1.The role of Environmental Health in preventing antimicrobial resistance in low- and middle-income countries.
David MUSOKE ; Carol NAMATA ; Grace Biyinzika LUBEGA ; Filimin NIYONGABO ; Joviah GONZA ; Kondwani CHIDZIWISANO ; Sarah NALINYA ; Rebecca NUWEMATSIKO ; Tracy MORSE
Environmental Health and Preventive Medicine 2021;26(1):100-100
Antimicrobial resistance (AMR) is increasingly becoming a threat to global public health, not least in low- and middle-income countries (LMICs) where it is contributing to longer treatment for illnesses, use of higher generation drugs, more expenditure on antimicrobials, and increased deaths attributed to what should be treatable diseases. Some of the known causes of AMR include misuse and overuse of antimicrobials in both humans and animals, unnecessary use of antimicrobials in animals as growth promoters, and lack of awareness among the public on how to protect antimicrobials. As a result, resistant organisms are circulating in the wider environment, and there is a need to consider the One Health approach to minimise the continuing development of AMR. Environmental Health, specifically water, sanitation and hygiene (WASH), waste management, and food hygiene and safety, are key components of One Health needed to prevent the spread of antimicrobial-resistant microorganisms particularly in LMICs and reduce the AMR threat to global public health. The key Environmental Health practices in the prevention of AMR include: (1) adequate WASH through access and consumption of safe water; suitable containment, treatment and disposal of human excreta and other wastewater including from health facilities; good personal hygiene practices such as washing hands with soap at critical times to prevent the spread of resistant microorganisms, and contraction of illnesses which may require antimicrobial treatment; (2) proper disposal of solid waste, including the disposal of unused and expired antimicrobials to prevent their unnecessary exposure to microorganisms in the environment; and (3) ensuring proper food hygiene and safety practices, such as sale and consumption of animal products in which adequate antimicrobial withdrawal periods have been observed, and growing vegetables on unpolluted soil. Environmental Health is therefore crucial in the prevention of infectious diseases that would require antimicrobials, reducing the spread of resistant organisms, and exposure to antimicrobial residues in LMICs. Working with other professionals in One Health, Environmental Health Practitioners have a key role in reducing the spread of AMR including health education and promotion, surveillance, enforcement of legislation, and research.
Developing Countries
;
Disease Transmission, Infectious/prevention & control*
;
Drug Resistance, Microbial
;
Environmental Health/standards*
;
Food Safety
;
Health Personnel/standards*
;
Humans
;
Hygiene/standards*
;
Role
;
Sanitation/standards*
;
Waste Management/standards*
2.Effects of water, sanitation and hygiene (WASH) education on childhood intestinal parasitic infections in rural Dembiya, northwest Ethiopia: an uncontrolled before-and-after intervention study.
Zemichael GIZAW ; Ayenew ADDISU ; Henok DAGNE
Environmental Health and Preventive Medicine 2019;24(1):16-16
BACKGROUND:
Soil-transmitted helminthes (STH) infections are among the most common infections worldwide and affect the most deprived communities. Adequate water, sanitation, and hygiene (WASH) prevents environmental contamination, thereby preventing transmission of STH. Cognizant of this, WASH education was implemented in rural Dembiya to reduce intestinal parasitic infections. This study was, therefore, conducted to assess the impacts of the intervention on households' WASH conditions and prevalence of intestinal parasitic infections.
METHOD:
An uncontrolled before-and-after intervention study was used. Cross-sectional studies were done before and after the intervention. Two hundred twenty-five and 302 under five children were recruited randomly at the baseline and endline, respectively. Data were collected using a structured questionnaire and observational checklists. Direct stool examination and Kato-Katz methods were used to identify parasites in the stool. We used percent point change and prevalence ratio (PR) to see the effects of the intervention on WASH conditions and prevalence of intestinal parasitic infections respectively. Pearson chi-squared and Fisher's exact tests were used to test for statistically significant percentage point changes of WASH conditions. The effect of the intervention on intestinal parasitic infections was statistically tested on the basis of PR with 95% confidence interval (CI).
RESULTS:
The baseline prevalence of intestinal parasitic infections was 25.8%, and the endline prevalence was 23.8%. The prevalence of intestinal parasitic infections was not significantly decreased at the endline compared with the baseline [PR = 0.92, 95% CI = (0.62, 1.38)]. Ascaris Lumbricoides was the most prevalent parasitic infection both at the baseline and endline. The proportion of children who had good hygienic condition increased from 1.3% at the baseline to 34.4% at the end line (p < 0.05). The percentage of mothers/care givers who washed hands at different pick times was significantly increased from 24.4% at the baseline to 68.2% at the endline (p < 0.001). The proportion of households who practiced home-based water treatment was significantly increased from 7.6% at the baseline to 47% at the endline (p < 0.001). The proportion of households who used sanitary latrine was increased from 32% at the baseline to 49% at the endline (p < 0.05).
CONCLUSION
This before-and-after intervention study found that households' WASH performance was significantly improved at the endline compared with the baseline. The endline prevalence of intestinal parasitic infections was slightly lower than the baseline prevalence; however, the reduction was not statistically significant. The local health office needs to strengthen the WASH education program, mobilize the community to construct WASH facilities, and support the community to sustain households' WASH performance.
Adult
;
Child, Preschool
;
Cross-Sectional Studies
;
Drinking Water
;
parasitology
;
standards
;
Ethiopia
;
epidemiology
;
Family Characteristics
;
Feces
;
parasitology
;
Female
;
Health Behavior
;
physiology
;
Health Education
;
Health Knowledge, Attitudes, Practice
;
Helminthiasis
;
epidemiology
;
prevention & control
;
Humans
;
Hygiene
;
education
;
Infant
;
Intestinal Diseases, Parasitic
;
epidemiology
;
prevention & control
;
Male
;
Prevalence
;
Rural Population
;
Sanitation
;
Soil
;
parasitology
;
Surveys and Questionnaires