Unsafe Water Sources Research Articles

Provision of Clean Water as a Factor of Epidemiological Transition in Sub-Saharan Africa

The article examines the problem of access of the population of Sub-Saharan Africa to clean water and its impact on keeping high mortality rates in the region from communicable diseases. It is revealed that despite the increase in indicators of access to clean water, the situation for the countries of the region remains extremely difficult, due to the fact that more than 20% of the population still uses only unsafe water sources. The critical situation persists in Madagascar, DR Congo, CAR, Chad, and Angola, where more than a third of the population does not have access to clean water. The limitation of access to clean water sources hinders the passage of the epidemiological transition by the population: in most countries of the region, the proportion of deaths from communicable diseases still exceeds the proportion of deaths from chronic non-communicable diseases and injuries, which indicates the incompleteness of the second stage of the transition. The proportion of deaths from communicable diseases associated with the use of unsafe water sources is almost 3 times higher than the global average.

Liver fluke and schistosome cross-infection risk between livestock and wild mammals in Western Uganda, a One Health approach

Trematodiases strongly reduce the welfare of humans and animals causing a great decline in health and productivity. Insufficient data on the extent of trematode infection in definitive hosts and associated risk factors remain a great threat to its control. A cross-sectional study was conducted to establish the; prevalence of liver flukes and schistosomes in livestock and wild mammals and the socio-ecological risk factors associated with their spread. Fresh dung samples were collected opportunistically (n = 865) and examined using formal ether sedimentation and microscopy for parasite eggs. Twelve abattoir visits were conducted to examine the livers of animals killed for mature flukes. Key informants (n = 110) including farmers, butchers, game rangers, and herders were interviewed to document the socio-ecological risk factors. In the abattoirs, 57.1%(CI 0.422–0.712) of cattle were infected with Fasciola flukes and not sheep and goats. Cattle dung had the highest prevalence (56% CI 0.518–0.604) of Fasciola eggs, followed by sheep (50%, CI 0.319–0.681) and goats (28.2%, CI 0.218–0.353). Among wild mammals, hippos' dung (66%; 95% CI 0.53–0.777) had the highest prevalence of Fasciola followed by warthogs (8%; 95% CI 0.002–0.385) and baboons (6.7%; CI 0.002–0.319). No Fasciola eggs were observed in elephant dung (n = 21) and monkeys (n = 2). Schistosoma bovis was found in cattle dung from Mpeefu (2.6%; 95% CI 0.007–0.066) and Ndaiga (4.3%; 95% CI 0.022–0.075) while S. mattheei in goats’ (1.4%; 95% CI 0.00–0.075) and cattle (0.39%; 95% CI 0.00–0.021) dung samples from Ndaiga. Key informants had moderate knowledge of fasciolosis (62.7%), highest among butchers (89.7%), and lowest among herders (31.8%). Only veterinary officers knew about schistosomiasis in animals. Free-range grazing and unsafe water sources for livestock, shared with wild animals, were the risky practices by most farmers (66–100%). Fasciola was prevalent in livestock and wild mammals, while Schistosoma in cattle and goats.

Evaluating water-related health risks in East and Central Asian Islamic Nations using predictive models (2020–2030)

This paper presents a thorough evaluation of health outcomes linked to water-related challenges in Islamic nations across East Asia and Central Asia from 2020 to 2030. It has been examined carefully that the trajectory of deaths and disability-adjusted life years associated with unsafe water sources, lack of sanitation, and absence of handwashing facilities is showing a potential rise in negative health impacts due to water pollution. The direct health influences of water-related problems are thoughtful. The increase in deaths and DALYs due to poor water quality and sanitation leads to a higher occurrence of waterborne diseases such as cholera, diarrhea, and dysentery. These conditions not only cause instant health disasters but also subsidize to long-term health issues which include chronic gastrointestinal disorders and malnutrition that is particularly among susceptible populations like children and the elderly. Employing various predictive models including autoregressive integrated moving average, exponential smoothing, support vector machines, and neural networks. The study evaluates their predictive capabilities by using mean absolute percentage error. Support vector machines is found to be the most accurate in forecasting deaths and disability-adjusted life years which is outperforming autoregressive integrated moving average, exponential smoothing, and neural networks. This research aims to inform stakeholders by providing insights into effective strategies for improving water resource management and public health interventions in the targeted regions.

Evaluation of Utilization Practices towards Cholera Response Water Tanks among Residents: A Case Study of Lusaka District.

Cholera outbreaks generally occur when water, sanitation and hygiene (WASH) services are inadequate or compromised. Annual estimates stand at 2.9 million cases and 95,000 deaths across 69 cholera-endemic countries with Sub-Saharan Africa and South Asia leading on the global cholera morbidity and mortality rates. Zambia continues to report higher morbidity and mortality with each recurrent outbreak. This raises concern on the impact of available interventions. This study was cross-sectional and employed qualitative evaluative techniques. Thirty (30) Focus Group Discussions (FGDs) supplemented with field notes by researchers) were conducted with 14 participants in each group drawn from 2 epi-centers i.e. Matero and Kanyama Sub-districts which accounted for over 70% of mortalities and morbidities. These epi-centers received 107 water tanks from authorities. The study found that residents were aware of the outbreak and attributed it to hygiene standards in the community while citing poor waste management and unsafe drinking water sources. The study also found poor WASH practices which included inability to perform correct hand hygiene during water collection, use of uncovered buckets and allowing children at the water points. Residents accessed the cholera response tanks and appreciated the intervention the government had put in place. Among the uses of the water from the tanks, residents preferred the water from cholera response tanks as they noted it tasted like mineral water. However, the water was prominently used for bathing highlighting that it made their skin smooth. The study also noted erratic supply as tanks ran out of water within 24hrs and it took an average of 4 days to refill the tanks. The study concluded that this intervention was appreciated, however, due to poor hygiene standards and erratic supply of water, the intended result could not be realized. The study recommends long term solutions such as drilling of boreholes alongside the tanks as well as repairing existing supply networks to water kiosks with consistency in water supply by utility companies.

Prevalence of Vaginal Inflammation Due to Candida sp., Trichomonas vaginalis and Associated Factors Among Patients Visiting the Gynecology Clinic at Hoang Anh Gia Lai University Medical Hospital

Candida spp., T.vaginalis infections can cause genital inflammation in women, leading to many adverse effects such as increased risk of infertility and severely impacting the patient's health and quality of life. Objective: To determine the prevalence of vaginal inflammation due to Candida spp., T. vaginalis infections and identify associated factors. Subjects and methods: Cross-sectional research. The research subjects were women of reproductive age (18-49 years old) who visited the gynecology clinic at Hoang Anh Gia Lai University Medical Hospital, Gia Lai province. Results: The prevalence of vaginal inflammation due to Candida spp., T.vaginalis infection was 26.7% (of which Candida sp. was 99.1% and T.vaginalis was 0.9%). The group using unsanitary water sources had a 1.6 times higher risk of infection (95% CI: 1.1-2.6), and the group that did not regularly undergo gynecological examinations had a 1.8 times higher risk of infection (95% CI: 1.1-2.9). Conclusion: The prevalence of Candida spp., T.vaginalis infection was 26.7%, and was associated with the use of unsafe water sources and irregular gynecological checkups.

Beneath the Surface: Uncovering Heavy Metal Contamination in Public Drinking Well Water and the Public Health Implications in Kaduna South LGA, Nigeria

Unsafe drinking water has emerged as a critical global public and environmental health concern, particularly in underdeveloped nations. Evidence indicates that unsafe water sources are responsible for approximately 1.2 million deaths annually, most of which are the result of heavy metal (HM) contamination, which poses a severe threat to public health. This study explored selected HM contamination and the likely non-carcinogenic and carcinogenic health risks to the consumers of public drinking well water sources in Kaduna South LGA, Nigeria. Atomic absorption Spectroscopy was adopted for HM analysis, and potential health risks were evaluated using the established Human Health Risk Exposure Assessment Indices. The findings indicated an unsafe quantity of HMs, with the mean concentration above the recommended limit prescribed by the Standard Organization of Nigeria (2007) and the World Health Organization (2011) for most HMs in the order; Zn (33.523) > Mn (2.805) > Pb (0.793) > Cr (0.05), as well as a substantial non-carcinogenic and carcinogenic health risk for adults and children with the Hazard Index and Cancer Risk values above the recommended standards. The findings will prove useful to public health authorities in developing evidence-based monitoring and active interventions tot facilitate the delivery of safe drinking water to the local population.

Undernutrition and determinants among adolescent street children in DireDawa City, eastern Ethiopia: Vulnerability assessment

ObjectivesAdolescents go through rapid development and increased nutritional requirements that can put them at higher risk of undernutrition--a problem that can be highest among orphaned or street children. Evidence on nutritional risk and its contributing factors among this segment is lacking in the city of Dire Dawa, where many children are on the streets with limited access to proper care. The aim of this study was to identify determinants of undernutrition among street adolescents in Ethiopia. MethodsA community-based cross-sectional study was conducted with 358 street adolescents 12 to 19 y of age in Dire Dawa from January to February 2022. After conducting a preliminary survey and registering all available street children, a complete enumeration was made. For data collection, an interviewer-administered questionnaire was used along with anthropometric measurements using standard procedures. Height-for-age (HAZ) and body mass index (BMI) for age z scores were computed using World Health Organization (WHO) Anthroplus and statistical analysis was done using SPSS software version 26. Independent variables with P < 0.25 in bivariable analysis were included in multivariable logistic regression, and variables with P < 0.05 were considered statistically significant. A crude and adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. ResultsAmong 358 street adolescents, 44% (38.9–49.5) and 56% (50.8–61.4) were thin and stunted, respectively. Thinness among street children could be associated with a longer stay on the street (AOR, 1.65; 95% CI, 1.40–1.90), infrequent meal frequency (AOR, 1.32; 95% CI, 1.19–1.45), unprotected drinking water sources (AOR, 1.55; 95% CI, 1.40–1.71), alcohol drinking (AOR, 2.92; 95% CI, 1.51–4.32), inadequately diversified diet (AOR, 1.21; 95% CI, 1.06–1.36), and illness history (AOR, 1.34; 95% CI, 1.21–1.47). Moreover, odds of stunting were significantly associated with staying on the street (AOR, 1.32; 1.10–1.54), unsafe drinking water (AOR, 1.63; 95% CI, 1.13–2.66), smoking cigarettes (AOR, 1.54; 95% CI, 1.21–2.52), dietary diversity (AOR, 2.34; 95% CI, 1.43–3.82), and acute illness (AOR, 2.12; 95% CI, 1.31–5.23). ConclusionThinness and stunting were prevalent among street children and are associated with infrequent meals, poor dietary diversity, substance abuse, unsafe water sources, and illness histories that could be targeted for multisectoral interventions.

The effect of a comprehensive typhoid conjugate vaccine campaign on antimicrobial prescribing in children in Harare, Zimbabwe: a mixed methods study

Vaccines prevent infections and could subsequently reduce antimicrobial use. A 1-week mass vaccination campaign was done with Typbar-TCV (Bharat Biotech, Hyderabad, India) between Feb 25 and March 4, 2019. We investigated whether this typhoid conjugate vaccine campaign could affect antimicrobial prescribing in children presenting to primary care in Harare, Zimbabwe. In this mixed methods study, data for acute paediatric outpatient consultations between Jan 1, 2018, and March 31, 2020, were collected from five clinics in Harare. Interrupted time series analysis was done to compare prescription data before and after the campaign. To contextualise findings, qualitative data were collected between April 20, 2021, and July 20, 2022, comprising ethnographic research (ie, workshops, surveys, observations, and interviews) in 14 clinics. Ethnographic data were used for thematic analysis. The primary outcome was monthly antimicrobial prescriptions in children aged 6 months to 15 years, normalised by the number of trauma events in all age groups. In the data collection period, 27 107 paediatric consultations were recorded. 17 951 (66·2%) of 27 107 children were prescribed antimicrobials. Despite the perceived reduction in typhoid cases and a decreasing trend in the prescription of antimicrobials commonly used to treat typhoid (ie, ciprofloxacin and azithromycin), mass vaccination with Typbar-TCV did not affect the total rate of antimicrobials (adjusted rate ratio, 1·20, 95% CI 0·70-2·05, p=0·51) or the rate of typhoid antimicrobials prescribed (0·93, 0·44-1·96, p=0·85). Unsafe water sources and insufficient diagnostic services were reported to contribute to the continued disease burden and antimicrobial prescription. Non-specific febrile illness caused by confirmed or suspected typhoid is a common cause of antimicrobial use in endemic areas. Although effective in preventing typhoid fever, we were unable to identify any effect of Typbar-TCV on antimicrobial prescribing. Ethnographic research showed the effect of contextual factors on antimicrobial prescribing, including concerns regarding safe water access, appropriate sewage disposal, health-care and diagnostic availability. To realise effects beyond disease burden reduction, holistic approaches addressing these concerns are needed so that the value of vaccines mitigating the effects of antimicrobial use as a driver of antimicrobial resistance is fully achieved. Wellcome Trust. For the Shona translation of the abstract see Supplementary Materials section.

Product preferences and willingness to pay for potable water delivery: Experimental evidence from rural Bihar, India.

Despite dramatic reductions in global risk exposures to unsafe water sources, lack of access to clean water remains a persistent problem in many rural and last-mile communities. A great deal is known about demand for household water treatment systems; however, similar evidence for fully treated water products is limited. This study evaluates an NGO-based potable water delivery service in rural Bihar, India, meant to stand-in for more robust municipal treated water supply systems that have yet to reach the area. We use a random price auction and discrete choice experiment to examine willingness to pay (WTP) and stated product preferences, respectively, for this service among 162 households in the region. We seek to determine the impact of short-term price subsidies on demand for water delivery and the extent to which participation in the delivery program leads to changes in stated preferences for service characteristics. We find that mean WTP for the first week of service is roughly 51% of market price and represents only 1.7% of median household income, providing evidence of untapped demand for fully treated water. We also find mixed evidence on the effect of small price subsidies for various parts of the delivery service, and that one week of initial participation leads to significant changes in stated preferences for the taste of the treated water as well as the convenience of the delivery service. While more evidence is needed on the effect of subsidies, our findings suggest that marketing on taste and convenience could help increase uptake of clean water delivery services in rural and last-mile communities that have yet to receive piped water. However, we caution that these services should be seen as a stopgap, not a substitute for piped municipal water systems.

Case report: a rare presentation of typhoid fever due to eating over-ripened pineapple.

A 26-year-old black African male health care worker was admitted to the clinic on 21 July 2022, with a significant chief complaint of headache, loss of appetite, and watery diarrhea. The admitted patient presented with a 2-day history of hyperthermia, headache, loss of appetite, and watery diarrhea, as well as back pain, joint weakness, and insomnia. The H antigen titer was positive, which was 1:189 greater than the normal range and showed the past history of S. typhi infection. The O antigen titer value detected was a false negative result because it was done before the 7-day onset of fever. On admission, ciprofloxacillin 500mg was given orally twice a day for 7 days to treat typhoid by inhibiting the deoxyribonucleic acid replication of S. typhi by preventing S. typhi deoxyribonucleic acid topoisomerase and deoxyribonucleic acid gyrase. Typhoid fever pathogenesis is based on pathogenic factors, infecting species, and host immunity. By using the agglutination biochemical test, the Widal test was able to identify the patient's bloodstream as carrying the S. typhi bacteria that causes typhoid fever. Due to contaminated food or unsafe drinking water sources, typhoid fever is associated with travel to developing nations.

부산지역 먹는물공동시설의 자연방사성물질 분포 특성

A total of 150 spring water fountains in Busan were investigated to identify the distribution characteristics of the natural radioactive materials radon and uranium. Radon was detected at levels from 0.0 to 120.7 Bq/L, with an average of 17.2 Bq/L and a median of 7.4 Bq/L, while uranium levels ranged from 0.0 to 2.1 ㎍/L, with an average of 0.1 ㎍/L and a median of 0.0 ㎍/L. Radon did not exceed the guideline level for Drinking water in Korea (148 Bq/L) while uranium did not exceed the Standards for Drinking water in Korea (30 ㎍/L). The spring water fountains in Busan were characterized by the presence of granite, volcanic, or sedimentary rock. Average radon and uranium levels were highest in granite, followed by sedimentary and volcanic rock, and the highest concentration was found in the granite area. Correlation analysis of the radon and uranium concentration showed significant correlation p<0.01. As to physicochemical water quality, showed positive correlation with fluoride in common. Compared to the public drinking water facilities in other areas, the Busan area contained radon and uranium at safe drinking levels. However, to provide residents with safer drinking water, frequent monitoring of elements not covered by water quality standards, such as natural radiation, is necessary for public drinking water facilities that take water from unsafe raw water sources.

The burden of diarrhoeal diseases in the Democratic Republic of Congo: a time-series analysis of the global burden of disease study estimates (1990–2019)

BackgroundDiarrhoeal diseases are important causes of disability and mortality being one of the main causes of mortality in the Democratic Republic of Congo (DRC). One of the largest and wealthiest African countries, DRC has been for long subjected to continuous political and economic instability, conflicts and disease outbreaks. This study aimed to address the knowledge gap in understanding how prevalence, mortality and burden of diseases in DRC changed over time and examine the influence of specific factors in these disease-related outcomes.MethodsA time-series analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 estimates was performed to describe prevalence, years lived with disabilities (YLDs) and mortality due to diarrhoeal diseases, by age-group and sex, between 1990–2019 in DRC. The contribution of water, sanitation and hygiene (WASH) and child malnutrition risk factors to these outcomes was also analysed. Piecewise regression analysis was used to assess trends over time.ResultsThe overall age-standardised prevalence of diarrhoeal diseases for both sexes in DRC was 1350.84 (UI:1240.16—1461.62) cases per 100,000 people in 1990. The prevalence increased until 2019, also fuelled by the movement of Rwandan refugees to DRC and First/Second Congo wars between 1996–2003. Age-standardised prevalence and mortality were consistently higher in males, compared to females, decreasing by 42% and 54%, respectively, between 1990 and 2019. Overall prevalence was also usually higher in over 70 years old, except between 1998–2003 when mortality in under five years old was the highest. Unsafe water sources and child wasting among under five years old were the main contributors to YLDs and deaths associated to diarrhoeal diseases in DRC.ConclusionDiarrhoeal diseases are important and preventable causes of disability and mortality in DRC. National measures of surveillance and cost-effective interventions targeting the identified risk groups could be effective in reducing its prevalence and associated burden.

Role of Seasonal Variation on The Prevalence and Risk Factors of Trichuriasis Among the Aboriginal Community in Malaysia.

SummaryTrichuris trichiura is a soil-transmitted helminth prevalent in developing countries with poor, inadequate sanitation and unsafe water sources. In Malaysia, the prevalence of trichuriasis is relatively high among the aboriginal community due to poverty and poor sanitation. However, there are few studies to determine the seasonal variation on the prevalence and risk factors to acquire Trichuris trichiura infection in Malaysia. The present study found higher Trichuris trichiura infection during the dry season (63.6%; 138/217) in comparison to the wet season (55.5%; 142/256). Low household income, low education level and practice of open defecation were significant risk factors to acquire Trichuris trichiura infection during the wet season. Usage of untreated water supplies for daily activities was a risk factor to acquire trichuriasis during the dry season. This study highlighted that poverty and poor sanitation practices as well as drinking untreated water put the aborigines at high risk to acquire trichuriasis. Therefore, health education, improved sanitation and provision of treated water supply are recommended for the prevention and control of Trichuris trichiura infections in the aboriginal community.

Population health outcomes in Nigeria compared with other west African countries, 1998–2019: a systematic analysis for the Global Burden of Disease Study

SummaryBackgroundPopulation-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries.MethodsIn this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository.FindingsBetween 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2–66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0–9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9–6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1–3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7–2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians.InterpretationHealth outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health.FundingThe Bill & Melinda Gates Foundation.

Precipitation variability and risk of infectious disease in children under 5 years for 32 countries: a global analysis using Demographic and Health Survey data

Precipitation variability is a potentially important driver of infectious diseases that are leading causes of child morbidity and mortality worldwide. Disentangling the links between precipitation variability and disease risk is crucial in a changing climate. We aimed to investigate the links between precipitation variability and reported symptoms of infectious disease (cough, fever, and diarrhoea) in children younger than 5 years. We used nationally representative survey data collected between 2014 and 2019 from Demographic and Health Survey (DHS) surveys for 32 low-income to middle-income countries in combination with high-resolution precipitation data (via the Climate Hazards Group InfraRed Precipitation with Station dataset). We only included DHS data for which interview dates and GPS coordinates (latitude and longitude) of household clusters were available. We used a regression modelling approach to assess the relationship between different precipitation variability measures and infectious disease symptoms (cough, fever, and diarrhoea), and explored the effect modification of different climate zones and disease susceptibility factors. Our global analysis showed that anomalously wet conditions increase the risk of cough, fever, and diarrhoea symptoms in humid, subtropical regions. These health risks also increased in tropical savanna regions as a result of anomalously dry conditions. Our analysis of susceptibility factors suggests that unimproved sanitation and unsafe drinking water sources are exacerbating these effects, particularly for rural populations and in drought-prone areas in tropical savanna. Weather shifts can affect the survival and transmission of pathogens that are particularly harmful to young children. As our findings show, the health burden of climate-sensitive infectious diseases can be substantial and is likely to fall on populations that are already among the most disadvantaged, including households living in remote rural areas and those lacking access to safe water and sanitation infrastructure. University of California, San Diego FY19 Center Launch programme.

Socio-Environmental Determinants and Human Health Exposures in Arid and Semi-Arid Zones of Iran-Narrative Review.

Lifestyle is different in arid and semi-arid zones. However, where people are born and live have a lasting influence on their social and environmental exposure. This review focuses on the, various dimensions of environmental health imbalance inequality especially in significant environmental sources such as (ie, air, water, soil) among provinces that creates a big health gap in the center, East and the Southeast of Iran. Thus, the population of the arid and semi-arid zones of Iran is facing respiratory, cardiovascular, cancer and infection diseases linked to environmental problems such as chemical and microbial pollution due to air pollution and unsafe water sources, respectively. The prevalence of certain types of cancer such as skin, stomach, bladder, prostate and colorectal cancer together with some respiratory and cardiovascular diseases in arid and semiarid zones such as Kerman, Yazd, etc., has been reported in comparison with other provinces frequently. These impacts have effects on multiple levels of health security in those zones. Based on these concerns, we propose key questions that should guide research in the context of the socio environmental science to support science-based management actions in Iran and other similar semi-arid areas worldwide.

Human fascioliasis in Africa: A systematic review.

Fascioliasis is a globally distributed, parasitic zoonosis, caused by Fasciola hepatica and F. gigantica. A comprehensive overview of the epidemiology of human fascioliasis in Africa is missing up to now. Therefore, our objective was to conduct a systematic review aiming to summarize recent knowledge on the distribution, prevalence, and risk factors of human fascioliasis in Africa. A key word search was performed in PubMed, Web of Science and Africa Wide, to gather relevant literature, published between the 1st of January 2000 and 31st of December 2020. A total of 472 records were initially retrieved, with 40 full text articles retained for the qualitative synthesis. Human fascioliasis was reported in 12 African countries, namely Algeria, Angola, Cape Verde, Egypt, Ethiopia, Ghana, Morocco, Nigeria, Senegal, South-Africa, Tanzania and Tunisia. The majority of the studies was conducted in Egypt. A total of 28 records were population surveys. Coproscopy was the most commonly used tool for fascioliasis diagnosis in these surveys. Gender (being female), consumption of raw vegetables/seeds, age, owning livestock, and use of unsafe drinking water sources, were identified as risk factors in 7 studies. Furthermore, 43 case reports were retrieved, described in 12 studies. Eosinophilia was present in 39 of these cases, while 11 had positive coproscopy results. Eight cases described having eaten raw wild vegetables. Overall, the low number and quality of records retrieved indicates that human fascioliasis remains a truly neglected disease in Africa, and more epidemiological studies are urgently needed to both establish the actual distribution as well as risk factors on the continent.

Domestic drinking water management: Quality assessment in Oforikrom municipality, Ghana.

Drinking water in Ghana is estimated at 79%, but this only represents the proportion of the population with access to improved drinking water sources without regard to the quality of water consumed. This study investigated the quality of household drinking water sources in the Oforikrom municipality where potable water requirements are on the rise due to an ever-increasing population. Both quantitative and qualitative methods were employed in this study. One Hundred households were randomly selected and interviewed on the available options for drinking water and household water treatment and safe storage. A total of 52 points of collection (POC) and 97 points of use (POU) water samples from households were collected for physicochemical and microbial water quality analysis. Amongst the available drinking water options, sachet water (46%) was mostly consumed by households. Water quality analysis revealed that the physicochemical parameters of all sampled drinking water sources were within the Ghana Standards Authority (GSA) recommended values expected for pH (ranging from 4.50 to 7.50). For the drinking water sources, bottled (100%, n = 2) and sachet water (91%, n = 41) showed relatively good microbial water quality. Generally, POC water samples showed an improved microbial water quality in comparison to POU water samples. About 38% (n = 8) of the households practicing water quality management, were still exposed to unsafe drinking water sources. Households should practice good water quality management at the domestic level to ensure access to safe drinking water. This may include the use of chlorine-based disinfectants to frequently disinfect boreholes, wells and storage facilities at homes.

Socioeconomic determinants of Schistosoma mansoni infection using multiple correspondence analysis among rural western Kenyan communities: Evidence from a household-based study.

Socioeconomic inequality including wealth distribution is a barrier to implementation of health policies. Wealth distribution can be measured effectively using household data on durable assets. Compared to other methods of analysing Socio-economic Status (SES) using durable assets, Multiple Correspondence Analysis (MCA) can create more reliable wealth quintiles. We therefore evaluated socioeconomic determinants of Schistosoma mansoni using MCA on household data among adult population in western Kenya. The hypothesis of this study was that MCA would be a useful predictor of S. mansoni prevalence and/or intensity. Twelve villages, 6 villages that had showed the greatest decrease in S. mansoni prevalence (Responder villages) and 6 villages that showed relatively lower decrease (Hotspot villages) between the year 2011 and 2015 were randomly selected for this study. This was according to a previous Schistosomiasis Consortium for Operational Research and Elimination (SCORE) report from western Kenya. From each village, convenience sampling was used to identify 50 adults from 50 households for inclusion in this study. An interview with a questionnaire based upon MCA indicators was conducted. One stool sample from each of the 600 adults was examined based on four slides for S. mansoni eggs using Kato Katz technique. Mean Eggs per gram(EPG) was calculated by taking the average of the readings from the four slides. A log binomial regression model was used to identify the influence of the various age-groups(<30 years, 30-60 years and >60 years), household size, wealth class, occupation, education status, main water supply, sex and sub-county of residence on S. mansoni infection. EPG was then compared across variables that were significant based on multivariate log binomial model analysis using a mixed model. Overall prevalence of S. mansoni was 41.3%. Significantly higher prevalence of S. mansoni were associated with males, those aged below 30 years, those who use unsafe water sources (unprotected wells, lakes and rivers), residents of Rachuonyo North, Hotspot villages and those earning livelihood from fishing. Only sex and household size were significant predictors in the multivariate model. Males were associated with significantly higher prevalence compared to the females (aPR = 1.37; 95% CI = 1.14-1.66). In addition, households with at least four persons had higher prevalence compared to those with less than four (aPR = 1.29; 95% CI = 1.03-1.61). However, there was no difference in prevalence between the wealth classes(broadly divided into poor and less poor categories). Intensity of infection (Mean EPG)was also significantly higher among males, younger age group, Rachuonyo North residents and Hotspot Villages. Socioeconomic status based on an MCA model was not a contributing factor to S. mansoni prevalence and/or intensity possibly because the study populations were not sufficiently dissimilar. The use of convenience sampling to identify participants could also have contributed to the lack of significant findings.

Examining local perspectives on the influence of climate change on the health of Hamer pastoralists and their livestock in Ethiopia

This study explores the perceived influence of climate change on the health of Hamer pastoralists and their livestock in south-western Ethiopia. A combination of focus group discussions and key informant interviews were conducted with Hamer communities as well as local health workers, animal health workers and non-governmental organisation (NGO) staff. Thematic framework analysis was used to analyse the data. Reductions in rangeland, erratic rainfall, recurrent droughts and loss of seasonality were perceived to be the biggest climate challenges influencing the health and livelihoods of the Hamer. Communities were travelling greater distances to access sufficient grazing lands, and this was leading to livestock deaths and increases in ethnic violence. Reductions in suitable rangeland were also precipitating disease outbreaks in animals due to increased mixing of different herds. Negative health impacts in the community stemmed indirectly from decreases in livestock production, uncertain crop harvests and increased water scarcity. The remoteness of grazing lands has resulted in decreased availability of animal milk, contributing to malnutrition in vulnerable groups, including children. Water scarcity in the region has led to utilisation of unsafe water sources resulting in diarrhoeal illnesses. Further, seasonal shifts in climate-sensitive diseases such as malaria were also acknowledged. Poorly resourced healthcare facilities with limited accessibility combined with an absence of health education has amplified the community’s vulnerability to health challenges. The resilience and ambition for livelihood diversification amongst the Hamer was evident. The introduction of camels, increase in permanent settlements and new commercial ideas were transforming their livelihood strategies. However, the Hamer lack a voice to express their perspectives, challenges and ambitions. There needs to be collaborative dynamic dialogue between pastoral communities and the policy-makers to drive sustainable development in the area without compromising the values, traditions and knowledge of the pastoralists.