Background: With the MDG 7 target deadline approaching to halve the global population lacking access to improved water and sanitation by 2015, many nations find the need to explore alternative water sources. Rainwater may be a viable alternative water source. However, there have been concerns raised in recent decades as to the quality of rainwater harvested for potable use. Methods: Data from the Demographic and Health Surveys database which included 50,579 household surveys between 2002 and 2007 from the Dominican Republic were examined. STATA 8 was used for data analysis. Descriptive statistics were computed, and logistic regression analysis was used to compare toilet type, water source, and type of place of residence with prevalence of diarrheal disease in children under five. Results: This study found that rainwater presents less risk for diarrheal disease when compared to all other water sources (excluding bottled water). In 2002, people who consumed all other sources of water (excluding bottled) were 1.28 times more likely to have diarrhea in children under 5 (95% CI 1.05-1.57) compared to those who consumed rainwater. They were 1.33 times more likely to have diarrhea in children under 5 (95% CI 1.08-1.65) in 2007 and 1.31 times more likely in both years combined (95% CI 1.13-1.51). Discussion: This study concluded that consuming rainwater presents a decreased risk for diarrheal disease compared to all other sources (excluding bottled water). More studies are needed to add more evidence to the existing literature regarding health risks associated with rainwater consumption.

In children, diarrheal disease can lead to malnutrition, poor growth, and increased risk of developing other infectious disease. With multiple cholera outbreaks, natural disasters damaging vital infrastructure, and political unrest, the health and safety of Haitians, especially children, is at risk. The purpose of this cross-sectional study was to examine the relationships between the outcome variable, diarrheal disease reporting in the last two weeks and predictor variable, source of drinking water, while accounting for additional characteristics such as region, type of place of residence, education level of the child’s mother, and toilet facility in the home. Demographic and Health Survey data from 2016-2017, collected from the mothers of households in Haiti, (n=10654) was requested and analyzed. To be included in the current analysis, respondents had to have answered whether they had any household diarrheal illness in the last two weeks and the type of water source they used, leaving an analytic sample size of 3,599 individuals. Characteristics of the population were described using weighted percentages and unweighted frequencies. Bivariate and multivariate logistic regressions were used to examine factors associated with diarrheal disease in the last two weeks (yes/no). Unadjusted and adjusted odds ratios and corresponding 95% confidence intervals were reported. Nearly one quarter of households (24.40%) reported any diarrheal illness in the last two weeks. In the study’s final multivariate model, only region had a significant relationship with diarrheal illness. The regions of Nippes, Nord-Est, Nord-Ouest, Rest-Ouest, Sud, and Sud-Est all had lower odds of contracting diarrheal disease as compared to Aire-Metropolitaine. Children living in Sud-Est were 52.9% less likely to develop diarrheal disease in two weeks than those in Aire-Metropolitaine (OR=0.471, p=0.0061). In Rest-Ouest (OR=0.561, p=0.201), Nippes(OR=0.576, p=0.0420), and Nord-Est(OR=0.585, p=0.0327), children were 43.9%, 42.4%, and 41.5% less likely to develop diarrheal disease in the last two weeks, respectively, when compared to the Aire-Metropolitane region. Lastly, Nord-Ouest (OR=0.600 p=0.0371) and Sud (OR=0.605, p=0.0463). were both approximately 40% less likely than the reference group, Aire-Metropolitan. The statistical analyses conducted calls for multiple interventions, one of which being an assessment of infrastructure and health in the region of Aire-Metropolitaine. The capital city of Haiti, Port-au-Prince, is located in this region and has experienced many natural diseases as of late, especially earthquakes. As a result, the damaged infrastructure associated with septic lines and water sources could be impacting the quality of sanitation of water in the city. Despite the results of this study, there were limitations. The most pertinent limitation involves the cross-sectional nature of this study, which means that causality between variables cannot be established. Furthermore, only about one third of respondents answered questions related to household diarrheal illness and water source, limiting the sample size. Future research should involve inspecting prevalence of diarrheal disease over time, especially in Port-au-Prince, in order to better understand potential relationships between causative factors and diarrheal disease. In addition to this, geographic analyses examining specific areas of Port-au-Prince could be conducted in an attempt to identify areas needing additional support and infrastructure within the Aire-Metropolitaine region.

No description available.

The diploma thesis deals with the nutrition of calves, especially about the importance of the colostrum period, which is important for the development of their immunity and then dairy period until weaning. Furthermore, the thesis deals with diarrheal diseases of calves. Calves were divided into three groups: one control group and two experimental groups. Experimental groups received dietary supplements. The first group received Lactovita and the second group of Homeopathic. The supplements were administered once a day for a second feeding for 28 days. Calves were weighed within two hours of birth and 60 days of weaning. Diarrhea has been reported in calves. The data was recorded in the table and then statistically evaluated. The data showed a moderate improvement in mean weight gain over 60 days for the Lactovita group compared to the control group by 0.24 kg and a decrease in the increase in the Homeopathic Test Group versus the control group by 1.69 kg. Furthermore, the results showed a slight improvement in the incidence of diarrhea in the Lactovita group compared to the control group by 7.68%. However, the results of the observations were not statistically proven. Thus, there is a lack of efficacy of feed additives administered or a low number of experimental animals on the incidence of diarrheal diseases and the weight gains in calves from the colostrum to weaning.

Diarrheal diseases are a leading cause of childhood morbidity and mortality globally and in East Africa. Determining diarrheal disease risk factors and their strength of association to diarrheal disease in this region is necessary to identify and prioritize future research questions and interventions. Demographic and Health Surveys (DHS) Program Data on child health in Burundi, Rwanda, and Tanzania from 2010 were used and simple and multiple logistic regressions were completed to determine factors that predicted diarrheal disease. Diarrhea that occurred in the two weeks prior to data collection was reported for 24.80% of Burundian, 13.1% of Rwandan, and 13.91% of Tanzanian children under five. In Burundian children, increased risk of diarrhea was associated with unimproved sanitation, young mothers, and the mother’s education level (secondary school or less). In Rwandan children, increased risk of diarrhea was associated with more than 30-minute travel time to water source, rainy season, young mothers, mother’s lack of education, and low wealth index. In Tanzanian children, increased risk of diarrhea was associated with rainy season and young mothers. The impact of improved water source and sanitation facility on diarrheal disease is not consistent across the literature or results of this study. Future research should include information on hygiene practices, type of water storage container and types of household water treatment. Further, pathogen specific research, such as molecular fingerprinting, would assist to link the source to the disease. These additions would provide a more comprehensive understanding of risk factors for and sources of diarrheal disease globally and in East Africa.

Abstract Objectives: Diarrheal disease is a global health challenge that assumes gigantic importance with regard to child health in developing countries like Pakistan. Prompt medical attention and proper use of Oral Re-hydration Therapy (ORT) by mothers helps prevent dehydration and secondary complications among affected children. However, ORT use among mothers in Pakistan is low. This study seeks to examine how various socio-demographic factors impact the use of ORT and dispensary treatment among mothers of children affected with diarrhea. Methods:Data from Pakistan Demographic Health Survey (2012-2013) was used for the study. The study sample consisted of women aged 15-49 years old resident in Punjab region (N= 505) with children under five years old who had diarrhea within two weeks of the survey. Chi-square tests and logistic regression analyses were used to determine relationships between maternal socio-demographic characteristics and use of ORT and dispensary care. P-values Results: After controlling for place of residence, educational level and frequency of watching television, caregivers whose children had fever with diarrheal episodes had nearly two-fold increased odds of using ORT treatment [OR= 1.9, (95% CI: 1.28-2.82)], compared to those whose children did not have fever. Similarly poor and middle class socioeconomic status (SES) participants had 3 times increased odds [OR= 2.76, [95% CI: 1.1 -6.89)] of using dispensary treatment when compared to upper class mothers. Place of residence was not a significant predictor of ORT or dispensary use. Discussion: These findings are consistent with other studies that show that mothers’ socioeconomic status are a good indicator of their knowledge about ORT use, and health care seeking behavior. On the other hand, maternal place of residence was not a significant predictor of ORT use, or consultation at a dispensary, even though other studies have found significant associations. Conclusion: Interventions aimed at improving low-income mothers’ knowledge about diarrhea management can include lay medical personnel, such as dispensers, who are often the easily accessible medical resource to this population. Therefore, dispensers should be provided with further training to increase their knowledge and skills in treating children with diarrhea. Future studies that are more rigorous should be conducted to examine this public health issue.

Worldwide diarrheal disease is a leading cause of morbidity and mortality in children less than five years of age. Incidence and disease severity remain the highest in sub-Saharan Africa. Kenya has an estimated 400,000 severe diarrhea episodes and 9,500 diarrhea-related deaths per year in children. Current statistical methods for estimating etiological and exposure risk factors for moderate-to-severe diarrhea (MSD) in children are constrained by the inability to assess a large number of parameters due to limitations of sample size, complex relationships, correlated predictors, and model assumptions of linearity. This dissertation examines machine learning statistical methods to address weaknesses associated with using traditional logistic regression models. The studies presented here investigate data from a 4-year, prospective, matched case-control study of MSD among children less than five years of age in rural Kenya from the Global Enteric Multicenter Study. The three machine learning approaches were used to examine associations with MSD and include: least absolute shrinkage and selection operator, classification trees, and random forest. A principal finding in all three studies was that machine learning methodological approaches are useful and feasible to implement in epidemiological studies. All provided additional information and understanding of the data beyond using only logistic regression models. The results from all three machine learning approaches were supported by comparable logistic regression results indicating their usefulness as epidemiological tools. This dissertation offers an exploration of methodological alternatives that should be considered more frequently in diarrheal disease epidemiology, and in public health in general.

Les syndromes grippaux sont à l'origine des pathologies bénignes ou graves pouvant entrainer plusieurs millions de décès chaque année dans le monde. Ils s'expriment de façon épidémique, annuellement, et peuvent prendre un aspect pandémique. L'émergence d'une nouvelle souche de virus influenza A (pH1N1) en 2009 a suscité l'accroissement de la surveillance des virus grippaux. Par ailleurs, les syndromes diarrhéiques d'origine virale, représentent un problème majeur de santé publique chez les enfants de moins de 5 ans. Peu de données existent sur la circulation des virus grippaux et diarrhéiques au Gabon. Dans ce contexte, nous avons mis en place un réseau de surveillance des virus grippaux et diarrhéiques au Gabon. L'objectif de cette étude était de caractériser les virus responsables des syndromes grippaux et diarrhéiques dans quatre principales villes du Gabon. S'agissant des grippes, 1066 écouvillons nasaux ont été récoltés sur la période allant de Juillet 2009 à Juin 2011. Trois cent dix sept (317) selles ont été récoltées chez les enfants de moins de 5 ans dans la période allant de Mars 2010 à Juin 2011. Les étiologies virales ont été analysées par PCR en temps réel avec des amorces spécifiques des virus responsables des syndromes grippaux : les virus influenza A et B saisonnier, le virus influenza A pandémique (pH1N1), les parainfluenzavirus de type 1 à 4 (PIV1-4), le virus respiratoire syncytial (VRS), le métapneumovirus humain (hMPV), les coronavirus NL63 (HCoV-NL63), HKU1(HCoV-HKU1), OC43 (HCoV-OC43), 229E (HCoV-229E), les adénovirus (AdVs), les rhinovirus (HRVs), les parechovirus (HPeVs), les entérovirus (EVs). Les virus diarrhéiques recherchés ont été : les adénovirus, les norovirus de type 1 et 2 (NoV-I, NoV- II), les sapovirus (SaVs), les astrovirus (HAstVs) et les Rotavirus A (RVA). Les diversités génétiques ont été analysées par analyses phylogénétiques suivant les séquençages des fragments amplifiés. Parmi les écouvillons analysés, 61% (n=654) étaient positifs pour au moins un des virus recherchés : AdV (16%), PIVs (15%), virus influenza (13%), EV (12%), VRS (12%), HRV (8%), HCoVs (6,5%), hMPV (2%) et HPeV (0,5%). Les enfants de moins de cinq ans représentaient la population la plus susceptible (78%). Les co-infections virales ont été retrouvées dans près d'un tiers (1/3) des cas de syndromes grippaux : 25% (2 virus), 6% (3 virus) et 1 cas de co-infections par 4 virus. Elles concernent principalement les AdVs (41%) et EVs (43%). La saisonnalité des syndromes grippaux a été également mise en évidence : 70% surviennent pendant les saisons de pluies. La prévalence des étiologies virales des diarrhées chez les enfants de moins de 5 ans était de 60,9% (n=193). Les virus responsables de celles-ci étaient : RVA (21,7%), AdV (19,6%), NoV-I (9,1%), NoV-II (13,9%), SaV (9,5%) et HastV (6,3%). Parmi les AdV, le sérotype majoritaire était AdV-41 (espèce F) alors que le génotype majoritaire des astrovirus était HAstV-1. Nous avons obtenu un génotypage en G/P total ou partiel pour 59 patients. Les souches identifiées étaient : G1P[8] (8,5%), G2P[4] (3,4%), G3P[6] (1,7%), G6P[6] (40,7%), G12P[8] (3,4%), G1 (1,7%), G2 (3,4%), G3 (3,4%), G6 (13,5%), G12 (6,7%), P[6] (8,5%), P[8] (5,1%). Ce travail a permis la mise en place d'un réseau de surveillance des virus responsables des syndromes grippaux afin de mieux faire face aux épidémies et pandémies au Gabon. L'étude des syndromes diarrhéiques a permis d'identifier les souches circulant au Gabon, notamment celles de rotavirus ayant un impact en santé publique. Ces résultats permettent d'envisager une meilleure adaptation de la prise en charge thérapeutique et une réflexion en ce qui concerne la mise en place d'une stratégie vaccinale contre les rotavirus et les virus grippaux. / Influenza-like illness (ILI) is causing mild to severe illnesses that can cause million of deaths each year worldwide. They cause epidemics annually or pandemics. The emergence of a new strain of influenza A virus (pH1N1) in 2009 sparked increased surveillance of influenza viruses. In addition, diarrheal syndromes represent a major public health problem among children under 5 years old. Few data exist on the circulation of influenza and diarrhea viruses in Gabon. In this context, a network surveillance of ILI and diarrhea virus was established in Gabon. The objective of this study was to characterize the viruses responsible of influenza-like illness and diarrhea in four major cities of Gabon.1066 nasal swabs were collected from July 2009 to June 2011. Three hundred and seventeen (317) stools were collected from children under 5 years old from March 2010 to June 2011. Viral etiologies were analyzed by real-time PCR with primers specifics of viruses responsible of ILI: seasonal influenza A and B, pandemic influenza, parainfluenza viruses type 1-4 (PIV1-4), respiratory syncytial virus (RSV), human metapneumovirus (hMPV), coronaviruses NL63 (HCoV-NL63), HKU1 (HCoV-HKU1), OC43 (HCoV-OC43), 229E (HCoV-229E), adenoviruses (AdVs), rhinoviruses (HRVs), parechovirus (HPeVs), enteroviruses (EVs). The enteric viruses were: adenoviruses, noroviruses type 1, 2 (NoV-I, NoV- II), sapoviruses (SaVs), astroviruses (HAstVs) and rotaviruses A (RVA). Genetic diversity was analyzed by phylogenetic analysis following the sequencing of the amplified fragments.Among the swabs analyzed, 61% (n = 654) were positive for at least one virus: AdV (16%), PIVs (15%), virus influenza (13%), EV (12%), RSV (12%), HRV (8%), HCoVs (6.5%), hMPV (2%) and HPeV (0,5%). Children under five years old were the most susceptible population (78%). Viral co-infections were found in nearly one-third (1/3) cases of influenza-like illness: 25% (2 viruses), 6% (3 viruses) and 1 case of co-infection with four viruses. They mainly concerned AdV (41%) and EVs (43%). The seasonality of influenza-like illness has also been showed: 70% occured during the rainy seasons. The prevalence of viral etiologies of diarrhea in children under 5 years old was 60.9% (n = 193). The virus responsible of these were: RVA (21.7%), AdV (19.6%), NoV-I (9.1%), NoV-II (13.9%), SaV (9.5 %) and HastV (6.3%). Among the AdV, the majority serotype was AdV-41 (species F), while the majority of astrovirus genotype was HAstV-1. We got a total or partial genotyping G/P for 59 patients. The strains were identified: G1P[8] (8.5%), G2P[4] (3.4%), G3P[6] (1.7%), G6P[6] (40.7%), G12P[8] (3.4%), G1 (1.7%), G2 (3.4%), G3 (3.4%), G6 (13.5%), G12 (6.7%), P[6] (8.5%), P[8] (5.1%). This work allowed the establishment of a surveillance network of viruses responsible of ILI and diarrhea in order to deal with epidemics and pandemics in Gabon. The study of diarrheal syndromes identified strains circulating in Gabon, including rotavirus affecting public health. These results allow us to consider a better adaptation of therapeutic and reflection regarding the implementation of a vaccination strategy against rotavirus and influenza viruses.

Globally, gastrointestinal (GI) infections by enteric pathogens are the second leading cause of morbidity and mortality in children under the age of five (≤5). While GI pathogen exposure in households has been rigorously examined, there is little data about young children’s exposure in public domains. Public areas in low-income settings are often used for waste disposal practices beyond human feces disposal, including trash dumping in open drainage canals and unused lots. If young children play in public domains unattended, they might be exposed to interrelated and highly concentrated microbial, chemical, and physical hazards. This study performed structured observations at 36 public areas in a transitioning internally displaced persons community in Haiti, to document how often young children play in public areas and to quantify behaviors that might lead to illness and injury. Children ≤5 yrs played at all public sites, including toddlers (92%/sites) and infants (44%/sites). Children touched and mouthed trash (metal, glass, plastic), food and other objects from the ground, ate soil (geophagia), drank surface water; as well as touched latrines, animals, animal feces, and open drainage canals. Hand-to-mouth contact was frequent and significantly different among developmental stages (infants: 18/hr, toddlers: 11/hr, and young children: 9/hr), providing evidence that children could ingest trace amounts of GI pathogens and other contaminants on hands. These findings demonstrate that water, sanitation, and hygiene interventions need to consider the unique risks posed by public domains that contribute to GI infection in young children. Furthermore, this highlights the need for waste related interventions to address the broader set of civil conditions that create unsafe, toxic, and contaminated public environments where young children play.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2017-04-26T17:30:46Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Cleide.pdf: 1429466 bytes, checksum: 81f9ab342ea5879946a79d5c538ab2be (MD5) / Made available in DSpace on 2017-04-26T17:30:46Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Cleide.pdf: 1429466 bytes, checksum: 81f9ab342ea5879946a79d5c538ab2be (MD5) Previous issue date: 2016-05-24 / A doença diarreica aguda (DDA) é a doença que mais aflige a humanidade, ocorrendo anualmente mais de quatro bilhões de casos em todo o mundo: cerca de 1,8 milhões de crianças morrem em decorrência desta doença ou outras provocadas por água inadequada para o consumo humano e por más condições de saneamento. Este estudo analisa a correlação entre número de casos, internações e óbitos por doenças diarreicas agudas com as condições de saneamento básico, além de outras variáveis socioeconômicas, para o Estado de Pernambuco. Foi aplicado o teste de correlação de Spearman ao nível de 5% e 1%. Os dados são provenientes de: i) saneamento - Sistema de Informação de Atenção Básica (SIAB), ii) número e o custo das internações hospitalares - Sistema de Informação Hospitalar (SIH), iii) DDA por município - Sistema de Vigilância Epidemiológica das Doenças Diarreicas Agudas (SIVEP/DDA), e iv) dados populacionais e renda per capita - Instituto de Bibliografia e Estatística (IBGE). Observa-se que houve declínio no número de internações, gastos e óbitos por DDA, e que há correlação significativa e negativa entre o número de internações e de óbitos por DDA e fatores como renda, taxa de analfabetismo, serviço de coleta e lixo, esgotamento sanitário e energia elétrica. Em relação ao percentual de cobertura de atenção básica e de abastecimento de água, notou-se uma correlação pouco significativa e positiva. Conclui-se que algumas características socioeconômicas dos municípios, em especial, o saneamento básico tem grande relevância com a DDA e suas consequências. / Acute diarrheal disease (ADD) is a disease that afflicts more humanity, occurring annually over four billion cases worldwide: about 1.8 million children die from this disease or other caused by inadequate water for human consumption and poor sanitation. This study examines the correlation between number of cases, hospitalizations and deaths from acute diarrheal diseases with basic sanitation, and other socioeconomic variables, for the state of Pernambuco. Spearman correlation test was used at 5% and 1%. The data are derived from: i) sanitation - Primary Care Information System (SIAB), ii) number and cost of hospital admissions - Hospital Information System (SIH), iii) DDA by municipality - Epidemiological Surveillance System Disease diarrheal Agudas (SIVEP / DDA), and iv) population data and per capita income - Institute of Bibliography and Statistics (IBGE). It is observed that there was a decline in the number of admissions, expenses and deaths by DDA, and that there is a significant negative correlation between the number of hospitalizations and deaths by DDA and factors such as income, literacy rate, collection service and waste, sewage health and electricity. Regarding the primary care coverage percentage and water supply, it was noted only a slight positive correlation. We conclude that some socioeconomic characteristics of municipalities, in particular sanitation has great relevance to the DDA and its consequences.