A qualitative study was conducted to explore and describe the knowledge and perceptions of parents and caregivers on the causes of diarrhoea among children under five years living in the rural areas of the Eastern Cape Province, South Africa. The aim was to assist in correcting the negative perceptions of the causes of under five child diarrhoea through improved educational interventions. Data were collected through individual, semi-structured and face-to-face interviews from seven participants who were parents and caregivers of under-five children presenting with diarrhoea or admitted for the management of diarrhoea at a specific hospital and thematic analysis was done. The findings revealed that the participants had inadequate knowledge and lacked understanding of diarrhoea and its causes. Participants could not mention all the causes and risk factors associated with diarrhoea. Noteworthy is that the participants’ perceived diarrhoea as a serious condition. The study recommends that the implementation of policies regarding public education and health promotion programmes be targeted at educating parents and caregivers / Health Studies / M.A. (Public Health)

Since the establishment of a democratic South Africa in 1994, a number of rural water supply schemes have been implemented. A specific aim of these schemes is to improve the health of the population. The underlying assumption is that a supply of reticulated water will improve the quality of water used by the community, reduce the exposure of the community to contaminated water supplies, and reduce water related diseases, in particular diarrhoea. This research thesis focuses on two rural water supply schemes in KwaZulu-Natal: Mpolweni and Vulindlela, both being developed by Umgeni Water, the regional water utility. These communities depended variously on rivers, rain harvesting, and springs for their water supply. For sanitation, the majority of people used unimproved pit latrines. This research thesis is based on information gathered from the communities prior to the installation of the water supply schemes. It focuses on the linkage between water supply and health by examining diarrhoeal morbidity as a measurable disease outcome and by identifying possible pathways to the prevalence of diarrhoea. Questionnaire and observational surveys were undertaken of 181 households in Mpolweni and 100 households in Vulindlela. From these surveys, the prevalence of diarrhoea in Vulindlela households was found to be 40.4% and in Mpolweni to be 49%. Children under the age of five years old are the most vulnerable, with 20.1% of children in Mpolweni and 21 .3% of children in Vulindlela reported as having had diarrhoea in the recall period prior to the surveys. The Mpolweni study considered eighty exposure variables, finding an association between diarrhoeal disease and sixteen of these variables (p value < 0.05). The Vulindlela study considered fifty-five exposure variables, of which eight were considered significant (p value < 0.05). In regard to water and diarrhoea: • no association was found between the prevalence of diarrhoea and the source of water in either Mpolweni or Vulindlela. • using water to wash nappies was associated with diarrhoeal disease in Vulindlela. However, it is postulated that it is the faecal contamination in the nappy, rather than the water, that is problematic. No association between water use and diarrhoea was established in Mpolweni. • poor disinfection of stored water supplies was associated with diarrhoeal disease in both Mpolweni and Vulindlela. In addition, the use of plastic storage containers to store water at the household provided additional risk in Mpolweni. However, once the reticulated system is installed, the communities are likely to continue to store water due to a distrust of the reliability of water supply. The above surveys form the baseline for additional studies currently being undertaken by Umgeni Water that are intended to measure the effectiveness of the water supply schemes on community health. However, from this thesis, it is concluded that many of the risk factors associated with diarrhoeal disease in both Vulindlela and Mpolweni will not directly be addressed by the introduction of the water supply schemes. / Thesis (M.Sc.)-University of Natal, Pietermaritzburg, 2000.

A qualitative study was conducted to explore and describe the knowledge and perceptions of parents and caregivers on the causes of diarrhoea among children under five years living in the rural areas of the Eastern Cape Province, South Africa. The aim was to assist in correcting the negative perceptions of the causes of under five child diarrhoea through improved educational interventions. Data were collected through individual, semi-structured and face-to-face interviews from seven participants who were parents and caregivers of under-five children presenting with diarrhoea or admitted for the management of diarrhoea at a specific hospital and thematic analysis was done. The findings revealed that the participants had inadequate knowledge and lacked understanding of diarrhoea and its causes. Participants could not mention all the causes and risk factors associated with diarrhoea. Noteworthy is that the participants’ perceived diarrhoea as a serious condition. The study recommends that the implementation of policies regarding public education and health promotion programmes be targeted at educating parents and caregivers / Health Studies / M.A. (Public Health)

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

The purpose of this study was to investigate the environmental factors that impact on childhood diarrhoea in children under five years old in Akakikality sub city Addis Ababa, Ethiopia. Objectives of the study were to determine the prevalence of diarrhoea and to determine the environmental factors that impact on diarrhoea in children under five years old. A survey was done and a non-experimental approach was used in this descriptive and analytical quantitative study using a cross sectional study design. The instrument was a self-designed questionnaire. The target population for this study was all mothers or caretakers of children under five years found in the described study context – the sample size was 299. In this study 12.7% of the children had diarrhoea during the survey. Proper utilization of toilets, hand washing and safe storage of water in the households using narrow mouthed water containers were significant predictors of diarrhoea in the children. / Health Studies / M.A. (Public Health)

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background Diarrhoea (frequent, loose, watery stools) is one of the major causes of morbidity and mortality globally and affects mainly infants and children under the age of five years. Unhygienic feeding practices and feeding utensils contribute to diarrhoeal incidences. The most common causes of acute gastroenteritis worldwide are infectious agents, such as viruses, bacteria and parasites Aim The aim of the study was to investigate which out of three particular sterilising methods is the most effective for sterilising feeding bottles and cups. Methods An experimental quantitative approach was most appropriate for the current study. An in vitro experimental study with a descriptive design was utilised under controlled laboratory conditions. The study was conducted at the University of the Western Cape (UWC) in April 2009. Results The sample size consisted of 16 samples, of which two were used for each method of sterilisation, namely: two (2) bottles and two (2) cups for sunlight; two (2) bottles and two (2) cups for Milton™; two (2) bottles and two (2) cups for Sunlight™ dishwashing liquid; and control utensils that consisted of two (2) bottles and two (2) cups. The target population for the study comprised infant feeding bottles and feeding cups. The analysis for the APC cultures that was compared in the cups vs. bottles, in order to see whether there was a significant difference between the mean bacteria counts, shows that the average bacteria count (on the ln scale) was 6 cfu/ml and 9 cfu/ml for the cups and bottles, respectively. The t-value was -1.17524. As the ρ-value was 0.2595, no significant difference was found between the cups and bottles. The E. coli cultures were compared in the cups vs. bottles to see whether there was a significant difference between the mean bacteria counts. The results show that the average bacteria count (on the ln scale) was 7 cfu/ml and 7.6 cfu/ml for cups and bottles, respectively. The t-value was -0.211902. The ρ-value was 0.835237, and therefore there was no significant difference between cups and bottles. Conclusion The current study showed no significant difference between the sterilising methods or between the use of either bottles or cups. Therefore, a study with a larger sample size is recommended for further research. Recommendations The researcher recommends that future researchers conduct broader studies, with a larger sample size on the topic. Studies with a larger sample size enabled the real differences to be large enough to be significant. The use of sunlight is recommended as a sterilisation method for infant feeding utensils, as it is both time- and cost-effective. Sunlight is an inexpensive and readily available method of sterilisation; therefore, it can be used by relatively under resourced socio-economic communities. / AFRIKAANSE OPSOMMING: Agtergrond Diarree (gereelde, los, waterige stoelgang) is een van die hoofoorsake van morbiditeit en sterflikheid wêreldwyd en affekteer hoofsaaklik suigelinge en kinders onder die ouderdom van vyf jaar. Onhigiëniese voedingspraktyke en -gereedskap dra by tot die voorkoms van diarree-gevalle. Die mees algemene oorsake van akute gastroënteritus wêreldwyd word veroorsaak deur aansteeklike agente soos virusse, bakterieë en parasiete. Doel Die doel van hierdie studie is om ondersoek te doen na watter van die drie bepaalde steriliseringsmetodes die mees effektiewe is vir die sterilisering van bottels en koppies. Metodes ’n Eksperimentele kwantitatiewe benadering is die mees geskikte een vir die huidige studie. ’n In vitro-eksperimentele studie met ’n deskriptiewe ontwerp is onder gekontroleerde laboratorium omstandighede aangewend. Die studie is by die Universitet van die Wes-Kaap (UWK) in April 2009 uitgevoer. Resultate Die steekproefgroote het bestaan uit 16 monsters waarvan twee gebruik is vir elke steriliseringsmetode, naamlik: twee (2) bottels en twee (2) koppies vir sonlig; twee (2) bottels en twee (2) koppies vir Milton™; twee (2) bottels en twee (2) koppies vir Sunlight™ skottelgoedopwasmiddel; en kontrole gereedskap wat bestaan het uit twee (2) bottels en twee (2) koppies. Die teikenbevolking vir die studie het bestaan uit voedingsbottels en -koppies vir suigelinge. Die analise vir die APC-kulture wat vergelyk is in die koppies vs. bottels om te bepaal of daar ’n beduidende verskil is tussen die gemiddelde bakterie-tellings, toon dat die gemiddelde bakterie-telling (op die In-skaal) is 6 cfu/ml en 9 cfu/ml vir die koppies en bottels respektiewelik. Die t-waarde is -1.17524. Aangesien die p-waarde 0.2595 is, is daar geen beduidende verskil gevind tussen die koppies en die bottels nie. Die E. coli-kulture is vergelyk in die koppies vs. bottels om te bepaal of daar ’n beduidende verskil tussen die gemiddelde bakterie-tellings is. Die uitslae wys dat die gemiddelde bakterie-telling (op die In-skaal) is 7cfu/ml en 7.6 cfu/ml vir koppies en bottels respektiewelik. Die t-waarde is -0.211902. Die p-waarde is 0.835237 en dus is daar geen beduidende verskil tussen koppies en bottels nie. Gevolgtrekking Die huidige studie toon dat daar geen beduidende verskil tussen die steriliseringsmetodes of tussen die gebruik van of bottels of koppies is nie. Dus, ’n studie met ’n groter steekproefgrootte word aanbeveel vir toekomstige navorsing. Aanbevelings Die navorser beveel aan dat toekomstige navorsers meer omvattende studies met ’n groter steekproefgrootte oor die onderwerp uitvoer. Studies met ’n groter steekproefgrootte sal veroorsaak dat die werklike verskille vanweë hul grootte genoegsaam sal wees, om beduidend te wees. Die gebruik van sonlig as ’n steriliseringsmetode vir die gereedskap van suigelinge word aanbeveel, aangesen dit beide tyd- en kostebesparend is. Sonlig is ’n goedkoop en maklik verkrygbare metode van sterilisasie; dus kan dit gebruik word deur gemeenskappe wat nie oor die nodige middele beskik nie, vanweë hul sosio-ekonomiese situasies.

A diarréia neonatal é o principal problema sanitário que acomete os bezerros nas primeiras semanas de vida, causando grandes prejuízos devido à morbidade, mortalidade, custos com tratamento e atraso no desenvolvimento. Os rotavírus são os mais importantes agentes virais causadores de gastroenterites em crianças e diarreia em diferentes espécies animais. Além do seu impacto econômico na produção animal, os bovinos podem atuar como reservatórios da diversidade genética e antigênica para humanos. Assim, o diagnóstico deste agente é fundamental para o desenvolvimento de medidas profiláticas mais especificas visando o seu controle. O objetivo deste trabalho foi desenvolver um método de PCR em Tempo Real para a detecção de rotavírus bovinos em sistema Taqman&reg; tendo como alvo, a proteína não-estrutural 5 (NSP5). Para isso, 113 amostras de fezes bovinas foram coletadas de reabanhos do estado de São Paulo, e previamente testadas por PCR convencional. Para a padronização da PCR em Tempo Real, a estirpe padrão foi clonada, gerando um plasmídeo com 3x1010 cópias/reação. Como controle exógeno foi utilizado &#946;-actina. O limite de detecção foi determinado por diluições seriadas na base 10, detectando até 6x101 cópias/&micro;l. A curva padrão da PCR em Temo Real para a detecção do segmento codificador da proteína NSP5 teve como resultados, uma eficiência de 100,47%; com slope igual a -3,18 e R2 de 1,0. De um total de 113 amostras testadas pela PCR convencional 63 delas (55,7%) foram consideradas positivas para rotavírus. Dessas mesmas amostras testadas, 5 não amplificaram para &#946;-actina e não foram incluídas nas análises posteriores. Para a PCR em Tempo Real o limite de detecção foi considerado o valor de 6x101 cópias/reação, sendo definido o ponto de corte o ciclo (Ct) de número 36 para o teste com a amostra viral a partir do DNA ligado em vetor plasmidial. Considerando-se o ponto de corte de 60 (6x101) cópias/reação, das 108 amostras testadas, 63 (58,3%) foram consideradas positivas ao teste. O valor de concordância obtido através do teste Kappa, a um intervalo de confiança de 95%, a partir dos resultados gerados entre os testes de PCR convencional e PCR em foi de 0.279 (baixa concordância). Os resultados obtidos nesse estudo demonstrou que o teste foi eficiente podendo ser utilizado para um diagnóstico rápido e eficiente do rotavirus do grupo A, aumentando assim o repertório dos testes já estabelecidos / Neonatal diarrhea is the main health problem affecting the calves in the first weeks of life, causing major losses due to morbidity, mortality, treatment costs and delayed development. Rotaviruses are the most important causative agents of viral gastroenteritis in children and in different animal species. In addition to its economic impact on livestock, cattle can act as reservoirs for genetic and antigenic diversity for human samples. Therefore, the diagnosis of this agent is critical to the development of more specific preventive measures for their control. The objective of this work is to develop a method of PCR for rotavirus detection in cattle using TaqMan&reg; system targeting the 5 nonstructural protein (NSP5). For this, 113 samples of cattle feces were collected from farms of São Paulo, and previously tested by convencional PCR. To PCR standardization, the standard sample was cloned, generating plasmid 3x1010 copies/reaction. The &#946;-actin was usede as exogenous control. The limit of detection was determined by serial dilutions, to detect 6 x101 copies/&micro;l. The standard curve of PCR to encoding segment detection NSP5 protein had as a result, an efficiency of 108.5%; with slope equal to -3.18 and R2 equal 1.. From a total of 113 samples tested by conventional PCR 63 (55.7%) were positive for rotavirus. From these samples 5 not amplifyed for &#946;-actin gene and were not included in subsequent analyzes. For detection limit of Real-Time PCR was considered the amount of 6x101 copies / reaction, the cut-off being defined cycle (Ct) number 36 to the test with a viral sample from the DNA ligated into plasmid vector. Considering the cut-off 60 (6x101) copies/reaction of the 108 samples tested, 63 (58.3%) were positive to the test. The correlation value obtained by the Kappa test, at a 95% confidence interval, based on results generated between the conventional and PCR testing PCR was 0.279 (low agreement). The results of this study demonstrated that the probe can be efficiently used for a fast and efficient diagnosis of rotavirus of group A, thereby enhancing the repertoire of the established tests

clanata@iin.sld.pe / Introduction: Pneumonia and diarrhoea are leading causes of death in children. There is a need to develop effective interventions. Objective: We present the design and baseline findings of a community-randomised controlled trial in rural Peru to evaluate the health impact of an Integrated Home-based Intervention Package in children aged 6 to 35 months. Methods: We randomised 51 communities. The intervention was developed through a community-participatory approach prior to the trial. They comprised the construction of improved stoves and kitchen sinks, the promotion of hand washing, and solar drinking water disinfection (SODIS). To reduce the potential impact of non-blinding bias, a psychomotor stimulation intervention was implemented in the control arm. The baseline survey included anthropometric and socio-economic characteristics. In a sub-sample we determined the level of faecal contamination of drinking water, hands and kitchen utensils and the prevalence of diarrhoegenic Escherichia coli in stool specimen. Results: We enrolled 534 children. At baseline all households used open fires and 77% had access to piped water supplies. E. coli was found in drinking water in 68% and 64% of the intervention and control households. Diarrhoegenic E. coli strains were isolated from 45/139 stool samples. The proportion of stunted children was 54%. Conclusions: Randomization resulted in comparable study arms. Recently, several critical reviews raised major concerns on the reliability of open health intervention trials, because of uncertain sustainability and non-blinding bias. In this regard, the presented trial featuring objective outcome measures, a simultaneous intervention in the control communities and a 12- month follow up period will provide valuable evidence. / This study received financial support of the UBS Optimus Foundation, through a grant given to the IIN and Swiss TPH. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. / Revisión por pares

A diarréia neonatal é o principal problema sanitário que acomete os bezerros nas primeiras semanas de vida, causando grandes prejuízos devido à morbidade, mortalidade, custos com tratamento e atraso no desenvolvimento. Os rotavírus são os mais importantes agentes virais causadores de gastroenterites em crianças e diarreia em diferentes espécies animais. Além do seu impacto econômico na produção animal, os bovinos podem atuar como reservatórios da diversidade genética e antigênica para humanos. Assim, o diagnóstico deste agente é fundamental para o desenvolvimento de medidas profiláticas mais especificas visando o seu controle. O objetivo deste trabalho foi desenvolver um método de PCR em Tempo Real para a detecção de rotavírus bovinos em sistema Taqman&reg; tendo como alvo, a proteína não-estrutural 5 (NSP5). Para isso, 113 amostras de fezes bovinas foram coletadas de reabanhos do estado de São Paulo, e previamente testadas por PCR convencional. Para a padronização da PCR em Tempo Real, a estirpe padrão foi clonada, gerando um plasmídeo com 3x1010 cópias/reação. Como controle exógeno foi utilizado &#946;-actina. O limite de detecção foi determinado por diluições seriadas na base 10, detectando até 6x101 cópias/&micro;l. A curva padrão da PCR em Temo Real para a detecção do segmento codificador da proteína NSP5 teve como resultados, uma eficiência de 100,47%; com slope igual a -3,18 e R2 de 1,0. De um total de 113 amostras testadas pela PCR convencional 63 delas (55,7%) foram consideradas positivas para rotavírus. Dessas mesmas amostras testadas, 5 não amplificaram para &#946;-actina e não foram incluídas nas análises posteriores. Para a PCR em Tempo Real o limite de detecção foi considerado o valor de 6x101 cópias/reação, sendo definido o ponto de corte o ciclo (Ct) de número 36 para o teste com a amostra viral a partir do DNA ligado em vetor plasmidial. Considerando-se o ponto de corte de 60 (6x101) cópias/reação, das 108 amostras testadas, 63 (58,3%) foram consideradas positivas ao teste. O valor de concordância obtido através do teste Kappa, a um intervalo de confiança de 95%, a partir dos resultados gerados entre os testes de PCR convencional e PCR em foi de 0.279 (baixa concordância). Os resultados obtidos nesse estudo demonstrou que o teste foi eficiente podendo ser utilizado para um diagnóstico rápido e eficiente do rotavirus do grupo A, aumentando assim o repertório dos testes já estabelecidos / Neonatal diarrhea is the main health problem affecting the calves in the first weeks of life, causing major losses due to morbidity, mortality, treatment costs and delayed development. Rotaviruses are the most important causative agents of viral gastroenteritis in children and in different animal species. In addition to its economic impact on livestock, cattle can act as reservoirs for genetic and antigenic diversity for human samples. Therefore, the diagnosis of this agent is critical to the development of more specific preventive measures for their control. The objective of this work is to develop a method of PCR for rotavirus detection in cattle using TaqMan&reg; system targeting the 5 nonstructural protein (NSP5). For this, 113 samples of cattle feces were collected from farms of São Paulo, and previously tested by convencional PCR. To PCR standardization, the standard sample was cloned, generating plasmid 3x1010 copies/reaction. The &#946;-actin was usede as exogenous control. The limit of detection was determined by serial dilutions, to detect 6 x101 copies/&micro;l. The standard curve of PCR to encoding segment detection NSP5 protein had as a result, an efficiency of 108.5%; with slope equal to -3.18 and R2 equal 1.. From a total of 113 samples tested by conventional PCR 63 (55.7%) were positive for rotavirus. From these samples 5 not amplifyed for &#946;-actin gene and were not included in subsequent analyzes. For detection limit of Real-Time PCR was considered the amount of 6x101 copies / reaction, the cut-off being defined cycle (Ct) number 36 to the test with a viral sample from the DNA ligated into plasmid vector. Considering the cut-off 60 (6x101) copies/reaction of the 108 samples tested, 63 (58.3%) were positive to the test. The correlation value obtained by the Kappa test, at a 95% confidence interval, based on results generated between the conventional and PCR testing PCR was 0.279 (low agreement). The results of this study demonstrated that the probe can be efficiently used for a fast and efficient diagnosis of rotavirus of group A, thereby enhancing the repertoire of the established tests

Thesis (Ph.D (Plant Physiology) --University of Limpopo, 2006 / Refer to document / National Research Foundation and ARC (Nelspruit)