Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40.0% (95% uncertainty interval [UI] 39.4-40.7) to 50.3% (50.0-50.5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46.3% (95% UI 46.1-46.5) in 2017, compared with 28.7% (28.5-29.0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88.6% (95% UI 87.2-89.7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76.1% (95% UI 71.6-80.7) of countries from 2000 to 2017, and in 53.9% (50.6-59.6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.Peer reviewe

Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17

Background Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2 center dot 5th and 97 center dot 5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62 center dot 6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

STORAGE TIME STUDY OF SUGAR-FREE AND REDUCED CALORIE MILK CHOCOLATES

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)In order to study storage time, sensory properties and acceptability among consumers, regular, free-sugar (sucralose [Sucra] or stevioside [Ste]) and free-sugar/reduced calorie (Sucra or Ste], with whey protein concentrate as fat replacer) milk chocolates were evaluated over storage (0, 3, 6 and 9 months). Quantitative descriptive analysis showed that sensory properties do not change throughout the studied storage period. These results were confirmed by acceptability data. No significant changes (P >= 0.05) were observed on acceptability means for appearance, aroma, flavor, texture and overall liking. These results show that sugar-free and reduced calorie milk chocolates prepared with high-intensity sweeteners, Sucra and Ste, with partial fat replacement with whey protein concentrate had a similar storage time behavior as compared with regular chocolates. PRACTICAL APPLICATIONS This research aims to study sensory storage time of regular, sugar-free and sugar-free/reduced calorie milk chocolates. It can help food industries to understand storage time of these products as sensory properties for highly stable food products, such as chocolate, usually define shelf life.325577589Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Equisweet milk chocolates with intense sweeteners using time-intensity method

Five conventional chocolates were produced with different sucrose concentrations (from 40 to 52%) in order to determine ideal sweetness by acceptance test, and it was found that 43% sucrose milk chocolate has the ideal sweetness. Sucrose was replaced by bulking agents and sucralose or stevioside in order to prepare diabetic chocolates and 11 selected and trained judges determined the temporal characteristic of sweetness of these milk chocolates. Sucralose is 700 times sweeter than sucrose in this product, and stevioside, 200 times. Considering these potencies, they presented a time-intensity profile similar to chocolate with sucrose (i.e., conventional chocolate) and ideal sweetness. There is no significant difference between diabetic and conventional chocolates concerning the following physicochemical analyses: moisture content, medium particle size and Casson yield value.3061056106

EXPECTATIONS AND ACCEPTABILITY OF DIABETIC AND REDUCED-CALORIE MILK CHOCOLATES AMONG NONDIABETICS AND DIABETICS IN THE USA

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Consumer expectations and acceptance of six laboratory-developed prototypes of milk chocolate were evaluated by conjoint analysis and consumer acceptance testing with nondiabetics (n = 103 conjoint, n = 75 acceptance) and diabetics (n = 68 for conjoint, n = 71 acceptance). A conventional laboratory-developed chocolate was produced with sucrose. Diabetic laboratory-developed chocolates were made with a substitution of sucrose with high-intensity sweeteners, sucralose or stevioside, and a polydextrose/lactitol blend as a bulking agent. Diabetic/reduced-calorie milk chocolates were manufactured with an additional partial replacement of cocoa butter with whey protein concentrate. Sugar claim attribute was more important to diabetics than to nondiabetics; within this attribute, reduced sugar and sugar-free levels were more important to diabetics, while sugar-free was more important to nondiabetics. There was no difference for sweetener type and calorie reduction between the two groups. Differences in acceptance means (P < 0.05) for conventional, diabetic and diabetic/reduced-calorie milk chocolates (especially for samples made with stevioside) were documented within nondiabetic and diabetic consumers and between the two consumer groups. All samples were different across nondiabetic and diabetic consumers regarding overall liking. These results demonstrate that alternative products must be developed and labeled according to the specific consumer groups they are intended to address. PRACTICAL APPLICATIONS This study indicated which levels of sugar claim, sweetener type and calorie reduction should be used depending on whom - nondiabetics or diabetics - diabetic/reduced-calorie milk chocolates are being developed. Conjoint analysis is very important for development of new products because it allows for understanding which characteristics are most important prior to actual evaluation of products. Consumer testing using nondiabetic and diabetic consumers was helpful to validate the expectations determined through conjoint analysis with experimental samples.251133152North Carolina State University Agricultural Experiment Station [FSR 10-07]Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)North Carolina State University Agricultural Experiment Station [FSR 10-07

Time-intensity profile and internal preference mapping of strawberry jam

Time - intensity analysis was applied for sweet and sour tastes and strawberry flavor of six commercial brands of strawberry jam. For this test, 11 subjects, between 25 and 35 years old, were selected from an initial 12-member group. An affective test, with 117 consumers was also carried out and the results were analyzed by internal preference mapping. The least accepted samples were the ones with the lowest sweetness intensity, indicating that jam consumers prefer sweeter products. Also, one of them presented a higher sourness intensity, which may have had a negative influence on its acceptance. It is important to point out the fact that those least accepted samples were the low-calorie products. The internal preference mapping and cluster analysis showed two consumer clusters. The first one was a higher concentration of consumers toward traditional samples, and the second one showed a lower concentration of consumers in the direction of one of the low-calorie samples.23112513