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Trema orientalis and Trewia nudiflora are the fastest rotation trees (3–4 years' rotation) in Bangladesh, and experimentally planted in social forestry in Gazipur district. Biorefinery is the most cited topic in research recent era in order to established circular bioeconomy. In established a biorefinery initiative, both species were fractionated into pulp, lignin and hemicellulose by formic acid (FA) treatment at atmospheric conditions. After alkaline peroxide bleaching of FA treated pulp, the yield was 47.0 % and 41.0 % with α-cellulose of 82.39 % and 81.61 %, and residual pentosan content of 9.26 % and 11.13 % for T. orientalis and T. nudiflora, respectively. The brightness of the pulps was 84.5 % and 85.0 %. Cold alkali extraction of the bleached pulp increased α-cellulose to 92.36 % and 91.29 % which was suitable for cellulose derivatives. Lignin was separated from the spent liquor by adding water. The FA lignin from hardwood replaced 20 % phenol in phenol-formaldehyde resin preparation without sacrifice of shear strength. The lignin separated FA liquor contains mainly pentose sugars, which was subsequently converted to furfural with a yield of 41.39 % and 41.72 % at 170 °C using 0.1 % H2SO4 catalyst from T. orientalis and T. nudiflora, respectively. [ABSTRACT FROM AUTHOR]

The main drawback of recycled fibers is the deterioration of fiber bonding dependent papermaking properties (like tensile, tear and burst indexes) due to the hornification effect, as a results of drying during papermaking. In order to improve the papermaking properties through increasing fiber bonding, an alkaline treatment of Old Corrugated Cardboard (OCC) followed by fractionation were carried out in this investigation. Alkaline treatment dissolved 6.6 % organics (carbohydrates and lignin) and fibers became wider as a results of fiber swelling. The alkali treatment decreased fines from 39.9 % to 28.5 %, consequently, decreased drainage resistance from 26 °SR to 21 °SR. The papermaking properties of OCC pulp increased on alkaline treatment. Fiber fractionation of alkaline treated OCC further increased papermaking properties. At 40 °SR value, the tensile index, burst index and tear index of alkaline treated longer fiber fraction was 49 N m/g, 3.2 kPa m2/g, 7.2 mN m2/g, respectively while it was 40.4 N m/g, 2.1 kPa m2/g and 6.1 kPa m2/g, for non-treated longer fiber fraction, respectively. [ABSTRACT FROM AUTHOR]

Background: Number of elderly population is growing very faster all over the world. This growth in elderly population relative to other age groups challenges mostly the existing health services, family relationships and social security. In this article we tried to address the gravity of the issue at family, social and national level. We also examined the parents care scenario in Western World and Asian societies. Observations and conclusions: Our observations revealed that old people from both West and Asia are interested to stay in their home with their children and grandchildren. This is a way to transmit there real life experience to their third generation (grand children) which, however, is very essential for the emotional, humane and psychological development of our future generation of the World. The present day capitalistic attitude is eroding the emotion and affection to the old and a big number of then end up in West and although smaller in Asian countries, but showed increasing trend, end up old homes. There are, however, situations where facilities needed for care of older people who lost their children and sometimes ailing people in native countries where their children living or settled aboard. Taking into consideration of the growing issue and empathic care of those facilities in such situations run following guidelines and ethical rules. [ABSTRACT FROM AUTHOR]

An estimated 3.4 million people live in the overcrowded slums of Dhaka. Among them a handsome amount of population is women. These slum women are considered as poorest of the poor. Because their household activities are not recognized as productive ones. Study shows that, they have limited access to urban facilities such as water, gas, electricity and sanitation. Apart from these, they are living in unhygienic environment and facing a lot of challenges in slum life. The study was conducted on 150 women living in 10 slums of Dhaka city out of 4500 based on survey method. Besides, the study also suggests some solutions to improve the overall situation of slum women. [ABSTRACT FROM AUTHOR]

The comparative approach regarding the ethics of surrogacy from the Western secular and Islamic bioethical view reveals both commensurable and incommensurable relationship. It is not either straight forward 'commensurable' or straight forward 'incommensurable.' Islamic bioethics is straight-forward in prohibiting reproductive cloning on its own features and also guess social chaos and anarchy. Western secular bioethics has both arguments and counter arguments both for and against this scientific innovation. Both are eager to highlight the welfare of the society as a whole but the approaches are not always the same. [ABSTRACT FROM AUTHOR]

Improved sanitation has been hypothesized to reduce soil-transmitted helminth (STH) infections by reducing the prevalence and concentration of STH eggs/larvae in soil. We evaluated the effect of a randomized sanitation program (providing households with an improved dual-pit latrine, tools for child/animal feces management, and behavioral messaging) on reducing the prevalence and concentration of STH eggs in soil from household courtyards. We collected soil samples from 1405 households enrolled in the sanitation intervention (n = 419) and control (n = 914) groups of a cluster-randomized controlled trial (WASH Benefits) in rural Bangladesh approximately 2 years after the initiation of the interventions. We analyzed samples for Ascaris lumbricoides, Trichuris trichiura, and hookworm eggs by microscopy. We estimated prevalence ratios (PR) and egg count ratio (ECR) to compare the prevalence of STH eggs and arithmetic and geometric mean egg counts for STH eggs per gram of soil in the sanitation and control arms. Among intervention households, latrines achieved high and sustained user uptake by adults while child open defecation remained common and most households did not dispose of child feces hygienically. In courtyard soil from control households, the prevalence of any STH eggs was 75.7% and the prevalence of any larvated STH eggs was 67.3%. A. lumbricoides was detected in 63.0% of control samples and T. trichiura in 55.7% of control samples; hookworm was not detected in any sample. In the control arm, the arithmetic mean egg count for any STH was 3.96 eggs/dry gram, while the geometric mean was 1.58 eggs/dry gram. There was no difference between the intervention and control groups in the prevalence of any STH eggs (PR = 0.98 (95% CI: 0.91, 1.05)) or mean egg counts (ECR = 0.08 (95% CI: -0.10, 0.26) for geometric mean and 0.07 (95% CI: -0.22, 0.37) for arithmetic mean). Adjusted models gave similar results. A compound-level sanitation intervention that provided improved latrines and tools for disposal of child and animal feces did not have an impact on STH eggs in soil. In order to effectively reduce the prevalence and concentration of STH eggs in the environment, sustained, widespread use of sanitation strategies to isolate and hygienically dispose of child and animal feces may need to complement traditional strategies for containment of adult human feces. Trial Registration:NCT01590095. Author summary: Improved sanitation has been hypothesized to reduce soil-transmitted helminth (STH) infections by reducing the prevalence and concentration of STH eggs/larvae in soil. We evaluated the effect of a randomized sanitation program (providing households with an improved dual-pit latrine, tools for child/animal feces management, and behavioral messaging) on reducing the prevalence and concentration of STH eggs in soil from household courtyards. We collected soil samples from 1405 households enrolled in the control and sanitation intervention arms of a cluster-randomized controlled trial (WASH Benefits) in rural Bangladesh approximately 2 years after the initiation of the interventions. We analyzed samples for Ascaris lumbricoides, Trichuris trichiura and hookworm eggs by microscopy. We found no effect of the sanitation intervention on STH eggs in soil. In order to effectively reduce the prevalence and concentration of STH eggs in the environment, sustained, widespread use of sanitation strategies to isolate and hygienically dispose of child and animal feces may need to complement traditional strategies for containment of adult human feces. [ABSTRACT FROM AUTHOR]

Background: A significant concern for Bangladesh is the high prevalence of adolescent pregnancy and the associated negative consequences for mother and baby, including a teen-related increased risk of preterm birth (PTB). Bangladesh also has one of the highest incidences of PTB (19%). Despite these high numbers of adolescent pregnancies and PTB, little is reported about the experiences of adolescent mothers in caring for their preterm babies, and the interventions needed to support them. The aim of this study was to explore gaps and opportunities for improved care for preterm babies among adolescent mothers and communities in rural Bangladesh. Methods: We conducted a qualitative study in rural villages of Baliakandi sub-district of Bangladesh. Data collection involved in-depth interviews with adolescent mothers of premature and term babies, adult mothers with premature babies, and family members (n = 36); focus groups with community members (n = 5); and key informant interviews with healthcare providers (n = 13). Adolescent mothers with term and adult mothers with PTBs were included to elicit similarities and differences in understanding and care practices of PTB. A thematic approach was used for data analysis. Results: We explored two major themes- perceptions and understanding of PTB; care practices and care-seeking for illnesses. We observed gaps and variations in understanding of preterm birth (length of gestation, appearance, causes, problems faced) and care practices (thermal management, feeding, weight monitoring) among all, but particularly among adolescents. Immediate natal and marital-kins were prominent in the narratives of adolescents as sources of informational and instrumental support. The use of multiple providers and delays in care-seeking from trained providers for sick preterm babies was noted, often modulated by the perception of severity of illness, cost, convenience, and quality of services. Health systems challenges included lack of equipment and trained staff in facilities to provide special care to preterm babies. Conclusion: A combination of factors including local knowledge, socio-cultural practices and health systems challenges influenced knowledge of, and care for, preterm babies among adolescent and adult mothers. Strategies to improve birth outcomes will require increased awareness among adolescents, women, and families about PTB and improvement in quality of PTB services at health facilities. [ABSTRACT FROM AUTHOR]

Isolation of gene transcripts from desiccated leaf tissues of the resurrection grass, Sporobolus stapfianus, resulted in the identification of a gene, SDG8i, encoding a Group 1 glycosyltransferase (UGT). Here, we examine the effects of introducing this gene, under control of the CaMV35S promoter, into the model plant Arabidopsis thaliana. Results show that Arabidopsis plants constitutively over-expressing SDG8i exhibit enhanced growth, reduced senescence, cold tolerance and a substantial improvement in protoplasmic drought tolerance. We hypothesise that expression of SDG8i in Arabidopsis negatively affects the bioactivity of metabolite/s that mediate/s environmentally-induced repression of cell division and expansion, both during normal development and in response to stress. The phenotype of transgenic plants over-expressing SDG8i suggests modulation in activities of both growth- and stress-related hormones. Plants overexpressing the UGT show evidence of elevated auxin levels, with the enzyme acting downstream of ABA to reduce drought-induced senescence. Analysis of the in vitro activity of the UGT recombinant protein product demonstrates that SDG8i can glycosylate the synthetic strigolactone analogue GR24, evoking a link with strigolactone-related processes in vivo. The large improvements observed in survival of transgenic Arabidopsis plants under cold-, salt- and drought-stress, as well as the substantial increases in growth rate and seed yield under non-stress conditions, indicates that overexpression of SDG8i in crop plants may provide a novel means of increasing plant productivity. [ABSTRACT FROM AUTHOR]

Islam is second largest religion being practiced around the globe. It is fastest growing believe and rapidly expanding in the western world despite several misunderstanding including Islamic standpoint on organ transplantation and tissue grafting. The objective of this study is to determine the Islamic view point on organ transplantation and tissue grafting with special reference pertaining to human needs under the ambit of Shariah doctrine of necessity and world religions. Since, Islam and other world religions have given immense consideration to humans whether they are alive or dead, and the desecration of human body is considered a violation sufficed to a great sin. Injunctions of the holy Quran and Sunnah have evidently expressed sanctity to human life/body. Hence, taking one's life without a legal rights or even inflicting any sort of harm, injury, and aggression against an individual is terming an unlawful act. Notably, some scholars contended that, classical jurists' are silent on the issue of organ transplantation predominantly the transfer of organs from one species to another species. But, in reality, our argument is that, the organ re-plantation can be seen in the Prophetic era. However, as per their view, the reason is obvious, since the organ transplantation associated with the advancement of science. Accordingly, the recent progress in transplant sciences were not totally known to the classical jurists, although, issues pertaining to the sale of human organs have been discussed by them (jurists). Similarly, many other innovative matters can be seen in Prophetic traditions, and that is why, as per jurist's assertion, it can practically be traced in the Prophetic era. Consequently, this study argues that, the permissibility of organ donation and transplantation somehow mentioned in the main sources of Islamic law and biomedical ethics. Therefore, the basis and rules of permissibility will be derived while discussing organ transplantation, particularly in homo, allotransplant and other inter-related issues under the rubric of necessity doctrine. [ABSTRACT FROM AUTHOR]

Child open defecation is common in low-income countries and can lead to fecal exposure in the domestic environment. We assessed associations between child feces management practices vs. measures of contamination and child diarrhea among households with children <5 years in rural Bangladesh. We visited 360 households quarterly and recorded caregiver-reported diarrhea prevalence, and defecation and feces disposal practices for children <5 years. We examined caregiver and child hands for visible dirt and enumerated E. coli in child and caregiver hand rinse and stored drinking water samples. Safe child defecation (in latrine/potty) and safe feces disposal (in latrine) was reported by 21% and 23% of households, respectively. Controlling for potential confounders, households reporting unsafe child defecation had higher E. coli prevalence on child hands (prevalence ratio [PR] = 1.12, 1.04–1.20) and in stored water (PR = 1.12,1.03–1.21). Similarly, households reporting unsafe feces disposal had higher E. coli prevalence on child hands (PR = 1.11, 1.02–1.21) and in stored water (PR = 1.10, 1.03–1.18). Effects on E. coli levels were similar. Children in households with unsafe defecation and feces disposal had higher diarrhea prevalence but the associations were not statistically significant. Our findings suggest that unsafe child feces management may present a source of fecal exposure for young children. [ABSTRACT FROM AUTHOR]

The study is designed to investigate the issue of abortion for rape-victims to draw the attentions of Islamic clerics in order to appraise consciousness and outlook of legal edicts within constrain of Islamic bio-medical and bio-ethical norms. For this purpose, a number of Islamic treatises are systematically examined, and a cross-cultural along with a cross-country assessment of 47 countries abortion laws particularly 'Muslim-majority' (OIC member) countries are conducted to assess the momentous impacts on rape-victims. Additionally, contemporary data i.e. legal edicts and various reported rape/adultery cases in different Islamic countries are analyzed with special reference to the circumstances in which the verdicts are issued. The study asserts that mostly the classical and contemporary literature silent on the cited issue except few of the legal edicts. Although, Islamic lit and scripts including bio-medical and bio-ethical has discussed it in general way. As a result, the rape victims appeared that they may be allowed termination of unwanted fetus due to coerced sexual relation. But, whether in preview of, some of the legal edicts which causes intricacy, the state laws, rules and more particularly the religious and cultural aspects may allow this kind of deliberation? A predominantly conventional approach was found, since 18 out of 47 countries do not allow abortion except for necessity. Less than 50% of OIC members legally permit abortion on medical grounds. Nevertheless, there was a substantial diversity between Muslim countries. Albeit, a multidimensional viewpoint is very important due to the consequential psychiatric and social problems, since there is an immense need to provide real solutions to such cases that would not contradict Islamic bioethical principles. Therefore, termination of rape resulting pregnancies may be declared valid, provided with specific conditions and guidelines as per Shariah keeping in view bio-medical and bio-ethical norms. [ABSTRACT FROM AUTHOR]

Phyllodes tumor of the breast is a rare mixed tumor of epithelial and mesenchymal origin with an incidence of less than 1% of all primary breast tumors. This tumor is well known for its high potential for local recurrence ranging in 8–40% of patients. Excision of tumor with a 2-cm margin without raising skin flap along with overlying skin and underlying part of pectoralis major muscle described by our team seems to be a guarantee against local recurrence. It was a prospective cohort study conducted at the Department of Surgical Disciplines, AIIMS, New Delhi, India, from March 2011 to December 2016. Patients with large phyllodes tumor were managed with a "radical mastectomy without axillary lymph node dissection" whereas women with a small lesion were treated with a wide local excision with a 2-cm margin of healthy breast tissue all around the lesion following our surgical technique. Sixty-one women were enrolled in this study. Twenty-nine patients underwent wide local excision, and 32 patients with large, recurrent, or malignant tumors were managed by radical mastectomy without axillary lymph node dissection (ALND) (27 patients) and with ALND in 5 patients with enlarged axillary nodes. None of the patients have developed local recurrence till date with a follow-up period ranging from 2 to 59 months. Excision of tumor with a 2-cm margin without raising skin flap along with overlying skin and underlying part of pectoralis major muscle is a very effective technique to prevent local recurrence. [ABSTRACT FROM AUTHOR]

Background: Hands are a route of transmission for fecal-oral pathogens. This analysis aimed to assess associations between hand E. coli contamination and child age and determine if observed hand cleanliness can serve as a proxy for E. coli contamination on young children’s hands. Methods: Trained field workers collected hand rinse samples from children aged 1–14 months in 584 households in rural Bangladesh and assessed the visual cleanliness of child hands (fingernails, finger pads and palms). Samples were analyzed using the IDEXX most probable number (MPN) methodto enumerate E. coli. We assessed if child age (immobile children aged 1–4 months vs. mobile children aged 5–14 months) is associated with log10 E. coli counts on hands using generalized estimating equations (GEE). We estimated the log10 difference in hand E. coli counts associated with the cleanliness of different hand parts using a multivariable GEE model.We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for dirty fingernails, fingerpads, palms and overall hands (the three observed parts combined) against binary E. coli presence on hands. Results: E. coli was detected on 43% of child hands. Children in the mobile age range had 0.17 log10 MPN higher E. coli on hands than those in the immobile age range (Δlog10 = 0.17, 95% CI = 0.02, 0.32, p = 0.03). Children with visible dirt particles on finger pads had 0.46 log10 MPN higher E. coli on hands than those with clean finger pads (Δlog10 = 0.46, 95% CI = 0.05, 0.87, p = 0.03). Dirty fingernails indicated binary E. coli presence with 81% sensitivity and 26% specificity while dirty fingerpads and palms indicated E. coli presence with 29% sensitivity and 75–77% specificity. The PPV was 45–48% and NPV 59–65% for all three types of observations. Conclusion: Hand contamination with E. coli was prevalent among young children in rural Bangladesh, with higher levels of contamination among mobile children. Studies should assess if strategies to remove animal feces from the courtyard, provide designated hygienic play spaces for children and deliver targeted messaging to mothers to wipe or wash children’s hands after contact with animals and animal feces reduce child hand contamination. Visible hand cleanliness was a poor predictor of E. coli presence on young children’s hands so other low-cost field measurements are needed to accurately detect fecal contamination on hands. [ABSTRACT FROM AUTHOR]

Background: In the growing embryo, the vitamin A requirement is tightly regulated. Maternal vitamin A deficiency during pregnancy may alter maternal immune function to accommodate the fetus.Objective: Our primary objective was to determine the effect of oral vitamin A supplementation (VAS) during pregnancy and until 6 mo postpartum on pandemic H1N1-vaccine responses in mothers and their infants at 6 mo of age.Methods: In this randomized controlled clinical trial, pregnant women (n = 112) during the second trimester (mean ± SD: 14 ± 1 wk) were assigned to receive either an oral dose of 10,000 IU vitamin A or placebo weekly until 6 mo postpartum. During the third trimester, mothers received a single dose of inactivated pandemic H1N1-influenza vaccine. Hemagglutination-inhibition (HAI) titer was measured in cord, infant, and maternal blood samples. Multivariate regressions with adjustments were used for data analysis.Results: Seventy-six percent of women had low plasma retinol concentrations (<1.05 μmol/L) in their second trimester. VAS of mothers increased vitamin A concentrations in cord blood by 21.4% and in colostrum by 40.7%. At 6 mo postpartum, women in the vitamin A group had 38.7% higher HAI titers and a higher proportion of HAI titer of ≥1:40 of the cutoff compared with the placebo group. A total of 54.5% of infants had an HAI titer ≥1:40 at 6 mo of age, but there was no difference in HAI titer in infants between groups. Overall, HAI in cord blood did not differ between groups, but in the placebo group, cord blood HAI was negatively associated with maternal "vaccination-to-delivery intervals" (rs = -0.401; P = 0.5), and maternal VAS increased cord blood HAI 6-fold if antenatal immunization was administered ≥10 wk before delivery.Conclusions: In a community with low vitamin A status, weekly maternal VAS during pregnancy and postpartum increases the breast-milk vitamin A concentration and enhances prenatal H1N1-vaccine responses in mothers, but the benefits of maternal VAS in transplacental antibody transfer may depend on the time of gestation when mothers were vaccinated. This trial was registered at clinicaltrials.gov as NCT00817661. [ABSTRACT FROM AUTHOR]

Fecal-oral pathogens are transmitted through complex, environmentally mediated pathways. Sanitation interventions that isolate human feces from the environment may reduce transmission but have shown limited impact on environmental contamination. We conducted a study in rural Bangladesh to (1) quantify domestic fecal contamination in settings with high on-site sanitation coverage; (2) determine how domestic animals affect fecal contamination; and (3) assess how each environmental pathway affects others. We collected water, hand rinse, food, soil, and fly samples from 608 households. We analyzed samples with IDEXX Quantitray for the most probable number (MPN) of E. coli. We detected E. coli in source water (25%), stored water (77%), child hands (43%), food (58%), flies (50%), ponds (97%), and soil (95%). Soil had >120?000 mean MPN E. coli per gram. In compounds with vs without animals, E. coli was higher by 0.54 log10 in soil, 0.40 log10 in stored water and 0.61 log10 in food (p < 0.05). E. coli in stored water and food increased with increasing E. coli in soil, ponds, source water and hands. We provide empirical evidence of fecal transmission in the domestic environment despite on-site sanitation. Animal feces contribute to fecal contamination, and fecal indicator bacteria do not strictly indicate human fecal contamination when animals are present. [ABSTRACT FROM AUTHOR]

Purpose: The World Health Report identifies zinc deficiency as one of the major causes of disease in developing countries, and infants are at particular risk. We aimed to investigate the effect of maternal zinc supplementation on the infant's immune function in a population at risk of deficiency. Methods: In a randomized, double-blind placebo-controlled trial, mothers were supplemented either with 20 mg/day of elemental zinc ( n = 20) or placebo ( n = 19) at the beginning of second trimester, which continued until 6 months postpartum. Indicators of the infants' immune function measured included interleukin (IL)-7, thymic size and response to hepatitis B vaccination. Results: Infants born from mothers receiving zinc supplements during pregnancy and postpartum had significantly lower plasma zinc ( p < 0.05) but marginally higher IL-7 and antibody responses to hepatitis B vaccination ( p < 0.10) than infants born from mothers not receiving zinc. Maternal zinc supplementation showed no negative impact on copper status of mothers or their infants. Maternal zinc supplementation did not influence infant thymic size, but cord blood IL-7 was found positively associated with thymus size at 1 month of age ( r = 0.392) and with hepatitis B vaccine response at 6 months of age ( r = 0.386). Conclusion: Prenatal and postnatal zinc supplementation marginally improved T cell-dependent antibody responses in infants along with IL-7, a cytokine involved in human T cell development and maintaining homeostasis. [ABSTRACT FROM AUTHOR]

Background: Household-level sanitation interventions have had limited effects on child health or environmental contamination, potentially due to low community coverage. Higher community-level coverage with safely managed sanitation can reduce opportunities for disease transmission.Methods: We estimated associations between community sanitation coverage, environmental fecal contamination, and child health among 360 compounds in the control arm of the WASH Benefits trial in rural Bangladesh (NCT01590095). In each compound, we enumerated E. coli in environmental samples and recorded the 7-day prevalence of caregiver-reported diarrheal disease and acute respiratory infections (ARI) in children under five. We observed indicators of latrine access and quality among all neighboring compounds within 100 m of study compounds. We defined community coverage as the proportion of neighboring compounds with (1) at least one latrine, and (2) exclusively hygienic latrines (improved facility observed to safely contain feces), within both 50 m and 100 m of study compounds. We assessed effect modification by population density and season.Results: Adjusted for confounders, study compounds surrounded by 100% coverage of at least one latrine per compound within 50 m had slightly lower log10E. coli counts in stored water (Δlog = -0.13, 95% CI -0.26, -0.01), child hand rinses (Δlog = -0.13, 95% CI -0.24, -0.02), and caregiver hand rinses (Δlog = -0.16, 95% CI -0.29, -0.03) and marginally lower prevalence of diarrheal disease (prevalence ratio [PR] = 0.82, 95% CI 0.64, 1.04) and ARI (PR = 0.84, 95% CI 0.69, 1.03) compared to compounds surrounded by <100% coverage. Effects were similar but less pronounced at 100 m. At higher population densities, community latrine coverage was associated with larger reductions in E. coli on child and caregiver hands and prevalence of diarrheal disease. Coverage with exclusively hygienic latrines was not associated with any outcome.Conclusion: Higher community sanitation coverage was associated with reduced fecal contamination and improved child health, with stronger effects at highly local scales (50m) and at high population densities. Our findings indicate that the relationship between community sanitation coverage, environmental contamination, and child health varies by definition of coverage, distance, and population density. This work highlights significant uncertainty around how to best measure sanitation coverage and the expected health effects of increasing sanitation coverage using a specific metric. Better understanding of community-level sanitation access is needed to inform policy for implementing sanitation systems that effectively protect community health. [ABSTRACT FROM AUTHOR]