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Background: Inadequate water, sanitation, and hygiene (WASH) are important drivers of the global burden of disease, and their impact is exacerbated during outbreaks. Directives to practice handwashing and physical distancing may be impractical for people that have limited access to WASH resources. In this study, which took place during the acute phase of the COVID-19 pandemic, we explore the relationship between control measures for global health crises and water, sanitation, and hygiene insecurity, with implications for other infectious diseases and future health emergencies. Methods: We investigated the relationship between WASH-related factors and disease prevention behaviors (handwashing, physical distancing, and masking), and the role of demographic characteristics and risk perceptions in influencing these relationships in low-income neighborhoods of Beira, Mozambique during the COVID-19 pandemic. We utilized data collected from 1,762 randomly selected households during a population-based survey. We fit multivariable logistic regression models to examine the associations between various WASH factors and disease prevention outcomes of interest, adjusting for individual- and household-level demographic characteristics and risk perceptions. Results: Over 98% of people had access to improved drinking water and over 80% of people had access to improved sanitation facilities. There was a high level of reported adherence to handwashing (95.5%) and physical distancing (91.7%) practices during the COVID-19 pandemic. There was a lower odds of reported handwashing [aOR = 0.89; 95% CI: 0.81, 0.98] and physical distancing [0.85 (0.80, 0.92)] among respondents who had higher levels of water insecurity. Respondents that had a water source in their dwelling had a higher odds of reporting of physical distancing [2.03 (1.22, 3.41)] compared to people that had to leave their household to access water. There was a higher odds of reported handwashing and physical distancing among respondents who had their own sanitation facility, compared to a shared one [handwashing: 2.77 (1.35, 5.82); distancing: 1.61 (0.95, 2.73)], and those that had a sanitation facility inside their compound compared to outside their compound [handwashing: 2.11 (0.75, 5.71); distancing: 1.50 (0.65, 3.36)]. Respondents with a basic handwashing station, compared to no facility or a limited facility, had a higher odds of reported handwashing [4.45 (2.37, 8.65)], and those that had a connected handwashing station, compared to an unconnected handwashing station, had a higher odds of reporting handwashing and physical distancing [handwashing: 2.13 (0.68, 8.54); distancing: 1.77 (0.77, 4.53)]. Conclusions: Despite a high level of knowledge about the risks posed by COVID-19 and understanding of the benefits of handwashing and physical distancing, limitations in access to water, sanitation, and hygiene infrastructure acted as a barrier to people practicing disease prevention behaviors during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Preterm birth (PTB) is a leading cause of newborn deaths and morbidities. The pregnancy risk assessment monitoring system (PRAMS) from the U.S., and the maternity experiences survey (MES) from Canada, which was modeled from PRAMS, were used to examine between-country differences in risk factors of preterm birth. The adjusted risk ratio and population attributable fraction (PAF) were calculated for modifiable and semi-modifiable risk factors of PTB, and all measures were compared between the U.S. and Canada. PTB was defined here as a live singleton birth between 28 and 37 completed weeks gestation (using the clinical gestational age estimate) where the baby was living with the mother at the time of the survey. The PTB risk was 7.6 % (SE = 0.2) in the U.S. and 4.9 % (SE = 0.3) in Canada. The a priori high risk category of factors was almost always more prevalent in the U.S. than Canada, suggesting broad social differences, but individually most of these differences were not associated with PTB. The underlying risk of PTB was generally higher in the U.S. in both the higher risk and referent categories, and the risk ratios for most risk factors were similar between the countries. The primary exception was for recurrence of PTB, where the risk ratio (RR) and PAF were much higher in Canada. We observed between-country differences in both the prevalence of risk factors and the adjusted RR. Further between-country comparisons may lead to important inferences as to the influence of modifiable risk factors contributing to PTB. Electronic supplementary material The online version of this article (doi:10.1007/s10995-014-1576-y) contains supplementary material, which is available to authorized users., Author(s): Joshua V. Garn[sup.1] , Tharsiya Nagulesapillai[sup.2] , Amy Metcalfe[sup.3] , Suzanne Tough[sup.2] , Michael R. Kramer[sup.4] Author Affiliations: (1) Department of Epidemiology, Rollins School of Public Health and Laney [...]

The purpose of this study was to characterize the concentrations of lead (Pb), cadmium (Cd), manganese (Mn), and Fe (Fe) in drinking water sources in primary schools in Sindh Province, Pakistan and to quantify potential health risks among those school children. We conducted a representative, cross-sectional study among 425 primary schools in Sindh province of Pakistan. We used risk assessment models to estimate the metal index, pollution index, lifetime cancer risk, and hazard quotient index. Across the 425 sampled schools, the levels of heavy metals in the drinking water often exceeded the WHO permissible limits (67% of schools exceeded Pb limit, 17% for Cd, 15% for Fe). The average incremental lifetime cancer risk (ILCR) for Pb exceeded tolerable limits in all of the districts under study. The findings, particularly for Pb, are of concern, as Pb may negatively influence children's growth, development, school performance, and long-term health. [ABSTRACT FROM AUTHOR]

Background: In 2012, the Kenyan Ministries of Health and of Education began a programme to deworm all schoolage children living in areas at high risk of soil-transmitted helminths (STH) and schistosome infections. The impact of this school-based mass drug administration (MDA) programme in Kenya is monitored by the Kenya Medical Research Institute (KEMRI) as part of a five-year (2012-2017) study. This article focuses on the impact of MDA on STH infections and presents the overall achieved reductions from baseline to mid-term, as well as yearly patterns of reductions and subsequent re-infections per school community. Methods: The study involved a series of pre- and post-intervention, repeat cross-sectional surveys in a representative, stratified, two-stage sample of schools across Kenya. The programme contained two tiers of monitoring; a national baseline and mid-term survey including 200 schools, and surveys conducted among 60 schools pre- and post-intervention. Stool samples were collected from randomly selected school children and tested for helminth infections using Kato-Katz technique. The prevalence and mean intensity of each helminth species were calculated at the school and county levels and 95% confidence intervals (CIs) were obtained by binomial and negative binomial regression, respectively, taking into account clustering by schools. Results: The overall prevalence of STH infection at baseline was 32.3% (hookworms: 15.4%; Ascaris lumbricoides: 18.1%; and Trichuris trichiura: 6.7%). After two rounds of MDA, the overall prevalence of STH had reduced to 16. 4% (hookworms: 2.3%; A. lumbricoides: 11.9%; and T. trichiura: 4.5%). The relative reductions of moderate to heavy intensity of infections were 33.7% (STH combined), 77.3% (hookworms) and 33.9% (A. lumbricoides). For T. trichiura, however, moderate to heavy intensity of infections increased non-significantly by 18.0% from baseline to mid-term survey. Conclusion: The school-based deworming programme has substantially reduced STH infections, but because of ongoing transmission additional strategies may be required to achieve a sustained interruption of transmission. [ABSTRACT FROM AUTHOR]

OBJECTIVE--To describe the prevalence of biochemical B12 deficiency in adults with type 2 diabetes taking metformin compared with those not taking metformin and those without diabetes, and explore whether this relationship is modified by vitamin B12 supplements. RESEARCH DESIGN AND METHODS--Analysis of data on U.S. adults ≥50 years of age with (n = 1,621) or without type 2 diabetes (n = 6,867) from the National Health and Nutrition Examination Survey (NHANES), 1999-2006. Type 2 diabetes was defined as clinical diagnosis after age 30 without initiation of insulin therapy within 1 year. Those with diabetes were classified according to their current metformin use. Biochemical B12 deficiency was defined as serum B12 concentrations ≤148 pmol/L and borderline deficiency was defined as >148 to ≤221 pmol/L. RESULTS--Biochemical B12 deficiency was present in 5.8% of those with diabetes using metformin compared with 2.4% of those not using metformin (P = 0.0026) and 3.3% of those without diabetes (P = 0.0002). Among those with diabetes, metformin use was associated with biochemical B12 deficiency (adjusted odds ratio 2.92; 95% CI 1.26-6.78). Consumption of any supplement containing B12 was not associated with a reduction in the prevalence of biochemical B12 deficiency among those with diabetes, whereas consumption of any supplement containing B12 was associated with a two-thirds reduction among those without diabetes. CONCLUSIONS--Metformin therapy is associated with a higher prevalence of biochemical B12 deficiency. The amount of B12 recommended by the Institute of Medicine (IOM) (2.4 µg/day) and the amount available in general multivitamins (6 µg) may not be enough to correct this deficiency among those with diabetes. [ABSTRACT FROM AUTHOR]

Background: In 2012, the Kenyan Ministries of Health and of Education began a programme to deworm all school-age children living in areas at high risk of soil-transmitted helminths (STH) and schistosome infections. The impact of this school-based mass drug administration (MDA) programme in Kenya is monitored by the Kenya Medical Research Institute (KEMRI) as part of a five-year (2012-2017) study. This article focuses on the impact of MDA on STH infections and presents the overall achieved reductions from baseline to mid-term, as well as yearly patterns of reductions and subsequent re-infections per school community., Methods: The study involved a series of pre- and post-intervention, repeat cross-sectional surveys in a representative, stratified, two-stage sample of schools across Kenya. The programme contained two tiers of monitoring; a national baseline and mid-term survey including 200 schools, and surveys conducted among 60 schools pre- and post-intervention. Stool samples were collected from randomly selected school children and tested for helminth infections using Kato-Katz technique. The prevalence and mean intensity of each helminth species were calculated at the school and county levels and 95 % confidence intervals (CIs) were obtained by binomial and negative binomial regression, respectively, taking into account clustering by schools., Results: The overall prevalence of STH infection at baseline was 32.3 % (hookworms: 15.4 %; Ascaris lumbricoides: 18.1 %; and Trichuris trichiura: 6.7 %). After two rounds of MDA, the overall prevalence of STH had reduced to 16.4 % (hookworms: 2.3 %; A. lumbricoides: 11.9 %; and T. trichiura: 4.5 %). The relative reductions of moderate to heavy intensity of infections were 33.7 % (STH combined), 77.3 % (hookworms) and 33.9 % (A. lumbricoides). For T. trichiura, however, moderate to heavy intensity of infections increased non-significantly by 18.0 % from baseline to mid-term survey., Conclusion: The school-based deworming programme has substantially reduced STH infections, but because of ongoing transmission additional strategies may be required to achieve a sustained interruption of transmission.