#Water and #Sanitation #Deficits Take a Toll in Armed #Conflict Regions (JAMA, summary)

[Source: Journal of American Medical Association, full page: (LINK). Summary, edited.]

Global Health / May 21, 2019

Water and Sanitation Deficits Take a Toll in Armed Conflict Regions

M.J. Friedrich

JAMA. 2019;321(19):1861. doi:10.1001/jama.2019.6186

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Diarrheal diseases resulting from scarce clean water and sanitation in countries with protracted armed conflicts take more children’s lives than the violence itself, according to a recent United Nations Children’s Fund (UNICEF) report.

(…)

Keywords: Society; Poverty; Public Health; Wars.

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Estimates of the #global, regional, and national #morbidity, #mortality, and #aetiologies of #diarrhoea in 195 countries:… (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Diarrhoeal Disease Collaborators †

Published: September 19, 2018 / DOI: https://doi.org/10.1016/S1473-3099(18)30362-1

 

Summary

Background

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990–2016 and assesses how the burden of diarrhoea has changed in people of all ages.

Methods

We modelled diarrhoea mortality with a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modelled diarrhoea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health-care data. Diarrhoea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhoea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhoea. Each modelled estimate accounted for uncertainty.

Findings

In 2016, diarrhoea was the eighth leading cause of death among all ages (1 655 944 deaths, 95% uncertainty interval [UI] 1 244 073–2 366 552) and the fifth leading cause of death among children younger than 5 years (446 000 deaths, 390 894–504 613). Rotavirus was the leading aetiology for diarrhoea mortality among children younger than 5 years (128 515 deaths, 105 138–155 133) and among all ages (228 047 deaths, 183 526–292 737). Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhoea, responsible for 80·4% (95% UI 68·2–85·0), 72·1% (34·0–91·4), and 56·4% (49·3–62·7) of diarrhoea deaths in children younger than 5 years, respectively. Prevention of wasting in 1762 children (95% UI 1521–2170) could avert one death from diarrhoea.

Interpretation

Substantial progress has been made globally in reducing the burden of diarrhoeal diseases, driven by decreases in several primary risk factors. However, this reduction has not been equal across locations, and burden among adults older than 70 years requires attention.

Funding

Bill & Melinda Gates Foundation.

Keywords: Global Health; Diarrhea; Rotavirus; Worldwide.

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Impact of adding #handwashing and #water #disinfection promotion to oral #cholera #vaccination on diarrhoea-associated hospitalization in Dhaka, #Bangladesh: evidence from a cluster randomized control trial (Int J Infect Dis., abstract)

[Source: International Journal of Epidemiology, full page: (LINK). Abstract, edited.]

Impact of adding hand-washing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial

Nusrat Najnin, Karin Leder, Firdausi Qadri, Andrew Forbes, Leanne Unicomb, Peter J Winch, Pavani K Ram, Elli Leontsini, Fosiul A Nizame, Shaila Arman, Farzana Begum, Shwapon K Biswas, John D Clemens, Mohammad Ali, Alejandro Cravioto, Stephen P Luby

International Journal of Epidemiology, dyx187, https://doi.org/10.1093/ije/dyx187

Published: 02 September 2017 – Accepted: 15 August 2017

Citation: Nusrat Najnin, Karin Leder, Firdausi Qadri, Andrew Forbes, Leanne Unicomb, Peter J Winch, Pavani K Ram, Elli Leontsini, Fosiul A Nizame, Shaila Arman, Farzana Begum, Shwapon K Biswas, John D Clemens, Mohammad Ali, Alejandro Cravioto, Stephen P Luby; Impact of adding hand-washing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial, International Journal of Epidemiology, , dyx187, https://doi.org/10.1093/ije/dyx187

© 2017 Oxford University Press

 

Abstract

Background:

Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specified secondary outcome of a cluster-randomized controlled trial among >400 000 low-income residents in Dhaka, Bangladesh, we examined the impact of cholera vaccination plus a behaviour change intervention on diarrhoea-associated hospitalization.

Methods:

Ninety neighbourhood clusters were randomly allocated into three areas: cholera-vaccine-only; vaccine-plus-behaviour-change (promotion of hand-washing with soap plus drinking water chlorination); and control. Study follow-up continued for 2 years after intervention began. We calculated cluster-adjusted diarrhoea-associated hospitalization rates using data we collected from nearby hospitals, and 6-monthly census data of all trial households.

Results:

A total of 429 995 people contributed 500 700 person-years of data (average follow-up 1.13 years).Vaccine coverage was 58% at the start of analysis but continued to drop due to population migration. In the vaccine-plus-behaviour-change area, water plus soap was present at 45% of hand-washing stations; 4% of households had detectable chlorine in stored drinking water. Hospitalization rates were similar across the study areas [events/1000 person-years, 95% confidence interval (CI), cholera-vaccine-only: 9.4 (95% CI: 8.3–10.6); vaccine-plus-behaviour-change: 9.6 (95% CI: 8.3–11.1); control: 9.7 (95% CI: 8.3–11.6)]. Cholera cases accounted for 7% of total number of diarrhoea-associated hospitalizations.

Conclusions:

Neither cholera vaccination alone nor cholera vaccination combined with behaviour-change intervention efforts measurably reduced diarrhoea-associated hospitalization in this highly mobile population, during a time when cholera accounted for a small fraction of diarrhoea episodes. Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating faeces from the environment, food and water, with minimal behavioural demands on impoverished communities, remain an important area for research.

Vaccine, hand-washing, water treatment, diarrhoea, hospitalization

Topic: cholera – chlorine – diarrhea – bangladesh – cholera vaccines – disinfection – feces – food – soap – vaccines – pathogenic organism – washing hands – behavioral change – low income – community – potable water

Issue Section: – Original Article

 

Key Messages

  • Neither cholera vaccination alone nor cholera vaccination combined with hand-washing and water treatment promotion measurably reduced diarrhoea-associated hospitalization.
  • The possible reasons for lack of impact of cholera vaccine alone on all-cause diarrhoea hospitalization were: cholera incidence was too low during the study period; and high migration rate diluted cholera vaccination coverage of the intervention areas during the period of the analysis.
  • The reason for the lack of impact of the behavioural intervention on diarrhoea-associated hospitalization may have been because of the low uptake.
  • Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating faeces from the environment, food and water in impoverished communities remain an important area for research.

Keywords: Cholera; Diarrhea; Vaccines; Handwashing; Bangladesh.

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#Congo DR, Tshopo: 5 #décès dus à la #diarrhée à Belika (Radio Okapi, Nov. 25 ‘15)

[Source: Radio Okapi, full page: (LINK).]

Tshopo: 5 décès dus à la diarrhée à Belika [      ]

Cinq personnes sont décédées de la diarrhée accompagnée de vomissement sur les trente-deux cas enregistrés, depuis octobre dernier, dans la localité Belika, au Point kilométrique 211, en territoire de Bafwasende (Tshopo). Le médecin directeur de l’hôpital général de Bafwasende, docteur Pilili attribue la recrudescence de cette diarrhée au manque d’eau potable dans cette localité.

(…)

Keywords: Congo Dem. Rep., Acute Watery Diarrhea.

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