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Background: Water insecurity and inadequate sanitation have adverse impacts on the mental health of individuals., Objective: To review and synthesize evidence on the relationship between water insecurity, inadequate sanitation, and mental health globally., Data Sources: Relevant studies were identified by searching PubMed, PsycINFO, and EMBASE databases from inception up to March 2023., Study Eligibility Criteria: Only quantitative studies were included. The exposure was water insecurity and or inadequate sanitation. The outcome was common mental disorders (CMD: depression or anxiety), mental distress, mental health or well-being. There was no restriction on geographical location., Participants: General population or people attending health facilities or other services., Exposure: Water insecurity and/ or inadequate sanitation., Risk of Bias: The effective Public Health Practice Project (EPHPP) assessment tool was used to assess quality of selected studies., Synthesis of Results: A meta-analysis was conducted using a random effects statistical model., Results: Twenty-five studies were included, with 23,103 participants from 16 countries in three continents: Africa (Kenya, Ethiopia, Ghana, Uganda, South Africa, Malawi, Mozambique, and Lesotho), Asia (Nepal, Bangladesh, India, and Iran) and the Americas (Brazil, Haiti, Bolivia and Vietnam). There was a statistically significant association between water insecurity and CMD symptoms. Nine studies reported a continuous outcome (5,248 participants): overall standardized mean difference (SMD = 1.38; 95% CI = 0.88, 1.87). Five studies reported a binary outcome (5,776 participants): odds ratio 5.03; 95% CI = 2.26, 11.18. There was a statistically significant association between inadequate sanitation and CMD symptoms (7415 participants), overall SMD = 5.36; 95% CI = 2.51, 8.20., Limitations: Most of the included studies were cross-sectional which were unable to examine temporal relationships., Conclusions: Water insecurity and inadequate sanitation contribute to poorer mental health globally., Implications of Key Findings: Interventions to provide basic water, sanitation and psychosocial support, could substantially contribute to reducing the burden of CMD alongside other health and social benefits., Trial Registration: PROSPERO registration number: CRD42022322528., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kimutai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Lead poisoning is an emerging worldwide public health concern, especially in the developing countries. Occupational tasks such as spray painting and welding in informal automobile repair enterprises present risks of exposures to lead generally through inhalation and ingestion. The artisans therefore risk high blood lead (BPb) levels, which is critical to chronic adverse health effects of lead. The study aimed at assessing the influence of occupational tasks on personal airborne lead exposures and to evaluate the association between these exposures with blood lead (BPb) levels among the artisans. A cross-sectional study was conducted in ten informal automobile repair workshops. Task-specific personal inhalable air samples and blood samples were collected concurrently for 20 participants performing five distinct occupational tasks. Lead levels were analysed using inductively coupled plasma atomic emission spectroscopy and data analysed by analysis of variance, simple and multiple linear regressions. The results indicated significant differences in airborne lead (PbA) exposure levels in different occupational tasks (p = 0.000). Lead-acid battery repairs recorded mean PbA exposure level of [76.11 ± (10.81 SE) µg/m 3 ] exceeding the WHO 50 µg/m 3 airborne lead permissible exposure limit. The average (PbA) exposure level was 22.55 ± (5.05 SE) µg/m 3 , while the mean (BPb) level was 25.08 ± (3.48 SE) µg/dl. A significant positive correlation between task-based airborne lead with blood lead levels was observed (r = 0.68, p = 0.001). In conclusion, the occupational tasks influenced personal airborne lead exposure levels, which in turn was an important predictor of blood lead levels. The study recommends lead exposure assessments, medical screening and intervention measures to minimize the risk and consequences of occupational exposures to lead among the study population.

The present study was conducted to determine daily intake of cadmium (Cd), copper (Cu), and lead (Pb) and to assess noncarcinogenic human health risk caused by these trace metals in the commonly consumed fish species ( Oreochromis niloticus, Rastrineobola argentea, Lates niloticus , and Protopterus aethiopicus ) in Nakuru town, Kenya. Trace metal determination in the composite samples of the commonly consumed fish species was done using flame atomic absorption spectrophotometer. Cd, Cu, and Pb content in the muscle tissues of the commonly consumed fish species ranged from 0.11 ± 0.045 to 1.11 ± 0.931 mg kg -1 for Cd, 0.48 ± 0.013 to 3.00 ± 0.009 mg kg -1 for Cu, and 3.42 ± 0.045 to 12.78 ± 0.108 mg kg -1 for Pb. Cu concentrations were within Food and Agriculture Organization (FAO) recommended limits for this trace metal in fish. In contrast, Cd and Pb had values above their respective permissible limits in fish. The assessment of human exposure to trace metals indicated that exposure doses of Cd and Cu were safe for fish consumers. Conversely, target hazard quotient (THQ) values of Pb suggested possible health risks for consumers of the commonly consumed fish species in Nakuru town, Kenya., Competing Interests: Declaration of conflicting interest:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Background: Pit latrine operational management and sludge accumulation rate, presents a challenging sanitation problem in low-income urban settlements. However, these challenges have been under-researched. This study was carried out between December 2014 and September 2015 in Nakuru, Kenya. Its objectives were to determine pit latrine management activities and content accumulation rates., Methods: A longitudinal design was used to study 100 households and their respective pit latrines. Sludge accumulation in 73 pit latrines was monitored for 10 months using a digital laser range-finder. Data analysis included normality testing and descriptive statistics. Differences in fill up across and within the study areas were analysed using one-way analysis of variance and the Fisher's Exact Test used to determine areas with significant differences., Results: Sixty-one percent of the pit latrines were used as solid waste disposal points while 45% of the respondents had no hygiene awareness. The annual fill-up rate and individual sludge contribution were 0.87 ± 0.20 m 3 and 41.82 l respectively. The sludge accumulation rates across the study areas had statistically significant mean differences (p < 0.05)., Conclusion: Operational management and design affect the fill-up rates and post fill-up management operations. This study argues for a need to link information and awareness to users, construction artisans, property owners and local authorities on appropriate vault volumes and management practices. Linking the variables would ensure efficient sanitation service delivery and public health protection.

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provided comprehensive estimates of health loss globally. Decision makers in Kenya can use GBD subnational data to target health interventions and address county-level variation in the burden of disease., Methods: We used GBD 2016 estimates of life expectancy at birth, healthy life expectancy, all-cause and cause-specific mortality, years of life lost, years lived with disability, disability-adjusted life-years, and risk factors to analyse health by age and sex at the national and county levels in Kenya from 1990 to 2016., Findings: The national all-cause mortality rate decreased from 850·3 (95% uncertainty interval [UI] 829·8-871·1) deaths per 100 000 in 1990 to 579·0 (562·1-596·0) deaths per 100 000 in 2016. Under-5 mortality declined from 95·4 (95% UI 90·1-101·3) deaths per 1000 livebirths in 1990 to 43·4 (36·9-51·2) deaths per 1000 livebirths in 2016, and maternal mortality fell from 315·7 (242·9-399·4) deaths per 100 000 in 1990 to 257·6 (195·1-335·3) deaths per 100 000 in 2016, with steeper declines after 2006 and heterogeneously across counties. Life expectancy at birth increased by 5·4 (95% UI 3·7-7·2) years, with higher gains in females than males in all but ten counties. Unsafe water, sanitation, and handwashing, unsafe sex, and malnutrition were the leading national risk factors in 2016., Interpretation: Health outcomes have improved in Kenya since 2006. The burden of communicable diseases decreased but continues to predominate the total disease burden in 2016, whereas the non-communicable disease burden increased. Health gains varied strikingly across counties, indicating targeted approaches for health policy are necessary., Funding: Bill & Melinda Gates Foundation., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background Information: The post-2015 Sustainable Development Goals for sanitation call for universal access to adequate and equitable sanitation and an end to open defaecation by 2030. In Isiolo County, a semi-arid region lying in the northern part of Kenya, poor sanitation and water shortage remain a major problem facing the rural communities., Objective: The overall aim of the study was to assess the relationship between sanitation practices and the bacteriological quality of drinking water sources. The study also assessed the risk factors contributing to open defaecation in the rural environments of the study area., Methods: A cross-sectional study of 150 households was conducted to assess the faecal disposal practices in open defaecation free (ODF) and open defaecation not free (ODNF) areas. Sanitary surveys and bacteriological analyses were conducted for selected community water sources to identify faecal pollution sources, contamination pathways, and contributory factors. Analysis of data was performed using SPSS (descriptive and inferential statistics at α = .05 level of significance)., Results: Open defaecation habit was reported in 51% of the study households in ODNF villages and in 17% households in ODF villages. Higher mean colony counts were recorded for water samples from ODNF areas 2.0, 7.8, 5.3, and 7.0 (×10 3 ) colony-forming units (CFUs)/100 mL compared with those of ODF 1.8, 6.4, 3.5, and 6.1 (×10 3 ) areas for Escherichia coli , faecal streptococci, Salmonella typhi , and total coliform, respectively. Correlation tests revealed a significant relationship between sanitary surveys and contamination of water sources ( P  = .002)., Conclusions: The water sources exhibited high levels of contamination with microbial pathogens attributed to poor sanitation. Practising safe faecal disposal in particular is recommended as this will considerably reverse the situation and thus lead to improved human health., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study assessed the effect of vegetative filter strip (VFS) in removal of suspended sediment (SS), total nitrogen, total phosphorus and Escherichia coli ( E. coli ) in overland flow to improve receiving water quality standards. Four and half kilograms of cowpat manure was applied to the model pasture 14 m beyond the edge of vegetated filter strip (VFS) comprising 10-m Napier grass draining into 20-m Kikuyu grass (VFS II), 10-m Kikuyu grass draining into 20-m Napier grass (VFS III) and native grass mixture of Couch-Buffel (VFS I-control). Overland flow water samples were collected from the sites at positions 0, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25 and 30 m along the length of VFSs. E. coli removal by Napier grass VFS was on the order of log unit, which provided an important level of protection and reduced surface-flow concentrations of E. coli to below the 200 (CFU 100 mL -1 ) recommended water quality standards, but not for nutrients and SS. The Napier grass showed highest efficiency (99.6 %), thus outperforming both Kikuyu grass (85.8 %) and Couch-Buffel grasses VFS (67.9 ± 4.2 %) in removing E. coli from overland flow. The low-level efficiency of native Couch-Buffel grasses in reducing E. coli in overland flow was because of preferential flow. Composition and design of VFS was instrumental and could be applied with a high potential of contracting the uncertainty in improving water quality standards through mass reduction of SS, nutrients and E. coli load in watersheds.

Agro-pastoral operations have the potential to threaten public health with loading of diverse pathogens into surface waters through overland flow; increasing awareness of the limitations of fecal indicators has led to development of a number of advancements in detection, source tracking and predictive modeling of public health risk. These tools and techniques are beginning to be integrated into management strategies. The objective of this review was to determine the status of current knowledge and challenges of the fate and transport of Escherichia coli in overland flow and their interaction within vegetative filter strip (VFS) as one of these implemented best management practices and to critically evaluate its use in that setting as an indicator organism. With few studies directly focusing on VFS removal of E. coli from overland flow, we critically evaluated the available data on movement of E. coil from fecal source loading to retention and decay or re-release for potential contamination of water ways and pointed out potential limitations in both pathogen-specific removal and its use as an indicator organisms within overland flow and VFS. Critical areas of focus for future studies to reduce gaps in knowledge were identified, and the integration of newer approaches in source tracking, alternative indicators and the use of non-pathogenic surrogates for field testing of existing VFS models was encouraged. With VFS as a growing field of interest as an economical conservation practice and as an avenue for conservation of resources for small-scale agro-pastoral operations, management strategies to reduce initial fecal load from either applied manure constituents or shedding from free-range animals will continue to test the limits in the applications of models to overland flow and VFS management strategies. Further studies at the microscale in understanding discrepancies between low and high pathogenicity strains of E. coil and between E. coil and other fecal pathogens in the context of VFS will be critical. However, nuanced studies are needed to understand either biological or environmental differences in the fate and transport of the diverse types of fecal pathogens within these settings.

The fate and transport of Escherichia coli ( E. coli ) in lotic waters through vegetated filter strips (VFSs) was evaluated in a field model pasture, utilizing VFSMOD Windows along with direct pathogen testing. This study assessed effects of VFS on transport and deposition rates of E. coli in lotic overland flow waters. The VFS measured 44 m long by 40 m wide, covering an area of 1584 m 2 and land slope of 15 %. Cowpat was applied onto the model pasture and washed by overland flow into the VFS. The 4-methylumbelliferyl β-D-glucuronide substrate confirmed the identity of E. coli prior to cowpat application and after isolating them from soil using centrifugation and membrane filtration techniques. Napier grass root system recorded the highest recovery rates of E. coli at 99.9 % along the length of VFS III. This efficiency reduced significantly ( p < 0.05; df = 29) to 95 % in Kikuyu grass and 75 % in Couch grass-Buffer grass. The data demonstrated similarity in transport of manure-borne E. coli and organic carbon (OC) through all the simulated VFS. These results indicated that OC could be used as a true natural tracer of manure-borne E. coli , a pollution indicator organism of lentic and lotic surface waters provided the OC release kinetics from cowpat were similar to that of E. coli kinetics. Thus, efficient filtering to reduce E. coli concentrations and load in overland flows requires managing combined grass species, agro-pastoral systems models and dispersed or preferential flows to enhance surface water quality standards.

Geophagia is defined as deliberate consumption of earths' materials, e.g. soil, clay and soft stones. The practice is widespread among pregnant women, and there are conflicting views as to whether it is beneficial to health or not. Geophagic materials may be a source of micronutrients though the materials may bind the micronutrients thus reducing or hindering their bioavailability in the body. Geophagia is closely associated with geohelminthic infections among pregnant women and heavy metal poisoning, which constitute significant public health problem in many developing countries such as Kenya. In our research, the geophagic materials consumed by the pregnant women were studied. A total of 38 geophagic materials in the possession by different pregnant women were analysed. The collected samples were subjected to standard digestion procedures and analysed for zinc, lead and iron by atomic absorption spectroscopy. Results indicated that the geophagic materials contained elevated levels of Fe at mean concentration value of 80.10 ppm, Pb at 3.28 ppm and Zn 1.81 ppm for a 1.00 g sample. An average of 20 g of the geophagic materials was being consumed per day. Based on the average consumption, the pregnant women were exposed to 65.52 ppm Pb per day, 36.2 ppm Zn per day and 1602 ppm Fe per day. Lead exceeded the WHO-lead exposure limits of 25 ppm/day for pregnant women. The materials were also subjected to microscopic examination for Ascaris lumbricoides, Trichuris trichiura, Taenia Spp., Necator americanus and Ancylostoma duodenale. In conclusion, the women were exposed to heavy metals-iron, zinc and lead, but there was no observable eggs, larvae or adult species of the geohelminths. The key recommendation was that there is need to integrate public health education on geophagia, lead screening and testing with antenatal support care systems. This will enhance maternal and child health, thus reducing infant and maternal morbidity and mortality rates.

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution., Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol., Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa., Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks., Funding: Bill & Melinda Gates Foundation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development., Methods: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time., Findings: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries., Interpretation: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions., Funding: Bill & Melinda Gates Foundation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

External built residential environment characteristics include aspects of building design such as types of walls, doors and windows, green spaces, density of houses per unit area, and waste disposal facilities. Neighborhoods that are characterized by poor quality external built environment can contribute to psychosocial stress and increase the likelihood of mental health disorders. This study investigated the relationship between characteristics of external built residential environment and mental health disorders in selected residences of Nakuru Municipality, Kenya. External built residential environment characteristics were investigated for 544 residents living in different residential areas that were categorized by their socioeconomic status. Medically validated interview schedules were used to determine mental health of residents in the respective neighborhoods. The relationship between characteristics of the external built residential environment and mental health of residents was determined by multivariable logistic regression analyses and chi-square tests. The results show that walling materials used on buildings, density of dwelling units, state of street lighting, types of doors, states of roofs, and states of windows are some built external residential environment characteristics that affect mental health of adult males and females. Urban residential areas that are characterized by poor quality external built environment substantially expose the population to daily stressors and inconveniences that increase the likelihood of developing mental health disorders.

Background: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration., Methods: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets., Findings: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990., Interpretation: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action., Funding: Bill & Melinda Gates Foundation., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Many children under the age of five are exposed to environmental health risks in the home environment. These lead to diseases such as diarrhoea, which along with acute respiratory infections, malaria and intestinal worms, account for 70% of the total health burden to children under five in Kenya. The aim of this study was to investigate whether earth eating within the home environment by children is a risk factor for diarrhoeal disease., Methodology: A longitudinal study was conducted in 350 households having children aged below five years between April and October, 2005. Questionnaire and observation were used to collect data on participant demographics, earth eating practices in children, incidence of diarrhoea, structure of the home, sanitary facilities available, and presence of faecal matter in the yard., Results: Thirty-seven percent of index children ingest earth occasionally (less than a handful) and 12% ingest a lot (a handful or more). Diarrhoea is positively correlated with earth eating (r = 0.306), presence of human faeces in the yard (r = 0.587), presence of animal faeces in the yard (r = 0.225) and the index child not wearing loincloth (r = 0.471). Chi-square test of independence also indicates that earth eating is significantly related to diarrhoea (p<0.005)., Conclusion: Earth eating is a risk factor for diarrhoea in the home environment in this region of Kenya.