The 2008 Cholera Epidemic in Zimbabwe: Experience of the icddr,b Team in the Field

During August 2008–June 2009, an estimated 95,531 suspected cases of cholera and 4,282 deaths due to cholera were reported during the 2008 cholera outbreak in Zimbabwe. Despite the efforts by local and international organizations supported by the Zimbabwean Ministry of Health and Child Welfare in the establishment of cholera treatment centres throughout the country, the case-fatality rate (CFR) was much higher than expected. Over two-thirds of the deaths occurred in areas without access to treatment facilities, with the highest CFRs (>5%) reported from Masvingo, Manicaland, Mashonaland West, Mashonaland East, Midland, and Matabeleland North provinces. Some factors attributing to this high CFR included inappropriate cholera case management with inadequate use of oral rehydration therapy, inappropriate use of antibiotics, and a shortage of experienced healthcare professionals. The breakdown of both potable water and sanitation systems and the widespread contamination of available drinking-water sources were also considered responsible for the rapid and widespread distribution of the epidemic throughout the country. Training of healthcare professionals on appropriate cholera case management and implementation of recommended strategies to reduce the environmental contamination of drinking-water sources could have contributed to the progressive reduction in number of cases and deaths as observed at the end of February 2009

Zinc Treatment to Under-five Children: Applications to Improve Child Survival and Reduce Burden of Disease

Zinc is an essential micronutrient associated with over 300 biological functions. Marginal zinc deficiency states are common among children living in poverty and exposed to diets either low in zinc or high in phytates that compromise zinc uptake. These children are at increased risk of morbidity due to infectious diseases, including diarrhoea and respiratory infection. Children aged less than five years (under-five children) and those exposed to zinc-deficient diets will benefit from either daily supplementation of zinc or a 10 to 14-day course of zinc treatment for an episode of acute diarrhoea. This includes less severe illness and a reduced likelihood of repeat episodes of diarrhoea. Given these findings, the World Health Organization/United Nations Children\u2019s Fund now recommend that all children with an acute diarrhoeal illness be treated with zinc, regardless of aetiology. ICDDR.B scientists have led the way in identifying the benefits of zinc. Now, in partnership with the Ministry of Health and Family Welfare, Government of Bangladesh and the private sector, the first national scaling up of zinc treatment has been carried out. Important challenges remain in terms of reaching the poorest families and those living in remote areas of Bangladesh

Improvement of wastewater quality of Dhaleswari river, Bangladesh using submerged macrophyte Egeria densa

Clean water is one of the significant goals among the 17 Sustainable Development Goals (SDGs), which will be achieved by at least 2030. It includes six outcome-oriented targets- improve water quality, wastewater treatment, ensure freshwater supplies are three of them. In Bangladesh, Freshwater ecosystem is continuously degraded due to rapid industrialization, which occurred along the riverside areas. In this context, laboratory-based work has been conducted to analyze the water quality of Dhaleshwari River, Bangladesh, which has already been polluted by industrial waste. The collected water samples were treated by submerged macrophyte Egeria densa to observe the changing water quality parameters. The growth of plants and roots were assessed after 10 days of exposure to three categories of water treatment. Initial and final water quality parameters were observed by the analysis of pH, EC, TDS, TSS, Acidity, Alkalinity, Total Hardness, Ca Hardness, COD, Sulphate (SO42-), Phosphate (PO43) Total Chlorine (Cl-) and Copper (Cu2+). The result showed that almost all the toxic parameters of water were reduced significantly at the end of the experiment. The present study hypothesized that submerged macrophyte E. densa can be used as a potential tool to upgrade the water quality of polluted rivers.Keyword: Clean water, Submerged macrophyte, SDG 6, Dhaleswari River, Freshwater ecosyste

The 2008 Cholera Epidemic in Zimbabwe: Experience of the icddr,b Team in the Field

During August 2008-June 2009, an estimated 95,531 suspected cases of cholera and 4,282 deaths due to cholera were reported during the 2008 cholera outbreak in Zimbabwe. Despite the efforts by local and international organizations supported by the Zimbabwean Ministry of Health and Child Welfare in the establishment of cholera treatment centres throughout the country, the case-fatality rate (CFR) was much higher than expected. Over two-thirds of the deaths occurred in areas without access to treatment facilities, with the highest CFRs (>5%) reported from Masvingo, Manicaland, Mashonaland West, Mashonaland East, Midland, and Matabeleland North provinces. Some factors attributing to this high CFR included inappropriate cholera case management with inadequate use of oral rehydration therapy, inappropriate use of antibiotics, and a shortage of experienced healthcare professionals. The breakdown of both potable water and sanitation systems and the widespread contamination of available drinking-water sources were also considered responsible for the rapid and widespread distribution of the epidemic throughout the country. Training of healthcare professionals on appropriate cholera case management and implementation of recommended strategies to reduce the environmental contamination of drinking-water sources could have contributed to the progressive reduction in number of cases and deaths as observed at the end of February 2009

A comparison of traditional diarrhoea measurement methods with microbiological and biochemical indicators : a cross-sectional observational study in the Cox's Bazar displaced persons camp

Background Water, Sanitation, and Hygiene (WASH) systems aim to reduce the spread of enteric pathogens, particularly amongst children under five years old. The most common primary outcome of WASH trials is carer-reported diarrhoea. We evaluate different diarrhoea survey instruments as proxy markers of enteric pathogen presence in stool. Methods We recruited 800 community-based participants from the Cox's Bazar Displaced Person's Camp in Bangladesh, split evenly between the rainy (July/August 2020) and dry (November/December 2020) periods. Participants were randomized evenly into either a standard survey asking carers if their child under five years old has had diarrhoea in the past fortnight, or a pictorial survey asking carers to pick from a pictorial chart which stools their child under five years old has had in the past fortnight. We collected stools from a random sub-sample of 120. Stools were examined visually, and tested for proteins associated with enteric infection and 16 enteric pathogens. We calculated sensitivities and specificities for each survey type, visual examination, and proteins with respect to enteric pathogen presence. Findings The sensitivity of the standard survey for enteric pathogen presence was 0.49[95%CI:0.32,0.66] and the specificity was 0.65[0.41,0.85]. Similar sensitivities and specificities were observed for pictorial survey, visual inspection, and proteins. Interpretation While diarrhoea is an important sign in clinical practice it appears that it is a poor proxy for enteric pathogen presence in stool in epidemiological surveys. When enteric infection is of interest, this should be measured directly

Zinc Treatment to Under-five Children: Applications to Improve Child Survival and Reduce Burden of Disease

Zinc is an essential micronutrient associated with over 300 biological functions. Marginal zinc deficiency states are common among children living in poverty and exposed to diets either low in zinc or high in phytates that compromise zinc uptake. These children are at increased risk of morbidity due to infectious diseases, including diarrhoea and respiratory infection. Children aged less than five years (under-five children) and those exposed to zinc-deficient diets will benefit from either daily supplementation of zinc or a 10 to 14-day course of zinc treatment for an episode of acute diarrhoea. This includes less severe illness and a reduced likelihood of repeat episodes of diarrhoea. Given these findings, the World Health Organization/United Nations Children’s Fund now recommend that all children with an acute diarrhoeal illness be treated with zinc, regardless of aetiology. ICDDR.B scientists have led the way in identifying the benefits of zinc. Now, in partnership with the Ministry of Health and Family Welfare, Government of Bangladesh and the private sector, the first national scaling up of zinc treatment has been carried out. Important challenges remain in terms of reaching the poorest families and those living in remote areas of Bangladesh

Protection of staff and families during COVID-19 pandemic: experience from a research institute in Bangladesh

Summary: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), which contains the world's largest diarrheal disease hospital, established a service centre, including testing facilities, isolation unit, out-patient department, in-patient ward, and intensive care unit during COVID-19 pandemic. When the management of COVID-19 was challenging nationwide, icddr,b established this facility with the goal to provide COVID-related services to the staff and their relatives amidst the pandemic. Data related to this analysis were collected from April 2020 to December 2021. 1399 patients received treatment under this facility. Among them, 351 patients were treated at the out-patient facility, 98 at the isolation, and 197 at the in-patient ward. Among the admitted patients, survival was 86.29% (n = 170/197). Among the suspected patients, 17% (n = 103/606) were COVID-positive. Setting up an immediate COVID-19 management facility during the pandemic was challenging. It can be an example of how an organisation can adapt to any emergency and act accordingly

Sustainable food drying technologies based on renewable energy sources

Waste in the food supply chain is estimated to be about 30–40% of the total food production, which aggravates the world hunger and increases waste management burden and environmental impact. Despite the dire food scarcity, majority of this food waste takes place in developing countries because of the lack of appropriate and affordable preservation techniques. Traditional open sun drying is the most popular food-reservation technique to the local farmers due to near-zero capital cost and cheap labor cost. However, this method is highly energy intensive, unhygienic, and time demanding. The high energy consumption resulting from uncontrolled simultaneous heat, mass, and momentum transfer processes in traditional drying systems highlights the necessity of pursuing sustainability in drying process targeting reduced energy consumption, environmental and social impacts. This paper presents a comprehensive review on the sustainable food drying technologies based on renewable energy sources, with emphasis on the developing countries. It was observed that the integration of thermal energy storage with heat pump makes the integrated drying system more efficient, and dries food with better quality. Likewise, advanced integrated drying systems, such as, solar with microwave, and heat pump with microwave make the drying process more cost and quality competent. Finally, impact of resource distribution and governmental incentives for renewable energy use in sustainable drying is discussed

Different Features of Cholera in Malnourished and Non-Malnourished Children: Analysis of 20 Years of Surveillance Data from a Large Diarrheal Disease Hospital in Urban Bangladesh

Malnourished children are more prone to infectious diseases including severe diarrhea compared to non-malnourished children. However, data are scarce on differences in the presentation in such children. We aimed to identify clinical differentials among children with cholera with or without malnutrition. Data were extracted from the diarrheal disease surveillance system (DDSS) of Dhaka Hospital of International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) from January 2001 to December 2020. Among children under five in DDSS, cholera positive (culture confirmed) malnourished children (WAZ, WL/HZ or L/HAZ ˂ −2) were considered as cases (n = 920) and children with cholera but non-malnourished (WAZ, WL/HZ or L/HAZ ≥−2.00 to ≤+2.00) were controls (n = 586). After adjusting for potential confounders such as maternal illiteracy, day labor fathers, maternal employment, slum dwelling, non-sanitary latrine use, use of untreated water, and history of cough, it was revealed that malnourished cholera children significantly more often presented in hospital during evening hours (6 p.m. to 12 mid-night) (p p 24 h history of diarrheal duration (p p p < 0.05). The study results underscore the importance of understanding of basic differences in the presentation of severity of cholera in malnourished children for prompt identification and subsequent management of these vulnerable children