Hygiene behaviour in rural Nicaragua in relation to diarrhoea.
BACKGROUND: Childhood diarrhoea is a leading cause of morbidity and mortality in Nicaragua. Amongst the risk factors for its transmission are 'poor' hygiene practices. We investigated the effect of a large number of hygiene practices on diarrhoeal disease in children aged <2 years and validated the technique of direct observation of hygiene behaviour. METHODS: A prospective follow-up study was carried out in a rural zone of Nicaragua. From the database of a previously conducted case-control study on water and sanitation 172 families were recruited, half of which had experienced a higher than expected rate of diarrhoea in their children and the other half a lower rate. Hygiene behaviour was observed over two mornings and diarrhoea incidence was recorded with a calendar, filled out by the mother, and collected every week for 5 months. RESULTS: Of 46 'good' practices studied, 39 were associated with a lower risk of diarrhoea, five were unrelated and only for two a higher risk was observed. Washing of hands, domestic cleanliness (kitchen, living room, yard) and the use of a diaper/underclothes by the child had the strongest protective effect. Schooling (>3 years of primary school) and better economic position (possession of a radio) had a positive influence on general hygiene behaviour, education having a slightly stronger effect when a radio was present. Individual hygiene behaviour appeared to be highly variable in contrast with the consistent behaviour of the community as a whole. Feasible and appropriate indicators of hygiene behaviour were found to be domestic cleanliness and the use of a diaper or underclothes by the child. CONCLUSION: A consistent relationship between almost all hygiene practices and diarrhoea was detected, more schooling producing better hygiene behaviour. The high variability of hygiene behaviour at the individual level requires repeated observations (at least two) before and after the hygiene education in the event one wants to measure the impact of the campaign on the individual. (+info)
Dirt and diarrhoea: formative research in hygiene promotion programmes.
Investment in the promotion of better hygiene for the prevention of diarrhoeal diseases and as a component of water and sanitation programmes is increasing. Before designing programmes capable of sustainably modifying hygiene behaviour in large populations, valid answers to a number of basic questions concerning the site and the intended beneficiaries have to be obtained. Such questions include 'what practices favour the transmission of enteric pathogens?', 'what advantages will be perceived by those who adopt safe practices?' and 'what channels of communication are currently employed by the target population?' A study of hygiene and diarrhoea in Bobo-Dioulasso, Burkina Faso, used a mixture of methods to address such questions. This paper draws on that experience to propose a plan of preliminary research using a variety of techniques which could be implemented over a period of a few months by planners of hygiene promotion programmes. The techniques discussed include structured observation, focus group discussions and behavioural trials. Modest investment in such systematic formative research with clear and limited goals is likely to be repaid many times over in the increased effectiveness of hygiene promotion programmes. (+info)
A reassessment of the cost-effectiveness of water and sanitation interventions in programmes for controlling childhood diarrhoea.
Cost-effectiveness analysis indicates that some water supply and sanitation (WSS) interventions are highly cost-effective for the control of diarrhoea among under-5-year-olds, on a par with oral rehydration therapy. These are relatively inexpensive "software-related" interventions such as hygiene education, social marketing of good hygiene practices, regulation of drinking-water, and monitoring of water quality. Such interventions are needed to ensure that the potentially positive health impacts of WSS infrastructure are fully realized in practice. The perception that WSS programmes are not a cost-effective use of health sector resources has arisen from three factors: an assumption that all WSS interventions involve construction of physical infrastructure, a misperception of the health sector's role in WSS programmes, and a misunderstanding of the scope of cost-effectiveness analysis. WSS infrastructure ("hardware") is generally built and operated by public works agencies and financed by construction grants, operational subsidies, user fees and property taxes. Health sector agencies should provide "software" such as project design, hygiene education, and water quality regulation. Cost-effectiveness analysis should measure the incremental health impacts attributable to health sector investments, using the actual call on health sector resources as the measure of cost. The cost-effectiveness of a set of hardware and software combinations is estimated, using US$ per case averted, US$ per death averted, and US$ per disability-adjusted life year (DALY) saved. (+info)
Psychological factors associated with recurrent vaginal candidiasis: a preliminary study.
OBJECTIVE: To identify psychological factors associated with chronic recurrent vaginal candidiasis. DESIGN: A cross sectional exploratory study of women with chronic, recurrent vaginal candidiasis. PATIENTS: 28 women found culture positive and treated for vaginal candidiasis by a clinic physician at least twice within the past 6 months. All women reported that they had experienced vaginal thrush six or more times within 1 year. A comparison group comprised 16 women with no history of recurrent vaginal candidiasis, of similar age range, and recruited from a women's family planning service. METHODS: Both groups were compared on demographic criteria, sexual health histories, mental health, and psychological health characteristics. A purpose designed structured interview was administered alongside a battery of standardised psychometric instruments measuring mood, satisfaction with life, self esteem, and perceived stress. RESULTS: The two groups showed considerable similarities, with no significant differences in demographic characteristics and most sexual health issues. However, women with recurrent vaginal candidiasis were significantly more likely to suffer clinical depression, to be less satisfied with life, to have poorer self esteem, and to perceive their lives as more stressful. Additionally, women with recurrent vaginal candidiasis reported that their candidiasis seriously interfered with their sexual and emotional relationships. CONCLUSIONS: Overall, this study identified many areas of psychological morbidity associated with chronic vaginal candidiasis, and indicates that development of appropriate psychological treatment initiatives in this area is long overdue. (+info)
In vivo skin decontamination of methylene bisphenyl isocyanate (MDI): soap and water ineffective compared to polypropylene glycol, polyglycol-based cleanser, and corn oil.
In the home and workplace, decontamination of a chemical from skin is traditionally done with a soap-and-water wash, although some workplaces may have emergency showers. It has been assumed that these procedures are effective, yet workplace illness and even death occur from chemical contamination. Water, or soap and water, may not be the most effective means of skin decontamination, particularly for fat-soluble materials. This study was undertaken to help determine whether there are more effective means of removing methylene bisphenyl isocyanate (MDI), a potent contact sensitizer, from the skin. MDI is an industrial chemical for which skin decontamination, using traditional soap and water and nontraditional polypropylene glycol, a polyglycol-based cleanser (PG-C), and corn oil were all tried in vivo on the rhesus monkey, over 8 h. Water, alone and with soap (5% and 50% soap), were partially effective in the first h after exposure, removing 51-69% of the applied dose. However, decontamination fell to 40-52% at 4 h and 29-46% by 8 h. Thus, the majority of MDI was not removed by the traditional soap-and-water wash; skin tape stripping after washing confirmed that MDI was still on the skin. In contrast, polypropylene glycol, PG-C, and corn oil all removed 68-86% of the MDI in the first h, 74-79% at 4 h, and 72-86% at 8 h. Statistically, polypropylene glycol, PG-C, and corn oil were all better (p < 0.05) than soap and water at 4 and 8 h after dose application. These results indicate that a traditional soap-and-water wash and the emergency water shower are relatively ineffective at removing MDI from the skin. More effective decontamination procedures, as shown here, are available. These procedures are consistent with the partial miscibility of MDI in corn oil and polyglycols. (+info)
Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract.
AIM: To clarify the contribution of clinical and environmental factors and infection to the aetiology of vulvovaginitis in premenarchal girls, and to determine clinical indicators of an infectious cause. DESIGN: It was necessary first to define normal vaginal flora. Cases were 50 premenarchal girls > 2 years old with symptoms of vulvovaginitis; 50 controls were recruited from girls in the same age group undergoing minor or elective surgery. RESULTS: Interview questionnaire showed no difference between cases and controls in regards to hygiene practices, exposure to specific irritants, or history of possible sexual abuse. Normal vaginal flora was similar to that described in previous studies, with the exception of organisms likely to be associated with sexual activity. 80% of cases had no evidence of an infectious cause. In the 10 cases in whom an infectious cause was found, there was significantly more visible discharge and distinct redness of the genital area on examination compared with other cases. CONCLUSIONS: The findings suggest that vulvovaginitis in this age group is not usually infectious or necessarily related to poor hygiene, specific irritants or sexual abuse, although any of these can present with genital irritation. The possibility of sexual abuse should always be considered when a child presents with genital symptoms, but our data indicate it is not a common contributing factor. Infection is generally associated with vaginal discharge and moderate or severe inflammation. (+info)
Fin-de-siecle Philadelphia and the founding of the Medical Library Association.
Philadelphia at the time of the founding of the Medical Library Association (MLA) is described. Several factors that promoted the birth of the association are discussed, including the rapid increase in the labor force and the rise of other health related professions, such as the American Hospital Association and the professionalization of nursing. The growth of the public hygiene movement in Philadelphia at the time of Sir William Osler's residency in the city is discussed. Finally, the rapid growth of the medical literature is considered a factor promoting the development of the association. This article continues the historical consideration of the MLA begun in the author's article on the three founders of the association. The background information is drawn from the items listed in the bibliography, and the conclusions are those of the author. (+info)
Occupational hygiene science and its application in occupational health policy, at home and abroad.
This paper examines the role of occupational hygiene in the overall framework of occupational health. It draws attention to the unique combination of required individual science subjects, and to the way in which occupational hygiene science contributes to the practice of occupational hygiene in the real world. It focuses in particular on occupational exposure standards. The paper provides, as an example, the specific case of occupational aerosol exposures. It is here that scientific research has made a notable impact on standards and led to a considerable degree of international harmonization. Finally, some broader insights into occupational exposure standards are given, based on experience gained during visits to a number of contrasting countries. The similarities and differences between the various national approaches help indicate what is generic in how standards are set. Such insights provide a basis for further international harmonization in the future. It is concluded that occupational exposure standards appear to be most effectively applied in countries where there are strong occupational hygiene cultures. (+info)