Simple Low-cost Interventions Research Articles

National chlorhexidine coverage and factors associated with newborn umbilical cord care in Bangladesh and Nepal: a cross-sectional analysis using household data

BackgroundPreventable newborn deaths are a global tragedy with many of these deaths concentrated in the first week and day of life. A simple low-cost intervention, chlorhexidine cleansing of the umbilical cord, can prevent deaths from omphalitis, an infection of the umbilical cord. Bangladesh and Nepal have national policies promoting chlorhexidine use, as well as routinely collected household survey data, which allows for an assessment of coverage and predictors of the intervention.MethodsWe used data from the 2017–2018 Bangladesh Demographic and Health Survey and the 2016 Nepal Demographic and Health Survey, two large-scale nationally representative household surveys. We studied coverage of single application of chlorhexidine to the umbilical cord of newborns born in the past year using descriptive, bivariate and multivariable analyses. Key predictors of newborns receiving chlorhexidine cleansing, including socio-economic factors, healthcare related factors and the application of harmful and nonharmful substances, were explored in this study.ResultsCoverage of chlorhexidine cleansing was 15.0% in Bangladesh and 50.7% in Nepal, while the application of a harmful substance was 16.9% in Bangladesh and 22.6% in Nepal. Results from the multivariable analyses indicated that delivery in a health facility was strongly associated with a newborn’s receipt of chlorhexidine in both countries (Bangladesh: OR = 2.23, p = 0.002; Nepal: OR = 5.01, p = 0.000). In Bangladesh, delivery by Cesarean section and application of another non-harmful substance were significantly and positively associated with the receipt of chlorhexidine. In Nepal antenatal care was significantly and positively associated with chlorhexidine, while application of a harmful substance was significantly and negatively associated with receipt of chlorhexidine. Maternal education, urban/rural residence, religion and sex were not significant in the multivariable analysis. Wealth was not a significant factor in Bangladesh, but in Nepal newborns in the two highest wealth quintiles were significantly less likely to receive chlorhexidine than newborns in the lowest wealth quintile.ConclusionAs Bangladesh and Nepal continue to scale-up chlorhexidine for newborn umbilical cord care, additional focus on newborns born in non-facility environments may be warranted. Chlorhexidine cleansing may have the potential to be an equitable intervention, as newborns from the poorest wealth quintiles and whose mothers had less education were not disadvantaged in receiving the intervention in these two settings.

Impact of a Medication Reconciliation Improvement Package on Adherence to Medication Reconciliation Among Internal Medicine Physicians: A Quality Improvement Project in a Lower-Middle Income Country

Background: Medication reconciliation is one of the best measures to prevent medication-related errors at the time of admission and discharge of patients. We conducted a quasi-experimental study to evaluate the impact of a Medication reconciliation improvement package (intervention) on adherence to medication reconciliation at the time of admission in Department of Internal Medicine. The study included all adult patients admitted to internal medicine from August 2019 to December 2020. Pre-intervention data on adherence to medication reconciliation was less than 50%. The study involved creation of a quality improvement team to conduct a root-cause analysis which identified the need to target physician related issues and hence drafted a medication reconciliation improvement package which included meetings with physicians on the internal medicine floor, dedicated WhatsApp groups for repeated reminders, and appreciation messages for timely adherence. We used the Chi Square test to check the association between adherence to medication reconciliation and physicians and acuity level. Findings: We included 7914 records of patients, in which 4471 participants (56.4%) were from pre-intervention phase and 3443 (43.5%) were from intervention groups. The overall adherence to medication reconciliation was 54.3% (4297/7914). Adherence of medication reconciliation increased from 44.4% (1983/4471) in the pre-intervention phase to 67.2% (2314/3443) in the intervention phase ( P < .001). Improvement was observed in adherence of medication reconciliation done by residents and in low acuity areas ( P < .005). Conclusion: The Medical reconciliation improvement package is a simple low-cost intervention that resulted in improvement in adherence to medication reconciliation but needs further studies to assess its sustainability. However, it awaits to be seen if the same improvement can also be replicated to qualitative medication errors and clinical outcomes respectively.

Ostomy Belt Use Improves Quality of Life in Patients with a Stoma

Ostomy formation is a vital component in the treatment of advanced gastrointestinal diseases, including colorectal cancer and inflammatory bowel disease. It usually involves externalizing a part of the colon or small bowel to the skin surface. Thus, the creation of an ostomy can often have a major negative impact on quality of life. This study aimed to evaluate whether the use of an ostomy belt could improve quality of life measures in stoma patients through a prospective interventional open-label study of 17–80-year-old English- and Spanish-speaking patients with stomas who were using an ostomy belt for 8 weeks. Changes in quality of life were assessed using the Stoma Quality of Life Scale questionnaire at baseline, at 4 weeks, and at 8 weeks post ostomy belt use. A total of 45 patients enrolled (20 female, mean age 48) in the study. The ostomy belt significantly improved quality of life scores from baseline to 4 weeks regarding overall life satisfaction (F(2, 76) = 14.77, p < 0.001) and in the domains of work/social function (F(2, 72) = 30.32, p < 0.001), sexuality/body image (F(2, 68) = 3.34, p = 0.04), and stoma function (F(2, 72) = 8.72, p < 0.001). These improvements were sustained at the 8-week follow-up. No significant differences were observed in the domains of financial impact and skin irritation. This study represents the first prospective interventional study that provides evidence for the simple low-cost intervention of ostomy support belt use in improving quality of life in patients with a stoma.

The use of a train-the-trainer model to educate non-dental healthcare professionals for oral care

Background: Associations between oral health and systemic conditions have been well established in recent literature. Improvements in oral hygiene have consistently shown to significantly reduce the incidence of respiratory infections, which has high morbidity and mortality rates in the frail elderly. However, the simple low-cost intervention of good oral care remains overlooked in healthcare institutions and nursing homes, due to limited awareness and knowledge. Previous efforts for oral care training of non-dental healthcare professionals have been largely sporadic, with little impact and reach to the medical fraternity. Purpose: To overcome these challenges, we utilized a train-the-trainer model, where seven senior nurses from the long-term stay wards of a public community hospital were educated on the importance of good oral health and trained to administer a comprehensive oral care protocol in patients requiring assistance. The Oral Health Education Programme (OHEP) consisted of a full-day workshop on Common Dental Conditions, Oral Health Assessment Technique (OHAT), and oral hygiene instruction for normal and assisted tooth brushing in independent and mechanically ventilated patients respectively. Results: Majority of the nurses felt that the training was effective and applicable to their work. The number of patients with chronic respiratory infections in the wards were reduced after commencement of OHEP. Conclusion: This interprofessional education collaboration using the train-the-trainer model provides a standardized curriculum, while allowing autonomy for the trainers to customize modules relevant to their respective institutions. This partnership model between medical nurses and oral health professionals allows for better sustainability of the programme.

Apnoeic oxygenation for emergency anaesthesia of pre-hospital trauma patients

BackgroundEfficient and timely airway management is universally recognised as a priority for major trauma patients, a proportion of whom require emergency intubation in the pre-hospital setting. Adverse events occur more commonly in emergency airway management, and hypoxia is relatively frequent. The aim of this study was to establish whether passive apnoeic oxygenation was effective in reducing the incidence of desaturation during pre-hospital emergency anaesthesia.MethodsA prospective before-after study was performed to compare patients receiving standard care and those receiving additional oxygen via nasal prongs. The primary endpoint was median oxygen saturation in the peri-rapid sequence induction period, (2 minutes pre-intubation to 2 minutes post-intubation) for all patients. Secondary endpoints included the incidence of hypoxia in predetermined subgroups.ResultsOf 725 patients included; 188 patients received standard treatment and 537 received the intervention. The overall incidence of hypoxia (first recorded SpO2 < 90%) was 16.7%; 10.9% had SpO2 < 85%. 98/725 patients (13.5%) were hypoxic post-intubation (final SpO2 < 90% 10 minutes post-intubation).Median SpO2 was 100% vs. 99% for the standard vs. intervention group. There was a statistically significant benefit from apnoeic oxygenation in reducing the frequency of peri-intubation hypoxia (SpO2 < =90%) for patients with initial SpO2 > 95%, p = 0.0001. The other significant benefit was observed in the recovery phase for patients with severe hypoxia prior to intubation.ConclusionApnoeic oxygenation did not influence peri-intubation oxygen saturations, but it did reduce the frequency and duration of hypoxia in the post-intubation period. Given that apnoeic oxygenation is a simple low-cost intervention with a low complication rate, and that hypoxia can be detrimental to outcome, application of nasal cannulas during the drug-induced phase of emergency intubation may benefit a subset of patients undergoing emergency anaesthesia.

Systematic reviews as a "lens of evidence": Determinants of participation in breast cancer screening.

ObjectiveTo assess the determinants of the participation rate in breast cancer screening programs by conducting a systematic review of reviews.MethodsWe conducted a systematic search in PubMed via Medline, Scopus, Embase, and Cochrane identifying the literature up to April 2019. Out of 2258 revealed unique abstracts, we included 31 reviews, from which 25 were considered as systematic. We applied the Walsh & McPhee Systems Model of Clinical Preventive Care to systematize the determinants of screening participation.ResultsThe reviews, mainly in high-income settings, reported a wide range for breast cancer screening participation rate: 16–90%. The determinants of breast cancer screening participation were simple low-cost interventions such as invitation letters, basic information on screening, multiple reminders, fixed appointments, prompts from healthcare professionals, and healthcare organizational factors (e.g. close proximity to screening facility). More complex interventions (such as face-to-face counselling or home visits), mass media or improved access to transport should not be encouraged by policy makers unless other information appears. The repeated participation in mammography screening was consistently high, above 62%. Previous positive experience with screening influenced the repeated participation in screening programs. The reviews were inconsistent in the use of terminology related to breast cancer screening participation, which may have contributed to the heterogeneity in the reported outcomes.ConclusionsThis study shows that consistent findings of systematic reviews bring more certainty into the conclusions on the effects of simple invitation techniques, fixed appointments and prompts, as well as healthcare organizational factors on promoting participation rate in screening mammography.

Low-cost self-paced interventions increase birth satisfaction in first time fathers

ObjectiveThis research aims to investigate whether a skills or birth stories intervention for fathers can improve birth satisfaction of fathers. Study DesignOne hundred and seventy-four men were recruited and randomly assigned to a skills preparation group, a birth stories group, or a treatment as usual (TAU) group. One hundred sixteen men completed the three questionnaires relevant for this report (67% retention rate). Birth satisfaction was measured soon after birth. MeasuresDemographic data and data related to partners pregnancy, birth and preparation were collected. The Mackey Childbirth Satisfaction Rating Scale was the primary outcome measure. ResultsIt was found that men who received either of the birth preparation interventions (skills or birth stories booklet) had significantly higher birth satisfaction scores. An analysis found that, irrespective of intervention, his partner having an induction, a caesarean section, and his not being in full-time employment had a negative effect on birth satisfaction, while his partner having an epidural, his experiencing family life satisfaction before the birth, his finding antenatal classes useful, and having his birth delivery expectations met had a positive impact on birth satisfaction. ConclusionIncreasing the father’s understanding, role expectations, and preparation for his partner’s childbirth, may be important for fathers birth satisfaction. Expectations around childbirth and expectations of himself might be better managed to improve satisfaction. This study found evidence that simple low-cost interventions can improve birth satisfaction for new fathers.

Essential pain management at a rural district hospital in Burundi

Background: Pain management is a significant challenge in low- and middle-income countries (LMICs). In settings where resources are limited, interventions to improve pain management must be low-cost and context-appropriate. Methods: At a rural district hospital in Burundi, East Africa we undertook the delivery of a simple educational workshop called Essential Pain Management (EPM) and introduction of regular acute pain rounds for post surgical patients. At the same time, we carried out a pre- and post-intervention audit of pain management. We hypothesised that the use of the EPM educational workshop and introduction of regular acute pain rounds for post-surgical patients would lead to a reduction in patient pain scores, time to first ambulation, hospital length of stay, and changes to analgesic medication prescribing practices. Results: We found improvements in modified visual analogue scale (VAS) scores on postoperative days one (mean VAS 42.3 vs 31.4, p &lt; 0.001) and two (mean VAS 33.7 vs 27, p = 0.001), with no difference on day three. We also found a reduction in time to first ambulation after introduction of this service (median time of 38.8 hours vs 28 hours, p &lt; 0.001) with no change in length of stay (median four days in both groups). There was also a marked increase in administration of analgesic medications after the service was introduced. Conclusion: Our audit demonstrates a positive impact following a simple low-cost intervention in a rural hospital where resources are severely limited. We believe that this intervention offers a feasible and context appropriate approach for improving postoperative pain management in a low-resource setting.

Burden and factors associated with clinical neonatal sepsis in urban Uganda: a community cohort study

BackgroundNeonatal sepsis is one of the most important causes of mortality in developing countries and yet the most preventable. In developing countries clinical algorithms are used to diagnose clinical neonatal sepsis because of inadequate microbiological services. Most information on incidence and risk factors of neonatal sepsis are from hospital studies which may not be generalized to communities where a significant proportion of mothers do not deliver from health facilities. This study, conducted in urban Uganda, sought to determine the community based incidence of clinical neonatal sepsis and the factors associated.MethodsThis was a cohort of mother-neonate pairs in Kampala, Uganda from March to May 2012. The enrolled neonates were assessed for clinical sepsis and factors associated, and followed up till the end of the neonatal period. STATA version 10 was used to analyse the data.ResultsThe community based incidence of neonatal sepsis was 11% (95% CI: 7.6–14.4). On bivariate analysis, lack of financial support from the father (OR 4.09, 95% CI 1.60–10.39) and prolonged rupture of membranes more than 18 h prior to delivery (OR 11.7, 95% CI 4.0–31.83) were significantly associated with neonatal sepsis. Maternal hand washing prior to handling the baby was found to be protective of neonatal sepsis (OR 0.41, 95% CI 0.18–0.94). Of the 317 infants who completed the follow up period, one died within the neonatal period giving a neonatal mortality of 0.003%.ConclusionThe high incidence of clinical neonatal sepsis in this urban community with high rates of antenatal care attendance and health facility delivery places a demand on the need to improve the quality of antenatal, perinatal and postnatal care in health facilities with regards to infection prevention including promoting simple practices like hand washing. The astoundingly low mortality rate is most likely because this was a low risk cohort. However it may also suggest that the neonatal mortality in developing countries may be reduced with promotion of simple low cost interventions like community follow up of neonates using village health teams or domiciliary care.

Simple low cost intervention decreases missed opportunity visits and increases human papillomavirus (HPV) vaccination in underserved adolescents

Simple low cost intervention decreases missed opportunity visits and increases human papillomavirus (HPV) vaccination in underserved adolescents

Can aggregate quarry silt lagoons provide resources for wading birds?

Wading birds have declined across Europe as the intensification of lowland agriculture has resulted in the loss and degradation of wetland areas. Lowland aggregate extraction sites that incorporate areas of fine, waste sediments deposited in silt lagoons have the potential to be restored for wader conservation. We set out to determine the potential value of silt lagoons to wading birds by comparing the water quality, sediment profiles, aquatic invertebrate abundance and diversity (prey availability) and wader site use at five sites representing various stages of active aggregate extraction and restoration for conservation purposes. Wader counts were conducted monthly over a twelve month period using replicated scan samples, and the invertebrate communities studied during the breeding and autumn migration season (June–September). Water quality variables were similar between sites, but sediments from active quarries were dominated by moderately sorted fine sands in comparison to the coarser sediment profiles of restored areas. June and September there was no significant difference in invertebrate diversity between sites, however richness was significantly lower on quarry sites and total abundance a factor of ten higher at restored sites than on silt lagoons, with the dominant taxa similar across all sites. Waders used all sites; albeit at lower abundance and richness on silt lagoons and two species were recorded breeding on active silting sites. We conclude that the fine, uniform sediments of modern silt lagoons limited invertebrate diversity and abundance, diminishing the value of silt lagoons to waders. Simple low-cost intervention measures increasing substrate heterogeneity and creating temporary ponds could increase invertebrate richness and abundance, and enhance the conservation potential of these sites.

Improving door-to-needle times for patients presenting with ST-elevation myocardial infarction at a rural district general hospital.

Acute coronary syndrome is a common condition with a major global impact on healthcare resources and expenditure. International guidelines are clear in specifying that patients with acute ST-elevation myocardial infarction (STEMI) should receive urgent coronary reperfusion with either primary percutaneous coronary intervention (PCI) or thrombolysis. Although PCI is the gold standard in the treatment of STEMI, this is not always achievable in a rural hospital with no cardiac catheterization service. Consequently, local recommendations on STEMI management exist to promote timely administration of thrombolysis within 30 minutes of patient arrival. However, translating updated clinical policy into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders.Whilst working at a district general hospital in New Zealand, we noted a high incidence of patients presenting with STEMI receiving thrombolytic therapy outside the recommended 30 minutes door-to-needle time. Although final treatment was often only delayed by 5-10 minutes, we were concerned by the seemingly inconsistent management of these patients, often leading to unnecessary delays in the initiation of rapid reperfusion therapy.We therefore championed a newly updated clinical guideline and promoted an early STEMI recognition and treatment algorithm in our hospital to raise awareness amongst staff and improve door-to-needle times. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and cardiac nursing staff, as well as posters and training on the use of a remote electronic ECG interpretation system to streamline out-of-hours management.Overall, we found there to a be a steady improvement in door-to-needle times at our hospital, with 74% of patients receiving appropriate care within 30 minutes, compared to 43% prior to our interventions. This also translated to better patient outcomes.This project forms part of an ongoing process to instigate quality improvements in the management of STEMI within rural institutions. Whilst we have demonstrated improved utilisation of a local STEMI guideline and streamlining of out-of-hours services, the key challenge remains to ensure that momentum of this project continues and forms a platform for sustainable clinical improvement in the long term.

Improving household air, drinking water and hygiene in rural Peru: a community-randomized-controlled trial of an integrated environmental home-based intervention package to improve child health.

Background: Diarrhoea and acute lower respiratory infections are leading causes of childhood morbidity and mortality, which can be prevented by simple low-cost interventions. Integrated strategies can provide additional benefits by addressing multiple health burdens simultaneously. Methods: We conducted a community-randomized–controlled trial in 51 rural communities in Peru to evaluate whether an environmental home-based intervention package, consisting of improved solid-fuel stoves, kitchen sinks, solar disinfection of drinking water and hygiene promotion, reduces lower respiratory infections, diarrhoeal disease and improves growth in children younger than 36 months. The attention control group received an early child stimulation programme. Results: We recorded 24 647 child-days of observation from 250 households in the intervention and 253 in the attention control group during 12-month follow-up. Mean diarrhoea incidence was 2.8 episodes per child-year in the intervention compared with 3.1 episodes in the control arm. This corresponds to a relative rate of 0.78 [95% confidence interval (CI): 0.58–1.05] for diarrhoea incidence and an odds ratio of 0.71 (95% CI: 0.47–1.06) for diarrhoea prevalence. No effects on acute lower respiratory infections or children’s growth rates were observed. Conclusions: Combined home-based environmental interventions slightly reduced childhood diarrhoea, but the confidence interval included unity. Effects on growth and respiratory outcomes were not observed, despite high user compliance of the interventions. The absent effect on respiratory health might be due to insufficient household air quality improvements of the improved stoves and additional time needed to achieve attitudinal and behaviour change when providing composite interventions.

Can Technology Improve the Quality of Colonoscopy?

In order for screening colonoscopy to be an effective tool in reducing colon cancer incidence, exams must be performed in a high-quality manner. Quality metrics have been presented by gastroenterology societies and now include higher adenoma detection rate targets than in the past. In many cases, the quality of colonoscopy can often be improved with simple low-cost interventions such as improved procedure technique, implementing split-dose bowel prep, and monitoring individuals' performances. Emerging technology has expanded our field of view and image quality during colonoscopy. We will critically review several technological advances in the context of quality metrics and discuss if technology can really improve the quality of colonoscopy.

G252 Improving neonatal care in the first 24 h of admission: a completed audit cycle

Aims Neonatal death accounts for 24% of under 5 mortality inUganda, making it the largest cause. In a community hospital in ruralUganda, we aimed to review the care provided in the first 24 h of admission on the neonatal unit and identify areas to improve. We looked at history taken, treatment given, observations performed and outcomes. We used standards from World Health Organisation guidelines and hospital protocols. Method A retrospective case note review was performed on all admissions to the neonatal unit in August 2014. Interventions were undertaken including staff education, updating of the referral form used by maternity staff and development of a neonatal antibiotic protocol. A re-audit was done in October 2014. Results 18 babies were included in the initial audit and 19 babies on re-audit. Vitamin K administration increased from 56% to 100%. Antibiotics were given to 100% of babies in August 2014 as per hospital policy and to 95% of babies in October 2014 following the introduction of a neonatal antibiotic protocol. Half of gentamicin doses (2/4) given to preterm babies were incorrect in Aug 2014 but all were correct (9/9) on re-audit. History of risk factors for sepsis was taken in 0% of admissions in August 2014. In October 2014 this increased to 16%. The updated referral sheet which includes risk factors for infection is not yet widely used by maternity staff. All observations were performed more frequently on re-audit, with respiratory rate recording improving from an average of 4.7 recordings in the first 24 h in August 2014 to 11.9 recordings in October 2014. Recording of discharge weights in babies, who were discharged after 5 days or more, improved from 33% to 92%. Conclusions Improvements in Vitamin K administration, neonatal observations, antibiotic prescribing and recording of discharge weights have been achieved through the audit process. Simple low cost interventions can result in better patient care in a low income setting. There are challenges in implementing changes. Moving forward we hope to improve the history and documentation of risk factors for infection, by more consistent use of the updated referral sheet.

The Impact of an educational intervention on knowledge of attention-deficit hyperactivity disorder among primary school teachers in Lagos Nigeria

Objective: Primary school teachers have been identified as important partners in the prompt recognition, referral and management of children with ADHD. However their capacity to function in these roles is hinged on their extent of knowledge about ADHD. Furthermore teachers' knowledge about ADHD may influence the education and clinical outcomes of children with ADHD. This study assessed the impact of an educational intervention program on knowledge about ADHD among primary school teachers in Lagos, Nigeria.&#x0D; Method: An experimental study of the impact of a brief educational intervention on ADHD literacy among primary school teachers (n=144) in Lagos, Nigeria. At baseline, knowledge about symptoms and treatment of ADHD was elicited with a vignette-based questionnaire. The intervention consisted of the administration of an educational leaflet about ADHD, designed by the American Academy of Child and Adolescent Psychiatry. One week post-intervention, the baseline assessments were repeated.&#x0D; Results: At baseline, 92.4% of the teachers could not recognise features of ADHD. The majority were also unaware of the role of teachers, medications and psychological interventions in the management of children with ADHD. Post-intervention, significantly greater number of respondents compared with baseline (88.0% vs. 7.6%) correctly identified symptoms of ADHD (p&lt;0.005), and agreed that ADHD could be successfully managed with medications (63.2% vs. 9.0%; p&lt;0.005) and psychological treatment (79.2% vs. 16.7%; p&lt;0.005).&#x0D; Conclusion: A simple low-cost educational intervention is effective in improving knowledge about ADHD among primary school teachers in the shortterm. Further research is required to evaluate the impact of this intervention in the long term.

Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss: a systematic review

ObjectivesTo assess the effectiveness of community- and workplace-based interventions to reduce sickness absence and job loss in workers with musculoskeletal disorders (MSDs).MethodsWe identified relevant randomised controlled trials (RCTs) and cohort...

Effectiveness of reminders in reducing non-attendance among out-patients

Aims and methodNon-attendance rates in a psychiatric out-patient clinic and the effectiveness of telephone or postal reminders in reducing non-attendance were evaluated. All patients who did not attend the clinic for their second appointment within 2 weeks were contacted by telephone or letter. Patients who failed to attend the clinic 6 weeks after the reminder were classified as non-attendees.ResultsRate of non-attendance before the intervention was 31.3% (n = 61/195). After the intervention this was reduced to 23.1%, a relative risk reduction of 26.2%. Being male, not being prescribed medicines, having a diagnosis of psychoactive substance use or dementia were risk factors for non-attendance (odds ratio, OR&gt;1). Risk of non-attendance was low for bipolar disorder, schizophrenia and depressive disorder (OR &lt;1).Clinical implicationsA simple low-cost intervention in the form of a reminder reduced non-attendance rates. Routine implementation of this intervention should be considered in all psychiatry out-patient services in low- and middle-income countries.

Low-cost interventions improve indoor air quality and children's health

Intervention in the home environment to reduce asthma triggers theoretically improves health outcomes for asthmatic children. Practical benefit from application of these interventions has proven difficult. This single-blind study tested the effectiveness of simple low-cost home interventions in improving health scores of children with asthma. Families with at least one asthmatic child were recruited. Initial health examination, health, and home assessments were conducted and targeted interventions were implemented. Interventions included dehumidification, air filtration, furnace servicing, and high-efficiency furnace filters. When present, gross fungal contamination was remediated. Asthma education was provided along with education in healthy home practices. Follow-up assessments were conducted after 6 months. Health surveys were completed at enrollment and follow-up. This study enrolled 219 children with asthma. Home inspections and interventions were conducted in 181 homes and 83 families completed all phases. Reduction in asthma and allergy-related health scores was shown in follow-up health surveys. Health improvements were significant for cough when heating, ventilation, and air conditioning (HVAC) service and dehumidification were used. Breathing problems were significantly improved for dehumidification, HVAC service, and room air cleaners. Total dust allergen load was reduced for the dehumidification group (p < 0.05). Mold spore counts were reduced one order of magnitude in 25% of the homes. Indoor spore counts adjusted for outdoor spore levels were reduced overall (p < 0.01). Simple low-cost interventions directed to producing cleaner indoor air coupled with healthy home education improve the indoor air quality and health in asthmatic children.

Simple intervention to reduce mosquito breeding in waste stabilisation ponds

Waste stabilisation ponds (WSP) are the preferred method for treatment of urban wastewater in low-income countries but, especially in arid regions, the pond systems can be important breeding sites for mosquitoes of medical importance. In a WSP system in Faisalabad, Pakistan, we assessed the impact of simple environmental interventions on mosquito occurrence and abundance. Reducing the amount of floating matter in the ponds, eliminating emergent vegetation and repairing cracks in the cement structure reduced the number of mosquito-positive samples in the intervention ponds to almost zero, whereas the control ponds had a significant number of positive samples. This suggests that a combination of simple low-cost interventions is a feasible environmental management strategy for vector control in WSP systems that are located in areas where medically important mosquitoes may breed in the shallow ponds.