was isolated among surveillance catchment population and Escherichia coli spp. (82/277; 29.6%) was the most common pathogen isolated. Efforts were made to strengthen the systematic surveillance of suspected cholera with standardised patient screening, enrolment, and diagnostics. The first basic microbiology laboratory in Niassa Province established in Cuamba District under the MOCA project needs to be integrated into the national network of laboratories for sustainability. No reports of laboratory confirmed cholera cases from the surveillance catchment area may be highly related to the pre-emptive oral cholera vaccine (OCV) mass vaccination campaign conducted in 2018 and the use of drugs by local populations prior to visiting the sentinel HCFs. Continued systematic cholera surveillance is needed to closely monitor the cholera endemicity and epidemics, and further evaluate the long-term impact of this vaccination. High incidence of diarrheal illnesses needs to be addressed with improved water, sanitation, and hygiene (WaSH) conditions in Cuamba District. Efforts integrated with the prioritization of prevention measures are fundamental for the control of cholera in the country.

Effect of the Built Environment on the Cumulative Incidence of Acute Diarrheal Diseases: A Community-Based Cohort Study From Underprivileged Areas of Bhopal, India.

Background Diarrhea is a major public health problem in under-five children worldwide. Various sociodemographic, environmental, and behavioral factors play a role in the occurrence of diarrheal disease in children under the age of five. This study aims to estimate the cumulative incidence of acute diarrheal diseases during a one-year study period and examine its association with the built environment factors among children under the age of five in selected underprivileged areas of Bhopal. Methodology We conducted this study in Bhopal, a city in central India. We surveyed the underprivileged dwellers of Vajpayee Nagar, Sanjay Nagar, and Mother India Colony of Bhopal city. This is a prospective cohort study with a one-year follow-up period to examine the cumulative incidence of acute diarrheal diseases among under-five-year-old children in the study area. Data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results Data were collected from February 2021 to February 2022. A total of 658 families of eligible children were contacted to participate in the study. After excluding 38 participants for various reasons (denied consent: 3; lost to follow-up: 32; moved out of the study area: 3), data were finally analyzed for 620 participants. In the study among the under-five-year-old children, the cumulative incidence of acute diarrheal diseases was 23.8% (148 out of 620). In our study, lower age (adjusted odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.99, p = 0.041) and non-availability of flush latrine in the house (adjusted OR = 4.95, 95% CI = 1.80-13.59, p = 0.002) were statistically associated with a higher incidence of acute diarrheal disease among the study population. Conclusions In our investigation, we observed a cumulative incidence of diarrhea at 23.8% (148 out of 620) among the underprivileged under-five population residing in Bhopal, India. This incidence exhibited significant associations with younger age and the absence of in-house flush latrines.

Water as a social determinant of health: bringing policies into action

Water is one of the social determinants of health and a key factor towards improving health outcomes and inequalities. Access to safe and adequate water has been identified as an essential component for protecting, maintaining and promoting public health and reducing the total burden of diseases. Though India has made substantial progress in increasing access to safe drinking water in rural areas through household tap connections, there is a lack of contemporary evidence reflecting the progress achieved so far. A desk review of India’s schemes, programmes, and policies on access to drinking water was undertaken for review. Programme and policy documents from various central government websites such as the Ministry of Jal Shakti, Department of Drinking Water and Sanitation, Jal Jeevan Mission, and Central Water Commission websites were reviewed. The paper focuses on the recently launched Jal Jeevan Mission (JJM) in addressing the identified gaps of the former initiatives in rural areas. The broad vision of JJM also aims to reduce the incidence of acute diarrhoeal diseases. It was found that with the launch of JJM in 2019, tap water connections in rural households have increased from 16.69% (2019) to 62.79% (2023). The Government of India (GoI)’s commitment and citizen-centric approach to decentralised governance in providing safe drinking water to all is reflected in the financial allocations made under the JJM to states and fifteen finance commission (FC-XV) grants. The review highlights the need for intersectoral coordination across the levels to realise better results and health outcomes.

Evidence for long-term efficacy of a membrane filtration device in rural villages in Ghana

Drinking water contaminated by pathogenic micro-organisms increases the risk of infectious gastrointestinal disease which could potentially lead to acute kidney injury and even death, particularly amongst the young and the elderly. Earlier studies have shown a substantial reduction in the incidence of diarrheal disease over a period of one year using a polysulfone membrane water gravity-powered water filtration device. The current report is a continuation of these studies to assess the long-term effects of the innovative method on diarrheal incidence rates over a 4-year follow-up period. This follow-up study monitored the trend of self-reported diarrheal events in all households in the previously studied villages for 5 months, in the last half of each study year, using the same questionnaire utilized in the earlier study. Three villages that had no device yet installed served as controls. We computed monthly diarrheal incidence rates for all study years (standardized to per 100 person-months) and compared these to the pre-device incidence rate in 2018 and in the control group, using the Wilcoxon rank sum exact test. The average diarrheal incidence rates of 1.5 p100pm in 2019, 2.19 p100pm in 2021, and 0.54p100pm in 2022 were significantly different from an earlier study that reported 17.8 p100pm rates before the devices were installed in 2018, (all p-values < 0.05). Concomitantly, self-reported diarrheal infections were substantially higher in the “control villages” not yet having the filtration device installed (80.9, 77.6, and 21.5 per 100 pm). The consistent and large reduction in diarrhea incidence documents the long-term efficacy of the use of the membrane filtration device. This simple water purification method using gravity flow improves public health in remote regions with limited resources.

Impact of COVID-19-related nonpharmaceutical interventions on diarrheal diseases and zoonotic Salmonella

Non-pharmaceutical interventions (NPIs) have been proven effective in reducing the spread of the coronavirus disease 2019 (COVID-19), but their broader impact on gastrointestinal disorders remains poorly studied. Here, we report an observational analysis and retrospective study that compares the incidence of acute diarrheal diseases in Hangzhou, Zhejiang, China, between 2019 and 2020, with an examination of the antimicrobial resistance and genetic spectrum of non-typhoidal Salmonella (NTS) from 2015 to 2022, before and during the COVID-19 pandemic. Our findings underscore that NPIs related to COVID-19 effectively reduced the incidence of acute diarrhea, with a substantial decrease in most enteric pathogens. Notably, NTS exhibited an unexpected surge. Further genomic investigations of NTS isolates revealed an overall reduction in antimicrobial-resistant (AMR), disinfection-tolerant, and virulent capabilities, but with marked variations detected between human and animal isolates. Additional genome-based analysis confirmed a decrease in the scale of zoonotic transmission in response to NPIs, suggesting particular NTS types may contribute to human infections via alternative pathways. The collective findings manifested that COVID-19-related NPIs had a mixed impact on NTS infections, which may inform AMR NTS mitigation policy.

No Child's Play: Under-five Child Feces Management in a Rural Area of Bengaluru Urban District, India.

Inappropriate feces disposal leads to environmental contamination, and increases the risk of exposure to children. We aimed to estimate the proportion of rural households with knowledge and practice of safe management of feces (SMoF) among under-five children and to identify associated factors. A cross-sectional study was conducted in eight villages in Bengaluru Urban district over 2 months, using a face-validated semi-structured interview schedule. SMoF was defined based on five criteria - defecation site, transport tool, feces disposal, cleaning of transport tool, and hand washing. Out of 320 under-five children surveyed, 15.7% were pre-ambulatory and 84.3% were ambulatory. The majority of the caregivers (92.5%) felt that children should defecate in the latrine and only 23.7% were aware that child feces were more infectious than adult feces. SMoF was only practiced by caregivers of ambulatory children (52.6%). Households with older caregivers (P = 0.01) and those living in a pucca house (P = 0.02) with a latrine inside (P = 0.04) were found to practice SMoF. Children of households that practiced unsafe disposal of child feces experienced more diarrheal episodes (P = 0.04). Caregivers >20 years were found to have better odds of SMoF [20-25 years (adjusted odds ratio, aOR: 9.02), 26-30 years (aOR: 12.17), >30 years (aOR: 8.93)] compared to those <20 years. The proportion of households with knowledge and practice of SMoF was low. Awareness of SMoF is essential to reduce the incidence of diarrheal diseases and improve sanitation. Our findings also call for awareness building at schools and colleges.

The Correlation of Family Access to Clear Water with Diarrheal Disease Incidence in the Working Area of the Sumbersari Health Center, Jember Regency

Diarrhea is one of the digestive problems characterized by a decrease in fluid followed by a loss of electrolytes in the body; therefore, it requires further treatment so as not to cause more severe problems. The incidence of diarrheal disease can be influenced by optimal or inadequate access to clear water. This study aims to determine the relationship between family access to clear water and the incidence of diarrheal diseases in the working area of the Sumbersari Health Center, Jember Regency. This study was a non-experimental analytic research with a case-control design. The sample consisted of 140 participants in the case group and 140 participants in the control group, selected by the simple random sampling technique. Participants who met the inclusion and exclusion criteria were recruited into the study. Data collection tools included a demographic characteristics questionnaire, a questionnaire on clear water access, and a questionnaire about diarrhea disease incidence. Data analysis was performed using the Chi-square test (P&lt;0.05). The results showed that most of the respondents had optimal access to clear water (31.1% in the case group and 42.9% in the control group). Diarrhea sufferers were mostly in the early adult category (21.8%). Then, there is a significant relationship between family access to clear water and the incidence of diarrheal disease in the Sumbersari Public Health Center, Jember Regency (P&lt;0.001; OR: 0.274).

Risk Factors Affecting the Incidence of Diarrhea in Children Under Five Years Old in the Working Area of Tarus Public Health Center, Kupang District, in 2022

Diarrhea is a disorder of defecation characterized by defecation more than 3 times a day with the consistency of liquid stool, may be accompanied by blood. Until September 2022 Puskesmas Tarus had the highest incidence of diarrhea compared to other health centers with 126 cases of diarrhea in toddlers. The purpose of this study was to determine the risk factors associated with the incidence of diarrheal disease in children under five years of age in the working area of Puskesmas Tarus, Kupang Regency. This study was an analytic observational study using a case control study research design. This study was conducted in the working area of Puskesmas Tarus Kupang Regency in February-March 2023. The results showed a significant relationship between maternal knowledge (p=0.000; OR=3,974), maternal attitude (p=0.000; OR=4,594), hand washing behavior (p=0.000; OR=4,421), exclusive breastfeeding history (p=0.001; OR=3,632) and maternal education (p=0.023; OR=2,400) with the incidence of diarrhea in toddlers. There is no significant relationship between maternal employment status and the incidence of diarrhea in toddlers (p=0,114; OR=0,489). Conclusion, that the variables of maternal knowledge, maternal attitude. hand washing behavior, exclusive breastfeeding history and maternal education have a significant relationship with the incidence of diarrhea in toddlers, and the variable maternal employment status has no significant relationship with the incidence of diarrhea in toddlers in the working area of Puskesmas Tarus, Kupang Regency.

Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach

BackgroundThe climate of southern Africa is expected to become hotter and drier with more frequent severe droughts and the incidence of diarrhoea to increase. From 2015 to 2018, Cape Town, South Africa, experienced a severe drought which resulted in extreme water conservation efforts. We aimed to gain a more holistic understanding of the relationship between diarrhoea in young children and climate variability in a system stressed by water scarcity.MethodsUsing a mixed-methods approach, we explored diarrhoeal disease incidence in children under 5 years between 2010 to 2019 in Cape Town, primarily in the public health system through routinely collected diarrhoeal incidence and weather station data. We developed a negative binomial regression model to understand the relationship between temperature, precipitation, and relative humidity on incidence of diarrhoea with dehydration. We conducted in-depth interviews with stakeholders in the fields of health, environment, and human development on perceptions around diarrhoea and health-related interventions both prior to and over the drought, and analysed them through the framework method.ResultsFrom diarrhoeal incidence data, the diarrhoea with dehydration incidence decreased over the decade studied, e.g. reduction of 64.7% in 2019 [95% confidence interval (CI): 5.5–7.2%] compared to 2010, with no increase during the severe drought period. Over the hot dry diarrhoeal season (November to May), the monthly diarrhoea with dehydration incidence increased by 7.4% (95% CI: 4.5–10.3%) per 1 °C increase in temperature and 2.6% (95% CI: 1.7–3.5%) per 1% increase in relative humidity in the unlagged model. Stakeholder interviews found that extensive and sustained diarrhoeal interventions were perceived to be responsible for the overall reduction in diarrhoeal incidence and mortality over the prior decade. During the drought, as diarrhoeal interventions were maintained, the expected increase in incidence in the public health sector did not occur.ConclusionsWe found that that diarrhoeal incidence has decreased over the last decade and that incidence is strongly influenced by local temperature and humidity, particularly over the hot dry season. While climate change and extreme weather events especially stress systems supporting vulnerable populations such as young children, maintaining strong and consistent public health interventions helps to reduce negative health impacts.

The effect of a health extension program on improving water, sanitation, and hygiene practices in rural Ethiopia

BackgroundTo make basic primary health care services accessible, especially to the rural community, the government of Ethiopia launched the Health Extension Program (HEP) in 2004. Most of components of HEP are dedicated to hygiene and sanitation. Few studies have assessed the role of the Health Extension Program in improving water, hygiene, and sanitation (WASH) practices in Ethiopia. This study explored the role of health extension workers (HEWs) in influencing household water treatment practices, latrine ownership, latrine use and ownership, and the use of hand-washing facilities on the incidence of diarrheal diseases among the children under five years of age in rural Ethiopia.MethodsUsing a cross sectional design, we conducted a national assessment that covered all nine regions of Ethiopia. We conducted face-to-face interviews among a sample of 6430 rural households using a structured questionnaire and an observation checklist to collect data from March 2018 to May 2019. Multilevel logistic regressions models were used to determine the relationships between the exposure of households to HEWs and WASH practice outcomes such as the use of water from an improved water source, household water treatment practices, availability of hand-washing and hand-washing with soap and water, availability of latrines, and use of latrines as well as the incidence of diarrheal diseases among children age 5 and younger. Our models were adjusted for covariates and confounders and P-values less than 5% were set to determine statistical significance.ResultsWe found that 72.7% of rural households had some type of latrine and 27.3% reported practicing open defecation. A total of 71.5% of rural households had access to drinking water from improved water sources, but only 9.4% reported practicing household water treatment. Exposure to HEWs was positively associated with household water treatment practices (AOR: 1.46; 95% CI = 1.01–2.10) and latrine availability (AOR: 1.44; 95% CI = 1.15–1.80). Among the households who were either visited by HEWs at their home or the that visited health posts to meet with the HEWs, being exposed to WASH health education by HEWs was significantly associated with the availability of a hand-washing facility (AOR: 5.14; 95% CI = 4.11–6.42) and latrine availability (AOR: 1.48; 95% CI = 1.10–2.01). However, we did not find a relationship between the incidence of diarrhea among children age 5 and under and exposure to HEWs (AOR: 2.09; 95% CI = 0.73– 6.62).ConclusionOur results show a significant association between exposure to the Health Extension Program/ HEWs and improved household water treatment practices, latrine construction, and the availability of hand-washing facilities in rural Ethiopia, suggesting the need to strengthen efforts to change WASH behavior through the Heath Extension Program. On the other hand, further investigation is needed regarding the spillover effect of latrine use practices and the reduction of the incidence of diarrheal diseases.

Effect of COVID-19 pandemic on the incidence of acute diarrheal disease and pneumonia among under 5 children in Ethiopia- A database study.

COVID-19 has had a devastating impact on preventable and treatable pediatric diseases in Ethiopia. This study looks at the impact of COVID-19 on pneumonia and acute diarrheal diseases in the country, as well as the differences between administrative regions. In Ethiopia, we conducted a retrospective pre-post study to assess the impact of COVID-19 on children under the age of five who had acute diarrhea and pneumonia and were treated in health facilities during the pre-COVID-19 era (March 2019 to February 2020) and the COVID-19 era (March 2020 to February 2021). From the National Health Management District Health Information System (DHIS2, HMIS), we retrieved data on total acute diarrheal disease and pneumonia, along with their regional and monthly distribution. We calculated incidence rate ratios comparing the rates of acute diarrhea and pneumonia during the pre-and post-COVID-19 eras and adjusted for the year, using Poisson regression. The number of under-five children treated for acute pneumonia decreased from 2,448,882 before COVID-19 to 2,089,542 ((14.7% reduction (95%CI;8.72-21.28), p<0.001)) during COVID-19. Similarly, the number of under-five children treated for acute diarrheal disease decreased from 3,287,850 in pre-COVID-19 to, 2,961,771((9.91% reduction (95%CI;6.3-17.6%),p<0.001)) during COVID-19. In the majority of the administrative regions studied, pneumonia and acute diarrhea diseases decreased during COVID-19, but they increased in Gambella, Somalia, and Afar. During the COVID-19 period, the greatest reduction of children with pneumonia (54%) and diarrhea disease (37.3%) was found in Addis Ababa (p<0.001). The majority of administrative regions included in this study have seen a decrease in pneumonia and acute diarrheal diseases among children under the age of five, while three regions namely, Somalia, Gambela, and Afar saw an increase in cases during the pandemic. This emphasizes the importance of using tailored approaches in mitigating the impact of infectious diseases such as diarrhea and pneumonia during situations of a pandemic such as COVID-19.

Incidencia de pacientes pediátricos con enfermedades diarreicas del puesto de salud tres cerritos - pasaje en el periodo 2020 – 2022

Objective: This study aims to determine the incidence of diarrheal diseases in pediatric patients of the Tres Cerritos Health Post in the Pasaje Canton during the period 2020 - 2022. Methods: A cross-sectional observational-descriptive study was conducted. The pediatric population studied consisted of 5,774 children, among whom 76 cases of acute diarrhea were observed in children of both sexes. The PRAS system (Plataforma Registro de Salud) was used for data collection. Statistical analysis was carried out with Epi Info and Excel, presenting qualitative variables with frequency values (f), percentage (%) and quantitative variables with measures of central tendency and dispersion (mean, median/standard deviation, interquartile range). Results: According to the data collected in PRAS, an incidence of acute diarrhea of 13.16 per 1,000 inhabitants was determined. The average age of the affected children ranged from 2 to 9 years, with a predominance of the male sex (54%). The most affected age group was 2 to 4 years (49%). The most frequent symptomatology was diarrhea (42%), followed by the combination of diarrhea and vomiting (16%). Conclusion: The incidence of diarrhea in the Tres Cerritos Health Post was relatively low in the pediatric population. This is due to the fact that respiratory pathologies predominated during the study period, affecting the male sex more frequently.

Unimproved water and sanitation contributes to childhood diarrhoea during the war in Tigray, Ethiopia: a community based assessment

Access to water, sanitation, and hygiene (WASH) is a global public health problem. The situation is worst in conflict areas, where people are displaced from their usual homes. Household supply of WASH and the incidence of diarrhoeal disease among children during the war in Tigray are not known or documented. The objective of this study was to investigate the sources of drinking water, sanitation and hygiene practices, and the incidence of diarrhoeal diseases among children during the war in Tigray, Ethiopia. A cross—sectional study was conducted to collect data on selected WASH indicators in six zones of Tigray from August 4-20, 2021. Data were collected from a total of 4381 sample households selected by lottery. Descriptive analysis was performed and the analysed data are presented in tables, figures and explanatory notes. Binary logistic regression was performed to examine the relationship between independent and dependent variables. A total of 4381 households from 52 woredas participated in the study. Approximately 67.7% of the study participants reported that they relied on an improved source of drinking water during the war. Coverage of sanitation, hand washing, and menstrual hygiene during the war was reported as 43.9%, 14.5%, and 22.1%, respectively. The prevalence of diarrhoeal diseases among children was 25.5% during the war. Water source, latrine type, solid waste disposal and health extension worker visits were the significant predictors of the likelihood of diarrhoea in children (p < 0.05). The results of the study show that a decrease in services from WASH is associated with a higher prevalence of diarrhoeal disease among children during the war in Tigray. To prevent the high prevalence of diarrhoeal disease among children in war-torn Tigray, Ethiopia, improved access to water and sanitation is recommended. In addition, collaborative efforts are needed to engage health extension workers to provide appropriate promotion and prevention services to war-affected communities in Tigray, Ethiopia. Further comprehensive surveys of households with children over one year of age are recommended to assess access to WASH and the burden of WASH associated diseases.

Changes in Occurrence of Diarrheal and Respiratory Diseases before and during COVID-19 Pandemic among Nepalese Population

Background: The government of Nepal has adopted a number of preventative and control measures to halt the spread of coronavirus disease (COVID-19). In this study, we aimed to determine whether the use of preventive and control measures such as hand washing, social distancing, lockdown implementation, and mask-wearing has significantly slowed down the spread of infectious diseases like diarrhoea and respiratory illnesses during the pandemic period. Methods: A descriptive and cross-sectional study was conducted among 3086 participants across Nepal via electronic media from July 28 to August 30, 2020. The participants were asked to provide information about their experiences with diarrhoea and respiratory symptoms in the three months before and during the COVID-19 pandemic. The Mc-Nemar test was used to compare the incidence of respiratory and diarrheal diseases before and during the pandemic period. Results: Compared to before and during the COVID-19 pandemic, vomiting (3.3%), diarrhoea (7.3%) and abdominal pain (12.1%) decreased to 2.8%, 6.9%, and 6.1%, respectively. Between two concurrent periods, such as before the onset and during the COVID-19 pandemic lockdown, the prevalence of dysentery and stomach pain was statistically different (p-value&lt; 0.001). As the prevalence of the common cold decreased from 30.2% to 20.3%, so did that of sore throats (15.1% to 10.6%), coughs/chest pain (8.3% to 5.6%), dyspnoea (2.8% to 1.9%), and pneumonia (2.6% to 1.5%). This difference in the prevalence of respiratory diseases such as the common cold, sore throat, laryngitis/pharyngitis, cough/chest pain, dyspnoea, and pneumonia were statistically significant. Conclusion: Upon comparing the COVID-19 period to the pre-pandemic period, it appeared that the symptoms of diseases like diarrhoea and respiratory illnesses were on the decline. Therefore, we can conclude that the Government of Nepal's preventive measures for COVID-19 have helped to reduce the prevalence of such diseases.

Edukasi PHBS dalam Upaya Pencegahan Diare pada Anak Sekolah di Desa Dander Kecamatan Dander Kabupaten Bojonegoro

Diarrhea is still a public health problem in developing countries such as Indonesia, because of its high morbidity and mortality. Based on data from Puskesmas Dander, Bojonegoro it is known that the incidence of diarrheal disease has increased sharply in Desa Dander. This activity aims to increase the knowledge of elementary school children about PHBS to prevent diarrhea. The core activities are education about PHBS and diarrhea as well as hand-washing training. The target of the activity was elementary school children at SDN Dander III and SDN Dander IV, Kecamatan Dander, Kabupaten Bojonegoro, with the number of participants 72 children. The educational method using a combination of providing material with a Power Point presentation, videos, and hands-on practice. There was an increase in the average score between pre-test and post-test, from 45.69 to 61.25. The percentage of students with low and moderate levels of knowledge from the pre-test results decreased when compared to the post-test results, while students with high knowledge levels increased in the post-test. In addition, the number of student attendance exceeds the expected target.

The Distribution of Fecal Contamination in an Urbanized Tropical Lake and Incidence of Acute Diarrheal Disease

Aquatic ecosystems of tropical countries are vulnerable to fecal contamination that could cause spikes in the incidences of acute diarrheal disease (ADD) and challenge public health management systems. Vembanad lake, situated along the southwest coast of India, was monitored for one year (2018–2019). Escherichia coli, an indicator of fecal contamination, was prevalent in the lake throughout the year. Multiple antibiotic resistance among more than 50% of the E. coli isolates adds urgency to the need to control this contamination. The high abundance of E. coli and incidence of ADD were recorded during the early phase of the southwest monsoon (June–July), prior to the once-in-a-century floods that affected the region in the later phase (August). The extent of inundation in the low-lying areas peaked in August, but E. coli in the water peaked in July, suggesting that contamination occurred even prior to extreme flooding. During the COVID-19-related lockdown in March–May 2021, fecal contamination in the lake and incidence of ADD reached minimum values. These results indicate the need for improving sewage treatment facilities and city planning in flood-prone areas to avoid the mixing of septic sewage with natural waters during extreme climate events or even during the normal monsoon.

Urban risks due to climate change in the Andean municipality of Pasto, Colombia: A Bayesian network approach.

The current trends of climate change will increase people's exposure to urban risks related to events such as landslides, floods, forest fires, food production, health, and water availability, which are stochastic and very localized in nature. This research uses a Bayesian network (BN) approach to analyze the intensity of such urban risks for the Andean municipality of Pasto, Colombia, under climate change scenarios. The stochastic BN model is linked to correlational models and local scenarios of representative concentration trajectories (RCP) to project the possible risks to which the municipality of Pasto will be exposed in the future. The results show significant risks in crop yields, food security, water availability and disaster risks, but no significant risks on the incidence of acute diarrheal diseases (ADD) and acute respiratory infections (ARI), whereas positive outcomes are likely to occur in livestock production, influenced by population growth. The advantage of the BN approach is the possibility of updating beliefs in the probabilities of occurrence of events, especially in developing, intermediate cities with information-limited contexts.

Stunting among children aged 24–59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia

Stunting is a public health issue of global concern. Despite, poor sanitation, diarrhea, parasitic infections, and environmental enteric dysfunction (EED) are associated with stunting, their link is poorly understood and has not been investigated in Ethiopia. This study was conducted to assess the associations of stunting with sanitation, enteric infections, and EED among children aged 24–59 months in rural northwest Ethiopia. A community-based cross-sectional study was conducted among 224 randomly selected children aged 24–59 months in rural areas of the east Dembiya district. We collected information on household food insecurity and dietary diversity using pre-tested questionnaires adopted from the food and nutrition technical assistance (FANTA) project. We used height-for-age-z score (HAZ) to define stunting. We also used the data collected to measure the environmental exposures of children to intestinal parasitic infections and fecal biomarkers of EED. A multivariable binary logistic regression model was used to assess the association of stunting with sanitation, enteric infections, and EED. Of the 224 children, 33% (95% CI 27, 39%) were stunted. Stunting in children was significantly associated with poor dietary intake (AOR 3.0, 95% CI 1.2, 7.3), open defecation practice (AOR 3.0, 95% CI 1.2, 7.9), presence of animal excreta in the living environment (AOR 3.4, 95% CI 1.2, 9.9), E. coli contamination of drinking water (AOR 4.2, 95% CI 1.1, 15.3), diarrheal disease incidence (AOR 3.4, 95% CI 1.5, 7.7), intestinal parasites in children (AOR 3.3, 95% CI 1.3, 8.8), and higher EED disease activity scores (AOR 2.9, 95% CI 1.2, 6.7). One-third of the children in the study area were stunted and this high prevalence of stunting was associated with poor dietary intake, poor hygiene and sanitation conditions, enteric infections, and EED. Thus, stunting can be prevented by improving sanitation and hygienic conditions to prevent repeated enteric infections in children and by promoting dietary diversity of children.

Estimating the changing burden of disease attributable to unsafe water and lack of sanitation and hygiene in South Africa for 2000, 2006 and 2012.

The incidence of diarrhoeal disease is closely linked to socioeconomic and environmental factors, household practices and access to health services. South African (SA) district health information and national survey data report wide variation in the incidence and prevalence of diarrhoeal episodes in children under 5 years of age. These differentials indicate potential for reducing the disease burden through improvements in provision of water and sanitation services and changes in hygiene behaviour. To estimate the burden of disease attributed to unsafe water, sanitation and hygiene (WASH) by province, sex and age group for SA in 2000, 2006 and 2012. Comparative risk assessment methodology was used to estimate the disease burden attributable to an exposure by comparing the observed risk factor distribution with a theoretical lowest possible population distribution. The study adapts the original World Health Organization scenario-based approach for estimating diarrhoeal disease burden from unsafe WASH, by assigning different standards of household water and sanitation-specific geographical classification to capture SA living conditions in rural, urban and informal settlements. SA experienced an improvement in water and sanitation supply in eight of the nine provinces between 2001 and 2011, with the exception of Northern Cape Province. In 2011, 41% of South Africans lived with poor water and sanitation conditions; however, wide provincial inequalities exist. In 2012, it was estimated that 84.1% of all deaths due to diarrhoeal disease were attributable to unsafe WASH; this equates to 13 757 deaths (95% uncertainty interval (UI) 13 015 - 14 300). Of these diarrhoeal disease deaths, 48.2% occurred in children under 5 years of age, accounting for 13.9% of all deaths in this age group (95% UI 13.1 - 14.4). Between 2000 and 2012, the proportion of deaths attributable to diarrhoea reduced from 3.6% to 2.6%. Gauteng and Western Cape provinces experienced much lower WASHattributable death rates than the more rural, poorer provinces. Unsafe WASH remains an important risk factor for disease in SA, especially in children. High priority needs to be given to the provision of safe and sustainable sanitation and water facilities and promoting safe hygiene behaviours. The COVID-19 pandemic has reinforced the critical importance of clean water for preventing and containing disease.

Influence of Probiotic Strains Bifidobacterium, Lactobacillus, and Enterococcus on the Health Status and Weight Gain of Calves, and the Utilization of Nitrogenous Compounds.

The aim of this study was to monitor the effect of Bifidobacterium bifidum (BB) and the combination of Lactobacillus sporogenes, Enterococcus faecium, and Bifidobacterium bifidum (LEB) on the health status and weight gain of calves, and the utilisation of nitrogenous substances. The experiment was performed in the period from April 2020 to September 2020. A total of 90 Holstein heifers, which were one to 56 days old, were used as experimental animals. Differences in live weight gain were significant if we compared the LEB vs. BB group and the LEB vs. C, the control group (86.23 ± 5.49 kg vs. 84.72 ± 6.22 kg, p < 0.05; 86.23 ± 5.49 kg vs. 82.86 ± 5.35 kg, p < 0.01). Considering the live weight gain, group BB was heavier than group C only (84.72 ± 6.22 kg vs. 82.86 ± 5.35 kg, p < 0.05). An effect on reducing the incidence and duration of diarrheal diseases was not demonstrated in this study (p = 0.1957). The administration of feed additives had no statistically significant effect on the amount of N excreted in the feces. The values of hematological and biochemical parameters were unaffected except for the first sampling of urea. Other blood parameters were not affected by the addition of probiotic feed additives. The bacterial populations in the feces 5 days and 56 days after birth were not affected by the inclusion of feed additives.