Extreme hunger, malnutrition, and the lack of access to sanitation are among the most pressing development challenges, but the world is not on track to meet the targets that have been established by the Millennium Development Goals. The integration of wastewater treatment and food production systems allows for the recovery of resources from wastewater, and can provide an important solution to meet the sanitation needs of growing urban populations and provide periurban farmers with a consistent supply of water and nutrients. Stabilization ponds have been long considered to be an appropriate technology for wastewater reuse systems in developing countries, but advanced anaerobic treatment technologies, such as upflow anaerobic sludge blanket (UASB) reactors, are also becoming common. The objective of this study is to evaluate the reuse potential of wastewater for irrigation from two community-managed treatment systems in Bolivia: one consisting of three stabilization ponds in series (three-pond system) and the other consisting of a UASB reactor and two stabilization ponds in series (UASB-pond system). Specifically, the removal of helminth eggs and thermotolerant coliform bacteria is measured in both systems and evaluated with respect to the World Health Organization (WHO) guidelines for the safe use of wastewater in agriculture, which are based on health targets. Results indicate that both systems provide good removal of conventional water quality parameters but poor removal of nutrients, discharging effluents with 37 to 54 mg/L of total nitrogen and 5.7 to 9.4 mg/L of total phosphorus. The three-pond system provided >92% removal of helminth eggs and 3.4-log removal of thermotolerant coliforms, and no geohelminth eggs were detected in the system effluents. However, Ascaris eggs were detected in the effluents of the UASB-pond system and the overall removal of thermotolerant coliforms was only 2.3 log units. Viability estimates based on the use of a vital stain indicate that eggs detected in pond effluents are less likely to be viable than eggs detected in the raw wastewater, in the sludge, or in the effluent of the UASB reactor. Sludge samples from the facultative pond in the three-pond system had higher concentrations of helminth eggs than sludge samples from the UASB reactor. Based on these results, the effluents from the three-pond system can be reused for irrigating any crop with the exception of root crops and low-growing crops that can be consumed raw (i.e. onions and strawberries). Effluents from the three-pond system may be used to irrigate salad crops or high-growing crops that are consumed raw, but additional public health interventions must be implemented throughout the food production process to meet WHO recommendations for protecting the health of farmers and consumers. The effluents from the UASB-pond system should not be reused unless improvements to the system increase its pathogen removal efficiency. The results from this study indicate that a system consisting of stabilization ponds in series may produce a higher quality effluent that is more suitable for wastewater irrigation than a system with a UASB reactor.

Master of Public Health - MPH / Background: Severe acute malnutrition contributes disproportionately to child mortality rates despite availability of the WHO protocol, “Ten Steps”, to guide hospital management. Auditing morbidity and mortality rates of malnourished children at hospitals is useful to measure the effectiveness of hospital-based management compared to standards advocated by the WHO protocol. The study aimed to assess the adequacy of clinical management practices for severely malnourished children admitted to three district hospitals in the Western Cape as compared to the WHO guidelines. Objectives: To describe prognostic indicators on admission such as clinical severity of malnutrition and co-morbidities such as HIV, TB, diarrhoea and pneumonia. To assess the management practices of severe malnutrition against the key principles of management during the stabilisation phase as outlined by the WHO guidelines. To describe the number of severely malnourished children who were treated for or died due to preventable complications (hypothermia, hypoglycaemia, dehydration, over-hydration, infection, electrolyte imbalance). Methodology: A retrospective, descriptive study based on a folder review of medical records of 83 severely malnourished children admitted to the Stellenbosch, Helderberg and Eersteriver hospitals from September 2009 to June 2011 was done. viii Structured data collection was undertaken to capture data to allow assessment of the clinician’s management practices, and the adequacy thereof in implementing the first six steps of the WHO protocol guidelines. Results The predominant co-morbidities in the sample were diarrhoea in 51% ofcases and pneumonia in 33%. Thirteen percent were HIV infected, 28% of the sample had TB. Clinical signs were poorly documented by clinicians. The highest percentage of adequate management practices was for treatment of infections with 90% of patients receiving antibiotics. The second best management practice was for treatment of electrolyte and micronutrient deficiency. Hypoglycaemia and hypothermia were poorly managed as children developed these complications in the hospitals and yet these complications were still left untreated. Nineteen percent of the sample needed transfer to a specialist hospital. Conclusion The study concludes that overall management practices for children admitted with severe acute malnutrition to three district hospitals in the Western Cape was poor and often did not adhere to the WHO guidelines. Doctors showed poor understanding of the need for accurate assessment and monitoring in order to reduce the mortality risk of these patients.

Background. Swaziland adopted the World Health Organization’s (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007 to reduce case -fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in the case -fatality rate post-implementation of the guidelines. Objectives. To determine the case -fatality rate for childhood malnutrition post-implementation of the WHO treatment guidelines and determine the level of adherence to the guidelines at Mbabane Government Hospital. Methods. A retrospective observational study was undertaken. All children under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 had their demographic-, anthropometric- and clinical characteristics recorded and analysed, as well as the outcome of admission. Results. Of the 227 children admitted during the study period, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition. One-hundred-and-eleven children died during admission, an overall case -fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children compared to those with moderate malnutrition, (46.9% vs 27.6%, OR 3.0 (95% CI 1.7 to 5.3)). Comorbid pneumonia and gastroenteritis were significant predictors of mortality – , OR 2.0 (95% CI 1.2 to 3.4) and 1.9 (95% CI 1.1 to 3.2) respectively. Conclusion. Case -fatality rates for childhood malnutrition remain high, despite adoption of the WHO treatment guidelines. A need exists for improved adherence to the WHO guidelines and periodic clinical audits to reduce deaths from childhood malnutrition to meet the WHO mortality target of less than 5% and improve child survival. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Clinical Epidemiology / unrestricted

Bakgrund: Utöver hormonbaserade läkemedel har fysisk aktivitet visat effekt på klimakterierelaterade besvär men få studier har utförts om relationen mellan fysisk aktivitet, klimakteriebesvär och hälsorelaterad livskvalitet i en svensk population. Syfte: Syftet var att undersöka klimakteriebesvär, hälsorelaterad livskvalitet och fysisk aktivitetsnivå bland kvinnor i Sverige i klimakteriet samt att studera hur fysisk aktivitetsnivå relaterar till livskvalitet och klimakteriebesvär. Metod: Enkät med flervalsfrågor om klimakteriebesvär (Menopause Rating Scale), fysisk aktivitetsnivå (Socialstyrelsens screeningfrågor om fysisk aktivitet) och hälsorelaterad livskvalitet (RAND-36) skickades till två slutna Facebookgrupper för kvinnor i klimakteriet. Resultatsammanfattning: Enkätsvaren visade att kvinnorna (n=381) skattade sömn och fysisk/mental trötthet som de mest besvärande symtomen, var fysiskt aktiva i genomsnitt 315 minuter i veckan och hade lägst hälsorelaterad livskvalitet avseende energi/fatigue och högst hälsorelaterad livskvalitet avseende fysisk funktion. De som uppnådde rekommendationerna för fysisk aktivitet skattade både högre fysisk hälsa (p<0.001) och emotionell hälsa (p=0.004) jämfört med de som inte uppnådde rekommendationerna. Ett svagt men signifikant samband fanns mellan grad av klimakteriebesvär och totalt antal aktivitetsminuter (ρ=-0.156) respektive fysisk träning (ρ=-0.149). Konklusion: Resultaten tyder på en relation mellan tillräcklig fysisk aktivitet och högre hälsorelaterad livskvalitet, särskilt avseende dimensionerna fysisk och emotionell hälsa. Sambandet mellan klimakteriebesvär och fysisk aktivitet fanns men var svagt. Resultaten ger insikter i komplexa samband mellan klimakteriebesvär, fysisk aktivitet och hälsorelaterad livskvalitet men belyser betydelsen av fysisk aktivitet för denna grupp. / Background: Besides hormone-based treatments, physical activity has shown effectiveness in menopausal symptoms, but few studies have explored the relationship between physical activity, menopausal symptoms, and health related quality of life in a Swedish population. Objective: The objective was to examine menopausal symptoms, health related quality of life, and physical activity levels among menopausal women in Sweden, and to explore how physical activity levels correlates to health related quality of life, and menopausal symptoms. Method: A multiple-choice questionnaire about menopausal symptoms (Menopause Rating Scale), physical activity (Socialstyrelsens Screeningfrågor om Fysisk Aktivitet), and health related quality of life (RAND-36) was sent to two closed Facebook groups for menopausal women. Results: Survey responses from the women (n=381) reported sleep and physical/mental fatigue as the most severe symptoms. On average, they were physically active for 315 minutes per week and had the lowest heath related quality of life related to energy/fatigue and the highest heath related quality of life related to physical function. Those who met the recommendations for physical activity reported higher physical health (p<0.001) and emotional health (p=0.004) compared to those who did not meet the recommendations. A weak but significant relationship was found between the degree of menopausal symptoms and the total number of physical activity (ρ=-0.156) and physical exercise (ρ=-0.149). Conclusion: The results suggest a relationship between sufficient physical activity and higher health related quality of life, especially concerning the dimensions physical and emotional health. The association between menopausal symptoms and physical activity was present but weak. The findings provide insights into the complex relationships between menopausal symptoms, physical activity, and health related quality of life, highlighting the significance of physical activity for this group.

The Covid-19 pandemic prompted significant lifestyle changes, including physical inactivity and remote working. This cross-sectional study aimed to explore the prevalence of health-promoting physical activity (PA) and its association with demographic factors and remote working among Swedish adults (18-64 years) using secondary data collected during the Covid-19 pandemic. Health-promoting PA(HPPA) was defined according to WHO guidelines, and demographic factors were identified with the theoretical understanding of the Social ecological model for PA. Binary logistic regression was used to study the associations between demographic factors gender, age & occupation, and HPPA. Of the sample (n= 776), 50.3% were males, and the mean age was 43.6 years. The prevalence of health-promoting PA was 55 % in the total sample, 61% in males, and 48% in females. In occupation, the prevalence of HPPA was 63% in students and 49% in non-Manual workers. In logistic regression analysis, the odds of HPPA were lower in females (OR = 0.56; 95% CI 0.42- 0.75) than in males. In occupation, the odds of engaging in HPPA were lower in non-Manual workers (OR= 0.47, 95% CI, 0.27- 0.81) than in students/others. In conclusion, slightly more than half of the Swedish adults had health-promoting physical activity during covid 19 pandemic. However, HPPA was less common among females and non-Manual workers compared to males and students/others.

Background Oxygen is one of the most commonly used drugs by anesthesiologists. The World Health Organization (WHO) gave recommendations regarding perioperative oxygen administration, but the practice of oxygen use in anesthesia, critical emergency, and intensive care medicine remains unclear. Methods We conducted an online survey among members of the European Society of Anaesthesiology and Intensive Care (ESAIC). The questionnaire consisted of 46 queries appraising the perioperative period, emergency medicine and in the intensive care, knowledge about current recommendations by the WHO, oxygen toxicity, and devices for supplemental oxygen therapy. Results Seven hundred ninety-eight ESAIC members (2.1% of all ESAIC members) completed the survey. Most respondents were board-certified and worked in hospitals with > 500 beds. The majority affirmed that they do not use specific protocols for oxygen administration. WHO recommendations are unknown to 42% of respondents, known but not followed by 14%, and known and followed by 24% of them. Respondents prefer inspiratory oxygen fraction (FiO2) ≥80% during induction and emergence from anesthesia, but intraoperatively < 60% for maintenance, and higher FiO2 in patients with diseased than non-diseased lungs. Postoperative oxygen therapy is prescribed more commonly according to peripheral oxygen saturation (SpO2), but shortage of devices still limits monitoring. When monitoring is used, SpO2 ≤ 95% is often targeted. In critical emergency medicine, oxygen is used frequently in patients aged ≥80 years, or presenting with respiratory distress, chronic obstructive pulmonary disease, myocardial infarction, and stroke. In the intensive care unit, oxygen is mostly targeted at 96%, especially in patients with pulmonary diseases. Conclusions The current practice of perioperative oxygen therapy among respondents does not follow WHO recommendations or current evidence, and access to postoperative monitoring devices impairs the individualization of oxygen therapy. Further research and additional teaching about use of oxygen are necessary.