The association of water carriage, water supply and sanitation usage with maternal and child health. A combined analysis of 49 Multiple Indicator Cluster Surveys from 41 countries

Background  Millions of people carry water home from off-plot sources each day and lack improved sanitation. Research on the health outcomes associated with water fetching is limited, and with usage of improved sanitation is inconclusive.  Objectives  To analyse the association of water fetching, unimproved water supplies, and usage of improved sanitation facilities with indicators of women’s and children’s health.  Methods  49 Multiple Indicator Cluster Surveys from 41 countries were merged, creating a data set of 2,740,855 people from 539,915 households. Multilevel, multivariable analyses were conducted, using logistic regression for binary outcomes, negative binomial regression for count data and ordinary linear regression for linear data. We adjusted for confounding factors and accounted for clustering at survey, cluster and household level.  Results  Compared to households in which no-one collects water, water fetching by any household member is associated with reduced odds of a woman giving birth in a health care facility (OR 0.88 to 0.90). Adults collecting water is associated with increased relative risk of childhood death (RR 1.04 to 1.05), children collecting water is associated with increased odds of diarrheal disease (OR 1.10 to 1.13) and women or girls collecting water is associated with reduced uptake of antenatal care (β-0.04 to -0.06) and increased odds of leaving a child under five alone for one or more hours, one or more days per week (OR 1.07 to 1.16). Unimproved water supply is associated with childhood diarhhoea (OR 1.05), but not child deaths, or growth scores. When the percentage of people using improved sanitation is more than 80% an association with reduced childhood death and stunting was observed, and when more than 60%, usage of improved sanitation was associated with reduction of diarhhoea and acute undernutrition.  Conclusion  Fetching water is associated with poorer maternal and child health outcomes, depending on who collects water. The percentage of people using improved sanitation seems to be more important than type of toilet facility, and must be high to observe an association with reduced child deaths and diarhhoea. Water access on premises, and near universal usage of improved sanitation, is associated with improvements to maternal and child health

Lectin binding studies on murine peritoneal cells: Physicochemical characterization of the binding of lectins from Datura stramonium, Evonymus europaea, and Griffonia simplicifolia to murine peritoneal cells

Purified 125I-labeled lectins from Datura stramonium, Evonymus europaea, and Griffonia simplicifolia (I-B4 isolectin) were used to analyze changes in the expression of carbohydrates on the surface of resident (PC) and thioglycollate-stimulated murine (C57B/6J) peritoneal exudate cells (PEC). The lectins from D. stramonium, E. europaea, and G. simplicifolia I-B4 bind specifically to PEC with relatively high affinity (Kd = 5.65 +/- 1.08 x 10-7 m, 1.08 +/- 0.12 x 10-8 m, and 1.33 +/- 0.15 x 10-7 m, respectively). Assuming a single lectin molecule binds to each cell surface saccharide, the number of receptor sites per cell ranged for different cell samples from 22.3 to 50.0 x 106, from 3.8 to 4.8 x 106, and from 2.0 to 16.8 x 106 for D. stramonium, E. europaea, and G. simplicifolia I-B4 lectins, respectively. There were approximately 3- to 7-fold, 16- to 20-fold, and 2-to 20-fold increases in binding capacity for D. stramonium, E. europaea and G. simplicifolia I-B4, respectively, compared to the binding to resident, peritoneal cells. Scatchard plots of the binding of all three lectins to PEC were linear, suggesting that the receptor sites for these lectins are homogeneous and noninteracting. The binding capacity of these lectins to PEC was unchanged after trypsin digestion of cells. The expression of carbohydrates on the surface of PEC was also monitored by an agglutination assay. PEC were agglutinated by all three lectins whereas PC either were not agglutinated or were agglutinated only at high lectin concentrations. On the basis of our knowledge of the carbohydrate binding specificity of the D. stramonium and G. simplicifolia I-B4 lectins, we postulate that, parallel with thioglycolate stimulation, there is an increase in the number of N-acetyllactosamine residues and terminal [alpha]--galactosyl end groups. The blood group B, and H type 1 determinants--Ga1[alpha]1,3[Fuc[alpha]1,2]Ga1[beta]1,3(or 4)GlcNAc and Fuc[alpha]1,2Ga1[beta]1,3G1cNAc, respectively, as well as Ga1[alpha]1,3Ga1[beta]1,3(or 4)GlcNAc--may be considered to be possible receptors for the E. europaea lectin. These glycoconjugates, present on the surface of peritoneal exudate cells, provide new chemical markers for studying the differentiation of resident peritoneal cells.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26332/1/0000419.pd

Protection from annual flooding is correlated with increased cholera prevalence in Bangladesh: a zero-inflated regression analysis

<p>Abstract</p> <p>Background</p> <p>Alteration of natural or historical aquatic flows can have unintended consequences for regions where waterborne diseases are endemic and where the epidemiologic implications of such change are poorly understood. The implementation of flood protection measures for a portion of an intensely monitored population in Matlab, Bangladesh, allows us to examine whether cholera outcomes respond positively or negatively to measures designed to control river flooding.</p> <p>Methods</p> <p>Using a zero inflated negative binomial model, we examine how selected covariates can simultaneously account for household clusters reporting no cholera from those with positive counts as well as distinguishing residential areas with low counts from areas with high cholera counts. Our goal is to examine how residence within or outside a flood protected area interacts with the probability of cholera presence and the effect of flood protection on the magnitude of cholera prevalence.</p> <p>Results</p> <p>In Matlab, living in a household that is protected from annual monsoon flooding appears to have no significant effect on whether the household experiences cholera, net of other covariates. However, counter-intuitively, among households where cholera is reported, living within the flood protected region significantly increases the number of cholera cases.</p> <p>Conclusions</p> <p>The construction of dams or other water impoundment strategies for economic or social motives can have profound and unanticipated consequences for waterborne disease. Our results indicate that the construction of a flood control structure in rural Bangladesh is correlated with an increase in cholera cases for residents protected from annual monsoon flooding. Such a finding requires attention from both the health community and from governments and non-governmental organizations involved in ongoing water management schemes.</p

Comparing cost-effectiveness of surface water flood management interventions in a UK catchment

This is the final published version. Available from Wiley via the DOI in this record.Despite significant consequences caused by recent events, surface water flooding has historically been of lower priority relative to fluvial and coastal risks in UK flood management. Legislation and research proposes a variety of innovative interventions to address this; however, widespread application of these remains a challenge due to a number of institutional, economic, and technical barriers. This research applies a framework capable of fast and high-resolution assessment of intervention cost-effectiveness as an opportunity to improve available evidence and encourage uptake of interventions through analysing permutations of type, scale, and distribution in urban catchments. Fast assessment of many scenarios is achieved using a cellular automata flood model and a simplified representation of interventions. Conventional and green strategies are examined across a range of design standard and high-magnitude rainfall events in an urban catchment. Results indicate high-volume rainwater capture interventions demonstrate a significant reduction in estimated annual damage costs, and localised surface water drainage interventions exhibit high cost-effectiveness for damage reduction. Analysis of performance across a wide range of return periods enhances available evidence for option comparison decision support and provides a basis for future resilience assessment of interventions.Engineering and Physical Sciences Research Council (EPSRC

Waterborne microbial risk assessment : a population-based dose-response function for Giardia spp. (E.MI.R.A study)

BACKGROUND: Dose-response parameters based on clinical challenges are frequently used to assess the health impact of protozoa in drinking water. We compare the risk estimates associated with Giardia in drinking water derived from the dose-response parameter published in the literature and the incidence of acute digestive conditions (ADC) measured in the framework of an epidemiological study in a general population. METHODS: The study combined a daily follow-up of digestive morbidity among a panel of 544 volunteers and a microbiological surveillance of tap water. The relationship between incidence of ADC and concentrations of Giardia cysts was modeled with Generalized Estimating Equations, adjusting on community, age, tap water intake, presence of bacterial indicators, and genetic markers of viruses. The quantitative estimate of Giardia dose was the product of the declared amount of drinking water intake (in L) by the logarithm of cysts concentrations. RESULTS: The Odds Ratio for one unit of dose [OR = 1.76 (95% CI: 1.21, 2.55)] showed a very good consistency with the risk assessment estimate computed after the literature dose-response, provided application of a 20 % abatement factor to the cysts counts that were measured in the epidemiological study. Doing so, a daily water intake of 2 L and a Giardia concentration of 10 cysts/100 L, would yield an estimated relative excess risk of 12 % according to the Rendtorff model, against 11 % when multiplying the baseline rate of ADC by the corresponding OR. This abatement parameter encompasses uncertainties associated with germ viability, infectivity and virulence in natural settings. CONCLUSION: The dose-response function for waterborne Giardia risk derived from clinical experiments is consistent with epidemiological data. However, much remains to be learned about key characteristics that may heavily influence quantitative risk assessment results

Spatially explicit integrated modeling and economic valuation of climate driven land use change and its indirect effects

We present an integrated model of the direct consequences of climate change on land use, and the indirect effects of induced land use change upon the natural environment. The model predicts climate-driven shifts in the profitability of alternative uses of agricultural land. Both the direct impact of climate change and the induced shift in land use patterns will cause secondary effects on the water environment, for which agriculture is the major source of diffuse pollution. We model the impact of changes in such pollution on riverine ecosystems showing that these will be spatially heterogeneous. Moreover, we consider further knock-on effects upon the recreational benefits derived from water environments, which we assess using revealed preference methods. This analysis permits a multi-layered examination of the economic consequences of climate change, assessing the sequence of impacts from climate change through farm gross margins, land use, water quality and recreation, both at the individual and catchment scale

Self-Potential as a Predictor of Seawater Intrusion in Coastal Groundwater Boreholes

This work was supported by the Natural Environment Research Council in the UK, as part of the Science and Solutions for a Changing Planet Doctor Training Partnership, run by the Grantham Institute for Climate Change at Imperial College London. We thank Southern Water for access to the boreholes at Saltdean and Balsdean. We thank Southern Water and Atkins Global for funding the installation of the equipment. We also thank Dr Amadi Ijioma for providing a prototype of the electrodynamic modelling code in MATLAB, which has since been adapted for use in a coastal chalk aquifer. Three anonymous reviewers are thanked for their comments, which greatly helped to improve the manuscript. The data used in this paper are in the tables, figures and cited information. The authors have no conflicts of interest to declare.Peer reviewedPublisher PDFPublisher PD

Water-loss (intracellular) dehydration assessed using urinary tests, how well do they work? Diagnostic accuracy in older people

Background: Water-loss dehydration (hypertonic, hyperosmotic or intra-cellular dehydration) is due to insufficient fluid intake and distinct from hypovolemia due to excess fluid losses. It is associated with poor health outcomes such as disability and mortality in older people. Urine specific gravity (USG), color and urine osmolality have been widely advocated for screening for dehydration in older adults. Objective: To assess the diagnostic accuracy of urinary measures to screen for water-loss dehydration in older people.Design: This was a diagnostic accuracy study of people aged ≥65years taking part in the Dehydration Recognition In our Elders (DRIE, living in long-term care) or Dietary Strategies for Healthy Ageing in Europe (NU-AGE, living in the community) studies. The reference standard was serum osmolality, index tests included USG, urine color, osmolality, cloudiness, additional dipstick measures, ability to provide a urine sample, and volume of a random urine sample. Minimum useful diagnostic accuracy was set at sensitivity and specificity ≥70% or receiver operating characteristics plot area under the curve ≥0.70. Results: DRIE participants (67% women, mean age 86 years, n=162) had more limited cognitive and functional abilities than NU-AGE participants (64% women, mean age 70 years, n=151). 19% of DRIE and 22% of NU-AGE participants were dehydrated (serum osmolality >300mOsm/kg). Neither USG nor any other potential urinary tests were usefully diagnostic for water-loss dehydration. Conclusions: Although USG, urine color and urinary osmolality have been widely advocated for screening for dehydration in older adults, we show in the largest study to date that their diagnostic accuracy is too low to be useful and these measures should not be used to indicate hydration status in older people (either alone or as part of a wider tranche of tests). There is a need to develop simple, inexpensive and non-invasive tools for the assessment of dehydration in older people

Specific induction of pp125 focal adhesion kinase in human breast cancer

The pp125 focal adhesion kinase (FAK) is involved in integrin-mediated cell signalling and overexpressed in a variety of solid tumours. Focal adhesion kinase expression has been correlated to invasion and metastasis, but the data on breast cancer are inconclusive. We analysed FAK mRNA, protein levels and expression patterns in primary breast cancer and normal breast tissue. FAK expression on the functional protein level and mRNA was determined in 55 matched pairs of breast cancer and corresponding normal tissue by Western blot, immunohistochemistry and RT–PCR. Using a score ranging from 0 to +5 for Western blots, we determined in normal breast tissue a score of 1.51±0.84 (mean±standard deviation), which was strongly induced to 2.91 (±1.22) in breast cancers (P<0.001). Overall, 45 out of 55 tissue pairs (81.8%) showed this upregulation of FAK protein in tumours in comparison to normal tissue. Immunohistochemistry confirmed these findings with a significant higher score for tumours vs physiological tissue (1.0±0.63 vs 2.27±0.91; P=0.001). Interestingly, no overall significant difference in the mRNA levels (P=0.359) was observed. In conclusion, expression levels of the FAK protein are specifically upregulated in breast cancer in comparison to matched normal breast tissue supporting its pivotal role in neoplastic signal transduction and representing a potential marker for malignant transformation

Factors associated with compliance among users of solar water disinfection in rural Bolivia

ABSTRACT: BACKGROUND: Diarrhoea is the second leading cause of childhood mortality, with an estimated 1.3 million deaths per year. Promotion of Solar Water Disinfection (SODIS) has been suggested as a strategy for reducing the global burden of diarrhoea by improving the microbiological quality of drinking water. Despite increasing support for the large-scale dissemination of SODIS, there are few reports describing the effectiveness of its implementation. It is, therefore, important to identify and understand the mechanisms that lead to adoption and regular use of SODIS. METHODS: We investigated the behaviours associated with SODIS adoption among households assigned to receive SODIS promotion during a cluster-randomized trial in rural Bolivia. Distinct groups of SODIS-users were identified on the basis of six compliance indicators using principal components and cluster analysis. The probability of adopting SODIS as a function of campaign exposure and household characteristics was evaluated using ordinal logistic regression models. RESULTS: Standardised, community-level SODIS-implementation in a rural Bolivian setting was associated with a median SODIS use of 32% (IQR: 17-50). Households that were more likely to use SODIS were those that participated more frequently in SODIS promotional events (OR = 1.07, 95%CI: 1.01-1.13), included women (OR = 1.18, 95%CI: 1.07-1.30), owned latrines (OR = 3.38, 95%CI: 1.07-10.70), and had severely wasted children living in the home (OR = 2.17, 95%CI: 1.34-3.49). CONCLUSIONS: Most of the observed household characteristics showed limited potential to predict compliance with a comprehensive, year-long SODIS-promotion campaign; this finding reflects the complexity of behaviour change in the context of household water treatment. However, our findings also suggest that the motivation to adopt new water treatment habits and to acquire new knowledge about drinking water treatment is associated with prior engagements in sanitary hygien and with the experience of contemporary family health concerns.Household-level factors like the ownership of a latrine, a large proportion of females and the presence of a malnourished child living in a home are easily assessable indicators that SODIS-programme managers could use to identify early adopters in SODIS promotion campaigns. TRIAL REGISTRATION: ClinicalTrials.gov: NCT0073149