A cross-sectional survey of water and clean faces in trachoma endemic communities in Tanzania

<p>Abstract</p> <p>Background</p> <p>Face washing is important to interrupt the transmission of trachoma, the leading infectious cause of blindness worldwide. We aimed to assess the household and personal factors that affected water use and face washing practices in Kongwa, Tanzania.</p> <p>Methods</p> <p>We conducted a household water use survey in 173 households (329 children) in January, 2010. Self reported data on water use practices, observed water in the household, and observed clean faces in children were collected. Contingency table analyses and logistic regression analyses were used to measure associations between unclean faces and risk factors.</p> <p>Results</p> <p>We found that women are recognized as primary decision makers on water use in a household, and respondents who reported laziness as a reason that others do not wash children's faces were significantly more likely to have children with clean faces. Washing was reported as a priority for water use in most households. Sixty four percent (95% Confidence Interval = 59%-70%) of children had clean faces.</p> <p>Conclusions</p> <p>Attitudes toward face washing and household water use appear to have changed dramatically from 20 years ago when clean faces were rare and men made decisions on water use in households. The sources of these attitudinal changes are not clear, but are positive changes that will assist the trachoma control program in strengthening its hygiene efforts.</p

Risk Factors for Ocular Infection with Chlamydia trachomatis in Children 6 Months following Mass Treatment in Tanzania

Trachoma control programs aim for high coverage of endemic communities with oral azithromycin to reduce the pool of infection with Chlamydia trachomatis. However, even with high coverage, infection is seen following treatment. In four communities in Tanzania, we followed every child aged under ten years from baseline through treatment to six months post-treatment. We determined who had infection at baseline and who still had or developed infection six months later. Coverage was over 95% in children in these communities, and infection in these children decreased by over 50% at six months. The study found that, at baseline, uninfected children who were treated had prevalence of infection at 6 months of 6%, but infected children who were treated had prevalence of infection of 22% at 6 months. Other risk factors for infection at 6 months included living in a household with other infected children, and living in a household with untreated children. Our data suggest that households with untreated children might be targeted for more intensive follow up to increase coverage and reduce subsequent infection in the community

Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP.

BackgroundNutritional status is an important factor in predicting the risk associated with surgery for cancer patients. This is especially true in colorectal cancer. Many nutritional assessments are used in clinical practice, but those assessments are rarely evaluated for their ability to predict postoperative outcome.MethodsThis is a retrospective, multi-institutional study of the ACS-NSQIP database, investigating preoperative nutrition status and its association with postoperative mortality and morbidity.ResultsThe prevalence of malnutrition is higher in colorectal cancer, when compared with other most common cancers. Among 42,483 colorectal cancer patients postoperative mortality was significantly associated with hypoalbuminemia (hazard ratio = 3.064, p &lt; 0.001), body weight loss (hazard ratio = 1.229, p = 0.033) and body mass index of &lt;18.5 kg/m(2) (hazard ratio = 1.797, p &lt; 0.001). Only hypoalbuminemia significantly predicted all postoperative complications, even in further multivariate logistic regression analyses (p &lt; 0.001). Multiple regression analysis showed that the hypoalbuminemia group had the highest coefficient in significant association with length of total hospital stay (B = 3.585, p &lt; 0.001) and overall complication (B = 0.119, p &lt; 0.001).ConclusionsIn colorectal cancer, malnutrition significantly contributes to postoperative mortality, morbidity and length of total hospital stay. Hypoalbuminemia, with levels below 3.5 g/dl, serves as an excellent assessment tool and preoperative predictor of postoperative outcomes

Baseline characteristics of the 1991 children in the study sample vs. 161 children who had no data at 6 months.

<p>*34 children had unusable PCR at baseline.</p><p>**chi square tests and a t-test for difference in mean ages.</p

Baseline characteristics of the sub group of 1439 children who were not infected at baseline, and infected at 6 months (n = 96).

<p>*Only children in this age group had assessment of facial cleanliness at baseline.</p><p>**The number reflects other children in household infected, not counting the index child.</p><p>***From a logistic model with infection at 6 months as the outcome accounting for clustering at the household level.</p

Sample population.

<p>Sample population.</p

Interaction of baseline infection and treatment, and infection at 6 months^**.

<p>*34 specimens were unusable at baseline.</p><p>**Interaction of treatment and baseline infection status, adjusted for age and clustering at household level, was not significant, p = .59.</p><p>***From a logistic model with infection at 6 months as the outcome accounting for clustering at the household level.</p

Multivariate logistic regression model predicting infection at 6 months^*.

<p>*adjusted for clustering of children in the households.</p