Environmental Health Update – Oct 26, 2003

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WHO Bulletin – September 2003

  • Community wells to mitigate the arsenic crisis in Bangladesh,  Alexander van Geene
  • More Articles

 Emerging Infectious Diseases – October 2003

  • Environmental Risk and Meningitis Epidemics in Africa, A.M. Molesworth
  • More Articles

 New Reports/Websites

Abstracts of Recent Studies

1: Clin Infect Dis. 2003 Aug 1;37(3):398-405. Epub 2003 Jul 22. 
Cholera, diarrhea, and oral rehydration therapy: triumph and indictment.
Guerrant RL, Carneiro-Filho BA, Dillingham RA.
Center for Global Health, School of Medicine, Division of Infectious Diseases
and International Health, University of Virginia, Charlottesville, VA 22908,
USA. [email protected] 
Cholera drove the sanitary revolution in the industrialized world in the 19th
century and now is driving the development of oral rehydration therapy (ORT) in
the developing world. Despite the long history of cholera, only in the 1960s and
1970s was ORT fully developed. Scientists described this treatment after the
discovery of the intact sodium-glucose intestinal cotransport in patients with
cholera. This new understanding sparked clinical studies that revealed the
ability of ORT to reduce the mortality associated with acute diarrheal disease.
Despite the steady reductions in mortality due to acute dehydrating diarrheal
diseases achieved by ORT, the costly morbidity due to these diseases remains,
the result of a failure to globalize sanitation and to control the developmental
impact of diarrheal diseases and their associated malnutrition. New advances in
oral rehydration and nutrition therapy and new methods to recognize its costs
are discussed in this review.

2: Int J Hyg Environ Health. 2003 Aug;206(4-5):269-78.  
Global urbanization and impact on health.
Moore M, Gould P, Keary BS.
Office of Global Health Affairs, U.S. Department of Health and Human Services,
Rockville, Maryland 20857, USA. [email protected] 
Nearly half the world's population now lives in urban settlements. Cities offer
the lure of better employment, education, health care, and culture; and they
contribute disproportionately to national economies. However, rapid and often
unplanned urban growth is often associated with poverty, environmental
degradation and population demands that outstrip service capacity. These
conditions place human health at risk. Reliable urban health statistics are
largely unavailable throughout the world. Disaggregated intra-urban health data,
i.e., for different areas within a city, are even more rare. Data that are
available indicate a range of urban health hazards and associated health risks:
substandard housing, crowding, air pollution, insufficient or contaminated
drinking water, inadequate sanitation and solid waste disposal services,
vector-borne diseases, industrial waste, increased motor vehicle traffic, stress
associated with poverty and unemployment, among others. Local and national
governments and multilateral organizations are all grappling with the challenges
of urbanization. Urban health risks and concerns involve many different sectors,
including health, environment, housing, energy, transportation, urban planning,
and others. Two main policy implications are highlighted: the need for
systematic and useful urban health statistics on a disaggregated, i.e.,
intra-urban, basis, and the need for more effective partnering across sectors.
The humanitarian and economic imperative to create livable and sustainable
cities must drive us to seek and successfully overcome challenges and capitalize
on opportunities. Good urban planning and governance, exchange of best practice
models and the determination and leadership of stakeholders across disciplines,
sectors, communities and countries will be critical elements of success.

3: BMC Public Health. 2003 Sep 3;3(1):29. 
Demographic and parasitic infection status of schoolchildren and sanitary
conditions of schools in Sanliurfa, Turkey.
Ulukanligil M, Seyrek A.
Harran University Medical School, Department of Microbiology, Sanliurfa, Turkey.
[email protected] 
BACKGROUND: The design and development of school health programmes will require
information at demographic characteristics of schoolchildren and the major
health burdens of the school-age group, the opportunities for intervention and
the appropriateness of the available infrastructure. This study aims to analyse
demographic and parasitic infections status of schoolchildren and sanitary
conditions of schools in Sanliurfa province of south-eastern Turkey. METHOD:
Three primary schools were randomly selected in the shantytown, apartment and
rural districts. A total of 1820 schoolchildren between 7-14 years age were took
part to the survey of whom 1120 (61.5%) were boys and 700 (38.4%) were girls. A
child form (including child's name, sex, age, school grade and parasitic
infections) and school survey form (including condition of water supply,
condition of latrines, presence of soaps on the basins and presence of garbage
piles around to the schools) were used for demographic, parasitic and sanitary
surveys. Stool samples were examined by cellophane thick smear technique for the
eggs of intestinal helminths. RESULTS: The demographic survey showed that number
of schoolchildren was gradually decreased as their age's increase in shantytown
school. The sex ratio was proportional until the second grade, after which the
number of females gradually decreased in children in shantytown and rural
schools while, in apartment area, schoolchildren was proportionally distributed
between age groups and gender even the high-grade students. The prevalence of
helminthic infections was %77.1 of the schoolchildren in shantytown, 53.2% in
apartment district and 53.1% of rural area. Ascaris lumbricoides was the most
prevalent species and followed by Trichuris trichiura, Hymenolepis nana and
Taenia species in three schools. Sanitation survey indicated that the tap water
was limited in shantytown school, toilet's sanitation was poor, available no
soaps on lavatories and garbage piles were accumulated around the schools in
shantytown and rural area, while, the school in apartment area was well
sanitised. CONCLUSIONS: These results indicated that burden of parasitic
infections and poor sanitation conditions constituted public health importance
among to the shantytown schoolchildren. School health programmes including
deworming and sanitation activities through the health education and improvement
of sanitation conditions in the schools have a potential to better health and
education for schoolchildren. These programmes also offer the potential to reach
significant numbers of population in the shantytown schools with high level of

4: Am J Phys Anthropol. 2003 Sep;122(1):85-97.  
Diarrhea, respiratory infections, protozoan gastrointestinal parasites, and
child growth in Kathmandu, Nepal.
Moffat T.
Department of Anthropology, McMaster University, Hamilton, Ontario L8S 4L9,
Canada. [email protected]
The differential impact of diarrhea, respiratory infections, and protozoan
parasitism on growth is investigated among children under five years of age
living in periurban Kathmandu, Nepal. The children's parents are all
carpet-making workers who live in an environment with crowded living conditions,
poor sanitation, and contaminated water. Anthropometric data, both
cross-sectional and longitudinal, were collected over a 9-month period.
Morbidity data were gathered from maternal reports, and a subsample of
children's stools were examined for gastrointestinal parasites. In a comparison
of current growth status and growth velocity for children with and without
diarrhea and respiratory infections, it is found that body weight is most
affected by infections, particularly for children under 24 months of age. For a
subsample of children whose stools were tested for parasites, there is a
statistically significant association between stunting (low height-for-age) and
the presence of a protozoan gastrointestinal parasite. It is concluded that
although growth faltering is associated with diarrhea and respiratory
infections, the impact of these infections is of less importance for long-term
linear growth retardation than is infection by protozoan gastrointestinal
parasites. Copyright 2003 Wiley-Liss, Inc.

5: Arch Environ Health. 2003 Feb;58(2):83-91.  
Water chlorination and birth defects: a systematic review and meta-analysis.
Hwang BF, Jaakkola JJ.
Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins
University, Baltimore, Maryland, USA.
The authors used the Medline data retrieval system for 1966-2001 to identify and
synthesize the epidemiological evidence for adverse effects of prenatal exposure
to chlorination byproducts on birth defects. For 5 studies that provided
estimates of the effect of exposure on 1 or several birth defects, the authors
calculated summary odds ratios and 95% confidence intervals using the
Mantel-Haenszel method for a fixed-effects model, and the DerSimonian-Laird
method for a random-effects model. The results of this meta-analysis provide
evidence for an effect of exposure to chlorination byproducts on the risk of any
birth defect, and of neural tube and urinary system defects. The results for
respiratory system, major cardiac, and oral cleft defects were heterogeneous and
inconclusive. Differences in the susceptibility of populations, and different
approaches in exposure assessment, may explain the heterogeneity of the results.

6: Southeast Asian J Trop Med Public Health. 2003 Jun;34(2):343-51.  
Causes of childhood diarrhea as perceived by mothers in the Punjab, Pakistan.
Nielsen M, Hoogvorst A, Konradsen F, Mudasser M, van der Hoek W.
International Water Management Institute (IWMI), Lahore, Pakistan.
This study was carried out in the southern Punjab, Pakistan, to outline the
causes of childhood diarrhea as perceived by mothers. Two hundred households in
ten villages were randomly selected. Information was obtained from mothers,
through a questionnaire, in-depth interviews, and direct observations. The focus
was on obtaining information from mothers of children who were below five years
of age. Causes of diarrhea reported by mothers were categorized in seven
different domains. Causes relating to the digestive system, especially
consumption of too much food, were the most important, followed by causes
pertaining to contamination and those pertaining to the humoral theory of 'hot'
and 'cold'. The mothers' health status was perceived as determining the health
of her child through her breast milk. Through in-depth interviews, diarrhea as a
symptom of envy and malice was brought up. The study draws attention to the
complexity and heterogeneity of beliefs, attitudes and practices concerning
diarrhea. This makes it difficult to come up with general rules for health
education campaigns. Rather, in health education, the outstanding 'good' and
'bad' behavior should be selected and should be the focus. On the other hand,
the heterogeneity of beliefs, attitudes and practices prevailing in the
community could make mothers more receptive to new ideas than when a small set
of rigid cultural norms would dominate thinking on disease transmission and
hygiene. The study found that despite the mother's central role as caretaker one
should not focus only on the traditional mother-child relationship, but also
include the husband-wife relationship, and target other individuals involved in
setting norms within the household or within the nearby community.

7: Rev Panam Salud Publica. 2003 Jul;14(1):31-41.  
Prevalence of endoparasitic infection in children and its relation with cholera
prevention efforts in Mexico.
Faulkner CT, Garcia BB, Logan MH, New JC, Patton S.
University of Tennessee, Department of Comparative Medicine, Knoxville,
Tennessee 37796-4543, United States of America. [email protected] 
OBJECTIVE: To investigate whether increased knowledge and use of public health
measures promoted for cholera prevention is reflected in lower prevalence of
parasitic infection in households in a community in the state of Tamaulipas,
Mexico, that is close to the border with the United States of America. METHODS:
Between 1994 and 1997, fecal samples from 438 children were collected through
convenience sampling and then examined for helminth eggs/larvae and protozoan
cysts as biologic indicators of household compliance with recommended cholera
prevention measures. The suggested measures were to wash hands before meals and
after defecation, to drink purified water, to wash fruits and vegetables, and to
eat well-cooked food. In addition, information on the knowledge of and the use
of cholera preventive measures was collected by interviews with adult informants
in 252 households (186 of those households also provided a fecal sample for
analysis). RESULTS: Parasitic infections occurred in 131 of the 438 children
(30%), who resided in 79 of the 186 households (42%) that provided fecal
samples. Giardia lamblia accounted for 12.5% of all infections. Infections with
Hymenolepis nana, Ascaris lumbricoides, Trichuris trichiura, Enterobius
vermicularis, Ancylostoma/Necator, Strongyloides stercoralis, Entamoeba coli,
Entamoeba hartmanni, Entamoeba histolytica, Endolimax nana, and Iodamoeba
butschlii were also noted. Infected children were older and more often had an
infected sibling. Households with three or more children were also more likely
to have an infected child. The primary caregivers in the households where at
least one child had a parasitic infection were distinguished by their inability
to list at least three cholera prevention measures from memory. CONCLUSIONS: The
42% household prevalence of parasitic infection was relatively high and
indicates that some residents of this community may not have fully embraced the
public health education efforts promoted for prevention of cholera. The
occurrence of nonpathogenic protozoan parasites such as Endolimax nana,
Entamoeba coli, Entamoeba hartmanni, and I. butschlii are important
bioindicators for the persistence of unhygienic behaviors that increase the risk
of cholera and other infectious diseases dependent on fecal-oral transmission.
Information obtained by similar studies can be useful for monitoring compliance
with community health and hygiene programs and may indicate the need to
intensify educational efforts for the prevention of diarrhea associated with
enteric pathogens that cannot be controlled by drugs alone.

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