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Objective: In South Asia, up to one in five individuals who ingest pesticides for self-poisoning and survive purchased them from a shop immediately prior to the event. Thus far, no research has taken place to determine whether interventions implemented through the pesticide sellers might be acceptable or effective, despite the hundreds of thousands of such risk purchases each year. We aimed to investigate factors associated with purchasing pesticides for self-poisoning in Sri Lanka.Methods: We used a case-control study. Cases (n = 50) were individuals who ingested pesticides after purchasing them for the act, and controls (n = 200) were customers who bought pesticides but did not use them for self-harm. Logistic regression analysis was used to assess socio-demographic and purchase-specific risk factors.Results: Alcohol intoxication (adjusted odds ratios [AOR] 36.5, 95% confidence intervals [CI] 1.7-783.4) and being a non-farmer AOR 13.3, 95% CI 1.8-99.6 were the main distinguishing factors when purchasing pesticides for self-poisoning. The positive predictive values were 93.3% (95% CI 68.0-99.8%) and 88.2% (95% CI 72.5-96.7%), respectively. One and/or other of these factors characterised 72.0% of cases but only 2.5% controls.Conclusion: While results need to be interpreted cautiously, sales restrictions to prevent alcohol-intoxicated persons and non-farmers purchasing pesticides for self-poisoning may be effective. [ABSTRACT FROM AUTHOR]

Harmful alcohol drinking can have health and socio-economic consequences. However, consumption is also associated with pleasure and symbolic meanings. Alcohol intake is increasing in Sri Lanka. In-depth explorations of alcohol patterns are needed to inform interventions and policies. Qualitative data were collected over 11 months in 2014 and 2015 in the North Central Province of Sri Lanka. Ten focus group discussions were conducted in gender, age and geographically (rural and semi-urban) segregated groups. Observations were conducted at alcohol selling establishments and social gatherings. Bourdieu's concepts practice, habitus, symbolic capital and distinction were used for the analysis. Three groups of consumers emerged: moderate consumers, abstainers and heavy drinkers. They each exercised distinctions through social codes of conduct within and towards other groups of consumers. Symbolic capital was expressed through choice of alcohol. Norms of 'acceptable consumption' were defined as 'moderate drinking' in covert, social and contained settings. Public, uncontrolled and solitary consumption violated norms of appropriate consumption. Young consumers communicated a 'modern lifestyle' through their consumption. This study found that alcohol practices mirrored social norms in this Sri Lankan setting. Alcohol and drug prevention and intervention efforts should take this into account. [ABSTRACT FROM AUTHOR]

Objective: Data from South Asia indicate that for 15%–20% of suicide attempts, pesticides are purchased from shops; otherwise, pesticides are obtained from an individual's house or nearby environment. We aimed to investigate the difference between individuals who directly purchase pesticides from shops for suicide attempts and suicide deaths versus those related to accessing the pesticides from an individual's house or nearby environment. Methods: We conducted two comparative studies in rural Sri Lanka: (1) non‐fatal shop cases (n = 50) were survivors of self‐poisoning with pesticides who ingested the pesticides after purchasing them from a shop; non‐fatal domestic cases (n = 192) were survivors who accessed pesticides from their house or nearby environment. (2) fatal shop cases (n = 50) were individuals who died after ingesting pesticides they purchased for the act; fatal domestic cases (n = 102) were patients who died after ingesting pesticides they accessed at house or nearby environment. Logistic regression analysis was used to assess the characteristics which distinguished between the shop and domestic cases. Results: Data indicate that 20.7% and 32.9% of individuals who used pesticides for suicide attempts and suicide deaths had purchased them from shops, respectively. Being a non‐farmer was the main distinguishing characteristic of shop cases: adjusted odds ratios (AOR) 8.9, 95% confidence intervals (CI) 3.2–24.4 for non‐fatal shop cases, and AOR 4.0, 95% CI 1.5–10.6 for fatal shop cases. Non‐fatal shop cases also had higher suicide intent (AOR 3.0, CI 1.0–8.9), and ingesting an insecticide (AOR 4.8, CI 1.8–1.0–8.9) than non‐fatal domestic cases. Conclusion: A high suicide intent of individuals who purchase pesticides for the event explains the high proportion of such fatal cases. Such high suicide intent makes the prevention implications difficult to spell out for those individuals who purchase pesticides for self‐poisoning. However, our findings are valuable for clinicians to assess pesticide poisoning cases in hospitals. [ABSTRACT FROM AUTHOR]

Teaching farmers integrated pest management (IPM) in farmer field schools (FFS) has led to reduced pesticide use and safer handling. This article evaluates the long-term impact of training farmers on IPM and the diffusion of knowledge from trained farmers to neighboring farmers, a subject of importance to justify training costs and to promote a healthy and sustainable agriculture. Training on IPM of farmers took place from 2002 to 2004 in their villages in La Paz County, Bolivia, whereas dissemination of knowledge from trained farmer to neighboring farmer took place until 2009. To evaluate the impact of the intervention, self-reported knowledge and practice on pesticide handling and IPM among trained farmers (n = 23) and their neighboring farmers (n = 47) were analyzed in a follow-up study and compared in a cross-sectional analysis with a control group of farmers (n = 138) introduced in 2009. Variables were analyzed using χ2 test and analysis of variance (ANOVA). Trained farmers improved and performed significantly better in all tested variables than their neighboring farmers, although the latter also improved their performance from 2002 to 2009. Including a control group showed an increasing trend in all variables, with the control farmers having the poorest performance and trained farmers the best. The same was seen in an aggregated variable where trained farmers had a mean score of 16.55 (95% confidence interval [CI]: 15.45–17.65), neighboring farmers a mean score of 11.97 (95% CI: 10.56–13.38), and control farmers a mean score of 9.18 (95% CI: 8.55–9.80). Controlling for age and living altitude did not change these results. Trained farmers and their neighboring farmers improved and maintained knowledge and practice on IPM and pesticide handling. Diffusion of knowledge from trained farmers might explain the better performance of the neighboring farmers compared with the control farmers. Dissemination of knowledge can contribute to justify the cost and convince donors and governments in low-income countries to prioritize farmers training. [ABSTRACT FROM AUTHOR]

Dams have often been constructed for hydropower, water storage and to support socio-economic development, particularly in areas of water stress. In many places, the water stored in human-made reservoirs is essential to meet the development objectives of water supply, agriculture, industry, energy generation and other sectors. However, in the absence of adequate foresight and planning, many past dams have had considerable negative impacts on ecosystems and the livelihoods of affected communities, resulting in conflicts and health hazards. While enhanced human health and well-being could be considered as the ultimate outcome of development programs, the public health impact of dams remains an issue that is often neglected by policy makers and investors. National policies and international guidelines, such as those of the World Commission on Dams (WCD), have been used to improve planning and impact assessment of dams. Here, we provide an analysis of four large dams, across three continents, and show that they had limited consistency with WCD principles and guidelines. Moreover, health aspects were largely neglected during planning, construction and operation of these dams, but seriously undermine their intended benefits. This perspective paper discusses impacts of dams on energy and food, ecosystem health, inclusion, and ultimately human health and wellbeing. We argue that a One Health perspective, based on these four categories, can support the systematic consideration of environmental, animal, and human health determinants. A dedicated One Health approach to dams and reservoirs remains to be developed but could potentially improve how dams, both existing and future, support more inclusive development. [ABSTRACT FROM AUTHOR]

Dams have often been constructed for hydropower, water storage and to support socio-economic development, particularly in areas of water stress. In many places, the water stored in human-made reservoirs is essential to meet the development objectives of water supply, agriculture, industry, energy generation and other sectors. However, in the absence of adequate foresight and planning, many past dams have had considerable negative impacts on ecosystems and the livelihoods of affected communities, resulting in conflicts and health hazards. While enhanced human health and well-being could be considered as the ultimate outcome of development programs, the public health impact of dams remains an issue that is often neglected by policy makers and investors. National policies and international guidelines, such as those of the World Commission on Dams (WCD), have been used to improve planning and impact assessment of dams. Here, we provide an analysis of four large dams, across three continents, and show that they had limited consistency with WCD principles and guidelines. Moreover, health aspects were largely neglected during planning, construction and operation of these dams, but seriously undermine their intended benefits. This perspective paper discusses impacts of dams on energy and food, ecosystem health, inclusion, and ultimately human health and wellbeing. We argue that a One Health perspective, based on these four categories, can support the systematic consideration of environmental, animal, and human health determinants. A dedicated One Health approach to dams and reservoirs remains to be developed but could potentially improve how dams, both existing and future, support more inclusive development. [ABSTRACT FROM AUTHOR]

Organophosphates and carbamates (OPs/CMs) are known for their acetylcholinesterase inhibiting character. A cross-sectional study of pesticide handling practices and self-perceived symptoms of acute pesticide poisoning was conducted using questionnairebased interviews with 89 pesticide sprayers in Boeung Cheung Ek (BCE) Lake, Phnom Penh, Cambodia. The study showed that 50% of the pesticides used belonged toWHOclass I + II and personal protection among the farmers were inadequate. Amajority of the farmers (88%) had experienced symptoms of acute pesticide poisoning, and this was significantly associatedwith the number of hours spent spraying with OPs/CMs (OR = 1.14, CI 95%: 1.02-1.28). The higher educated farmers reduced their risk of poisoning by 55% for each extra personal protective measure they adapted (OR = 0.45, CI 95%: 0.22-0.91). These findings suggest that improving safe pesticide management practices among the farmers and enforcing the effective banning of the most toxic pesticides will considerably reduce the number of acute pesticide poisoning episodes. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of cessation of irrigation before harvesting in reducing microbial contamination of lettuce irrigated with wastewater in urban vegetable farming in Ghana. Methods Assessment was done under actual field conditions with urban vegetable farmers in Ghana. Trials were arranged in completely randomized block design and done both in the dry and wet seasons. Seven hundred and twenty-six lettuce samples and 36 water samples were analysed for thermotolerant coliforms and helminth eggs. Results On average, 0.65 log units for indicator thermotolerant coliforms and 0.4 helminth eggs per 100 g of lettuce were removed on each non-irrigated day from lettuce in the dry season. This corresponded to a daily loss of 1.4 tonnes / ha of fresh weight of lettuce. As an input for exposure analysis to make risk estimates, the decay coefficient, k, for thermotolerant coliforms was 0.66 / day for the wet season and 1.49 / day for the dry season. Conclusion In combination with other measures for improving water quality, the measure can significantly reduce faecal contamination of lettuce during the dry season. However, it is not suitable for the wet season due to unfavourable conditions for pathogen die-off and re-contamination by splashes from contaminated soils. The results provide a good basis for risk assessments and for devising more appropriate measures for risk reduction, especially in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of simple irrigation methods such as drip irrigation kits, furrow irrigation and use of watering cans in reducing contamination of lettuce irrigated with polluted water in urban farming in Ghana. Methods Trials on drip kits, furrow irrigation and watering cans were conducted with urban vegetable farmers. Trials were arranged in a completely randomised block design with each plot having all three irrigation methods tested. This was conducted in both dry and wet seasons. Three hundred and ninety-six lettuce, 72 soil, 15 poultry manure and 32 water samples were analysed for thermotolerant coliforms and helminth eggs. Results Lettuce irrigated with drip kits had the lowest levels of contamination, with, on average, 4 log units per 100 g, fewer thermotolerant coliforms than that irrigated with watering cans. However, drip kits often got clogged, required lower crop densities and restricted other routine farm activities. Watering cans were the most popular method. Using watering cans with caps on outlets from a height <0.5 m reduced thermotolerant coliforms by 2.5 log units and helminthes by 2.3 eggs per 100 g of lettuce compared with using watering cans without caps from a height >1 m. Conclusion Simple, cheap and easily adoptable irrigation methods have great potential to reduce crop contamination in low-income areas. When used in combination with other on-farm and post-harvest risk reduction measures, these will help to comprehensively reduce public health risks from using polluted water in vegetable farming. [ABSTRACT FROM AUTHOR]

Background: Acute poisoning by agricultural pesticides is a well established global public health problem. Keeping pesticides under safe storage is now promoted as a potential way to reduce the number of severe poisoning cases. However, there have been no published studies documenting the feasibility of such an approach. Therefore, the objective of the study presented here was to determine community perceptions and use of in-house safe storage boxes for pesticides in rural Sri Lanka. Methods: Boxes with a lock, to be used for the in-house safe storage of pesticides, were distributed to 200 randomly selected farming households in two agricultural communities. A baseline survey determined pesticide storage practices and household characteristics prior to distribution. The selected households were encouraged to make use of the box at community meetings and during a single visit to each household one month after distribution. No further encouragement was offered. A follow-up survey assessed storage practices seven months into the project. Results: Following the distribution of the boxes the community identified a number of benefits including the protection of pesticide containers against exposure from the rain and sun and a reduced risk of theft. Data were analysed for 172 households that reported agricultural use of pesticides at follow-up. Of these, 141 (82%) kept pesticides in the house under lock against 3 (2%) at baseline. As expected, the distribution of boxes significantly reduced the number of households storing pesticides in the field, from 79 (46%) at baseline to 4 (2%) at follow-up. There was a significant increase in the number of households keeping pesticides safe from children between baseline (64%) and seven months after the distribution of boxes (89%). The same was true for adults although less pronounced with 51% at baseline and 66% at follow-up. Conclusion: The farming community appreciated the storage boxes and made storage of pesticides safer, especially for children. It seems that additional, intensive promotion is needed to ensure that pesticide boxes are locked. The introduction of in-house safe storage boxes resulted in a shift of storage into the farmer's home and away from the field and this may increase the domestic risk of impulsive self-poisoning episodes. This increased risk needs attention in future safe storage promotion projects. [ABSTRACT FROM AUTHOR]

We calculated mortality rates and years of life lost because of unintentional injuries and suicides using community based information obtained prospectively over a 7-year period, from 1998 to 2004, among a rural and peri-urban population of 108 000 in South India. Per 100 000 population the total mortality rate for unintentional injuries and suicides combined was 137.1, with 54.9 for unintentional injuries and 82.2 for suicides respectively. Hanging and self-poisoning with pesticides were the preferred means of suicide. Unintentional injuries and suicides resulted in 26.9% of total life years lost over the study period while 18.9% of all deaths in the population were attributable to unintentional injuries and suicides in the same period. The high burden is particularly notable in the 15–29 age group, where up to 70% of years of life lost are due to injury. The burden of injuries reported in this study is significantly higher than the figures reflected in available reports for India and is likely due to the under reporting in routine mortality statistics, particularly of suicides. [ABSTRACT FROM AUTHOR]

Abstract: This long-term study in Sri Lanka explored the complexities behind self-inflicted pesticide poisonings by 166 Sri Lankans. Using or threatening to use pesticides for self-harm has become a response to stressful events and a powerful message towards a specific individual, or to the outside world in general, conveying misgiving, anger, sadness, hopelessness, frustration, or simply a way to manipulate a situation to one''s own advantage. The effects of alcohol misuse are especially important in understanding self-harm at the community level in terms of the impact they have on the domestic environment. Also, issues around “love affairs,” arranged marriages and domestic physical, sexual or psychological abuse in the domestic environment are referred to by many self-harmers or their relatives as a reason for ingesting poison. Clearly, easy access to lethal pesticides by impulsive individuals often living under economically or psychosocially stressful conditions, combined with insufficient treatment facilities and limited outreach programs, can be a deadly blend. A strategy aimed at reducing the availability of the most toxic pesticides and improving case management should be implemented, as it is likely to reduce death from pesticides although unlikely to impact on the number of episodes. Support to families plagued by domestic violence and male alcohol misuse is essential to improve the quality of life for the most vulnerable and to reduce the number of self-harm episodes in the long-term. [Copyright &y& Elsevier]

This report describes the characteristics of patients with acute pesticide poisoning in a rural area of Sri Lanka and, for intentional self-poisoning cases, explores the relative importance of the different determinants. Data were collected for 239 acute pesticide-poisoning cases, which were admitted to two rural hospitals in Sri Lanka. Sociodemographic characteristics, negative life events and agricultural practices of the intentional self-poisoning cases were compared with a control group. Most cases occurred among young adults and the large majority (84%) was because of intentional self-poisoning. Case fatality was 18% with extremely high case fatality for poisoning with the insecticide endosulfan and the herbicide paraquat. Cases were generally younger than controls, of lower educational status and were more often unemployed. No agricultural risk factors were found but a family history of pesticide poisoning and having ended an emotional relationship in the past year was clearly associated with intentional self-poisoning. The presence of mental disorders could only be assessed for a subsample of the cases and controls and this showed that alcohol dependence was a risk factor. This study shows that acute pesticide poisoning in Sri Lanka is determined by a combination of sociodemographic and psychological factors. Suggestions are given for interventions that could control the morbidity and mortality due to acute pesticide poisoning in developing countries. [ABSTRACT FROM AUTHOR]

Traditionally, engineering and environment-based interventions have contributed to the prevention of malaria in Asia. However, with the introduction of DDT and other potent insecticides, chemical control became the dominating strategy. The renewed interest in environmental-management-based approaches for the control of malaria vectors follows the rapid development of resistance by mosquitoes to the widely used insecticides, the increasing cost of developing new chemicals, logistical constraints involved in the implementation of residual-spraying programs and the environmental concerns linked to the use of persistent organic pollutants. To guide future research and operational agendas focusing on environmental-control interventions, it is necessary to learn from the successes and failures from the time before the introduction of insecticides. The objective of this paper is to describe the experiences gained in Asia with early vector control interventions focusing on cases from the former Indian Punjab, Malaysia and Sri Lanka. The paper deals primarily with the agricultural engineering and land and water management vector control interventions implemented in the period 1900–1950. The selected cases are discussed in the wider context of environment-based approaches for the control of malaria vectors, including current relevance. Clearly, some of the interventions piloted and implemented early in the last century still have relevance today but generally in a very site-specific manner and in combination with other preventive and curative activities. Some of the approaches followed earlier on to support implementation would not be acceptable or feasible today, from a social or environmental point of view. [Copyright &y& Elsevier]

Hundreds of thousands of people are dying around the world each year from the effects of the use, or misuse, of pesticides. This paper reviews the different options to reduce availability of the most hazardous chemicals, focusing on issues in developing countries. Emphasis is placed on the fatal poisoning cases and hence the focus on self-harm cases. Overall, it is argued here that restricting access to the most hazardous pesticides would be of paramount importance to reduce the number of severe acute poisoning cases and case-fatalities and would provide greater opportunities for preventive programmes to act effectively. The aim should be to achieve an almost immediate phasing out of the WHO Classes I and II pesticides through national policies and enforcement. These short-term aims will have to be supported by medium- and long-term objectives focusing on the substitution of pesticides with safe and cost-effective alternatives, possibly guided by the establishment of a Minimum Pesticide List, and the development of future agricultural practices where pesticide usage is reduced to an absolute minimum. Underlying factors that make individuals at risk for self-harm include domestic problems, alcohol or drug addiction, emotional distress, depression, physical illness, social isolation or financial hardship. These should be addressed through preventive health programmes and community development efforts. [Copyright &y& Elsevier]

Examines the possibility of using irrigation water as a source of drinking water in the arid areas of Punjab, Pakistan. Assessment for the presence of diarrhea in irrigation seepage water; Impact of irrigation management on health; Reduction of diarrhea through the increased availability of water connection and storage.

Provides insights into the reasons for people's preferences for different types of healthcare facilities. Variations of the preferences within a rural community in Sri Lanka; Role of the village treatment center as main provider for diagnosis and treatment of malaria from government facilities; Factors influencing effective catchment area of a village treatment center.

In the dry zone of Sri Lanka, an interdisciplinary study was conducted to evaluate the effects of irrigation water releases on malaria mosquito breeding and to identify different water management options for vector control. The relationship between abundance of larvae of the vector, Anopheles culicifacies (An. culicifacies), and the water level in a stream was described mathematically.An inverse function was derived and incorporated into a water balance model developed for the area. The larval abundance was quantified under different irrigation and water management scenarios. The result demonstrates potential for effective vector control by feasible changes in irrigation management. [ABSTRACT FROM AUTHOR]

In an environment of growing scarcity and competition for water, there is increasing pressure on the irrigation sector to make irrigation for crop production more efficient and to transfer water to the urban, industrial and environmental sectors. However, irrigation water is extensively used for non-agricultural purposes, including domestic purposes, and an exclusive focus on water efficiency in agriculture could actually reduce the availability of domestic water within irrigated areas. It is argued, based on available literature, that this would have important health implications because in many developing countries the availability of water, rather than the quality of water, is of crucial importance to health. Two case studies are presented from Sri Lanka and Pakistan where people make use of irrigation water for a range of domestic activities. Water resource policies have to take these uses into account to avoid negative health implications for poor disadvantaged segments of the population. Barriers to optimizing benefits of linking the irrigation water supply to domestic needs seem to be institutional and psychological rather than medical, technical or economic. [ABSTRACT FROM AUTHOR]

Comments on the article by Esteban et.al. concerning human fascioliasis problem in Peru claimed to be associated with man-made irrigation systems colonized by lymnaeid snails. Health benefits from irrigation systems; Ecological risks associated with cultivation practices and infrastructure.

Purpose: Suicide and self-harm by pesticide self-poisoning is common in low- and middle-income countries (LMICs). Alcohol is an important risk factor for self-harm; however, little is known about its role in pesticide self-poisoning. This scoping review explores the role that alcohol plays in pesticide self-harm and suicide. Methods: The review followed the Joanna Briggs Institute scoping review guidance. Searches were undertaken in 14 databases, Google Scholar, and relevant websites. Articles were included if they focussed on pesticide self-harm and/or suicide and involvement of alcohol. Results: Following screening of 1281 articles, 52 were included. Almost half were case reports (n = 24) and 16 focussed on Sri Lanka. Just over half described the acute impact of alcohol (n = 286), followed by acute and chronic alcohol use (n = 9), chronic use, (n = 4,) and only two articles addressed harm to others. One systematic review/meta-analysis showed increased risk of intubation and death in patients with co-ingested alcohol and pesticides. Most individuals who consumed alcohol before self-harming with pesticides were men, but alcohol use among this group also led to pesticide self-harm among family members. Individual interventions were recognised as reducing or moderating alcohol use, but no study discussed population-level alcohol interventions as a strategy for pesticide suicide and self-harm prevention. Conclusion: Research on alcohol's role in pesticide self-harm and suicide is limited. Future studies are needed to: further assess the toxicological effects of combined alcohol and pesticide ingestion, explore harm to others from alcohol including pesticide self-harm, and to integrate efforts to prevent harmful alcohol use and self-harm. [ABSTRACT FROM AUTHOR]

Background: Effective control of emerging mosquito-borne viral diseases such as dengue, chikungunya, and Zika requires, amongst other things, a functional healthcare system, ready and capable of timely detection and prompt response to incipient epidemics. We assessed the readiness of Zanzibar health facilities and districts for early detection and management of mosquito-borne viral disease outbreaks.Methods: A cross-sectional study involving all 10 District Health Management Teams and 45 randomly selected public and private health facilities in Zanzibar was conducted using a mixed-methods approach including observations, document review, and structured interviews with health facility in-charges and District Health Management Team members.Results: The readiness of the Zanzibar healthcare system for timely detection, management, and control of dengue and other mosquito-borne viral disease outbreaks was critically low. The majority of health facilities and districts lacked the necessary requirements including standard guidelines, trained staff, real-time data capture, analysis and reporting systems, as well as laboratory diagnostic capacity. In addition, health education programmes for creating public awareness and Aedes mosquito surveillance and control activities were non-existent.Conclusions: The Zanzibar healthcare system has limited readiness for management, and control of mosquito-borne viral diseases. In light of impending epidemics, the critical shortage of skilled human resource, lack of guidelines, lack of effective disease and vector surveillance and control measures as well as lack of laboratory capacity at all levels of health facilities require urgent attention across the Zanzibar archipelago. [ABSTRACT FROM AUTHOR]

Background: Disease surveillance is a cornerstone of outbreak detection and control. Evaluation of a disease surveillance system is important to ensure its performance over time. The aim of this study was to assess the performance of the core and support functions of the Zanzibar integrated disease surveillance and response (IDSR) system to determine its capacity for early detection of and response to infectious disease outbreaks.Methods: This cross-sectional descriptive study involved 10 districts of Zanzibar and 45 public and private health facilities. A mixed-methods approach was used to collect data. This included document review, observations and interviews with surveillance personnel using a modified World Health Organization generic questionnaire for assessing national disease surveillance systems.Results: The performance of the IDSR system in Zanzibar was suboptimal particularly with respect to early detection of epidemics. Weak laboratory capacity at all levels greatly hampered detection and confirmation of cases and outbreaks. None of the health facilities or laboratories could confirm all priority infectious diseases outlined in the Zanzibar IDSR guidelines. Data reporting was weakest at facility level, while data analysis was inadequate at all levels (facility, district and national). The performance of epidemic preparedness and response was generally unsatisfactory despite availability of rapid response teams and budget lines for epidemics in each district. The support functions (supervision, training, laboratory, communication and coordination, human resources, logistic support) were inadequate particularly at the facility level.Conclusions: The IDSR system in Zanzibar is weak and inadequate for early detection and response to infectious disease epidemics. The performance of both core and support functions are hampered by several factors including inadequate human and material resources as well as lack of motivation for IDSR implementation within the healthcare delivery system. In the face of emerging epidemics, strengthening of the IDSR system, including allocation of adequate resources, should be a priority in order to safeguard human health and economic stability across the archipelago of Zanzibar. [ABSTRACT FROM AUTHOR]

There is an increasing awareness of the association between tourism activity and risks of emerging mosquito-borne diseases (MBDs) worldwide. In previous studies we showed that hotels in Zanzibar may play an important role in maintaining residual foci of mosquito vectors populations of public health concern. These findings indicated larval sources removal (LSR) interventions may have a significant negative impact on vector communities. However, a thorough analysis of the response vector species to potential LSM strategies must be evaluated prior to implementation of a large-scale area-wide control campaign. Here we propose a protocol for evaluation of the impact of LSR against mosquito vectors at hotel settings in Zanzibar. This protocol is set to determine the efficacy of LSR in a randomized control partial cross-over experimental design with four hotel compounds representing the unit of randomization for allocation of interventions. However, the protocol can be applied to evaluate the impact of LRS in more than four sites. Proposed interventions are active removal of disposed containers, and installation of water dispenser to replace single use discarded plastic water bottles, which were identified as the most important source of mosquitoes studied hotels. The ideal time for allocating intervention to the intervention arms the dry season, when the mosquito abundance is predictably lower. The possible impact of interventions on mosquito occurrence and abundance risks is then evaluated throughout subsequent rainy and dry seasons. If an appreciable reduction in mosquito abundance and occurrence risks is observed during the trial period, intervention could be extended to the control arm to determine whether any potential reduction of mosquito density is reproducible. A rigorous evaluation of the proposed LRS interventions will inspire large scale trials and provide support for evidence-based mosquito management at hotel facilities in Zanzibar and similar settings. [ABSTRACT FROM AUTHOR]

Background: In Zanzibar, little is known about the arboviral disease vector Aedes aegypti in terms of abundance, spatio-temporal distribution of its larval habitats or factors associated with its proliferation. Effective control of the vector requires knowledge on ecology and habitat characteristics and is currently the only available option for reducing the risk of arboviral epidemics in the island nation of Zanzibar. Methodology: We conducted entomological surveys in households and surrounding compounds from February to May 2018 in the urban (Mwembemakumbi and Chumbuni) and rural (Chuini and Kama) Shehias (lowest government administrative unit) situated in the Urban-West region of Unguja island, Zanzibar. Larvae and pupae were collected, transported to the insectary, reared to adult, and identified to species level. Characteristics and types of water containers were also recorded on site. Generalized linear mixed models with binomial and negative binomial distributions were applied to determine factors associated with presence of Ae. aegypti immatures (i.e. both larvae and pupae) or pupae, alone and significant predictors of the abundance of immature Ae. aegypti or pupae, respectively. Results: The survey provided evidence of widespread presence and abundance of Ae. aegypti mosquitoes in both urban and rural settings of Unguja Island. Interestingly, rural setting had higher numbers of infested containers, all immatures, and pupae than urban setting. Likewise, higher House and Breteau indices were recorded in rural compared to the urban setting. There was no statistically significant difference in Stegomyia indices between seasons across settings. Plastics, metal containers and car tires were identified as the most productive habitats which collectively produced over 90% of all Ae. aegypti pupae. Water storage, sun exposure, vegetation, and organic matter were significant predictors of the abundance of immature Ae. aegypti. Conclusions: Widespread presence and abundance of Ae. aegypti were found in rural and urban areas of Unguja, the main island of Zanzibar. Information on productive habitats and predictors of colonization of water containers are important for the development of a routine Aedes surveillance system and targeted control interventions in Zanzibar and similar settings. Author summary: Dengue is considered the most important mosquito-borne viral disease and a global public health threat. In recent decades, large scale epidemics of dengue have occurred across sub-Saharan Africa including mainland Tanzania. Aedes aegypti is identified as the principal vector for dengue transmission in most affected countries. In the absence of antiviral treatment and as a dengue vaccine is not readily available; dengue prevention depends largely on vector control. As mosquitoes develop resistance towards commonly applied chemical insecticides, environmental management targeting the destruction of larval habitats is recommended. In Zanzibar, little is known about Ae. aegypti in terms of type, magnitude, or distribution of its larval habitats. In this study, we identified the main larval habitats of Ae. aegypti, their seasonal variations and factors contributing to Ae. aegypti abundance across urban and rural settings of Unguja Island in Zanzibar. We found widespread presence and abundance of the vector with plastic and metal containers as well as car tires identified as the most important larval habitats. Season, location of water container, water storage, sun exposure, presence of vegetation and organic matter were among the factors associated with high Ae. aegypti abundance. This study is the first to document widespread occurrence and distribution of Ae. aegypti in Zanzibar and highlights the need for the establishment of a nation-wide Aedes surveillance program to guide the development and monitoring of targeted, context specific vector control interventions for prevention of dengue and other arboviral epidemics. Aedes surveillance involves periodic inspection of households and surrounding environments for presence of larvae/pupae in water-holding containers which are then targeted for larval source reduction, as well as monitoring of adult mosquito populations. [ABSTRACT FROM AUTHOR]

Background: In South Asia, up to 20% of people ingesting pesticides for self-poisoning purchase the pesticide from a shop with the sole intention of self-harm. Individuals who are intoxicated with alcohol and/or non-farmers represent 72% of such high-risk individuals. We aimed to test the feasibility and acceptability of vendor-based restrictions on pesticide sales for such high-risk individuals.Methods: We conducted a pilot study in 14 (rural = 7, urban = 7) pesticide shops in Anuradhapura District of Sri Lanka. A two-hour training program was delivered to 28 pesticide vendors; the aim of the training was to help vendors recognize and respond to customers at high risk of pesticide self-poisoning. Knowledge and attitudes of vendors towards preventing access to pesticides for self-poisoning at baseline and in a three month follow-up was evaluated by questionnaire. Vendors were interviewed to explore the practice skills taught in the training and their assessment of the program.Results: The scores of knowledge and attitudes of the vendors significantly increased by 23% (95% CI 15%-32%, p < 0.001) and by 16% (95% CI 9%-23%, p < 0.001) respectively in the follow-up. Fifteen (60%) vendors reported refusing sell pesticides to a high-risk person (non-farmer or intoxicated person) in the follow-up compared to three (12%) at baseline. Vendors reported that they were aware from community feedback that they had prevented at least seven suicide attempts. On four identified occasions, vendors in urban shops had been unable to recognize the self-harming intention of customers who then ingested the pesticide. Only 2 (8%) vendors were dissatisfied with the training and 23 (92%) said they would recommend it to other vendors.Conclusions: Our study suggests that vendor-based sales restriction in regions with high rates of self-poisoning has the potential to reduce access to pesticides for self-poisoning. A large-scale study of the effectiveness and sustainability of this approach is needed. [ABSTRACT FROM AUTHOR]

The authors consider a more flexible approach to defining universal functional sanitation. They cite global data which show that 2.5 billion people lack of access to any type of improved sanitation. They also mention that the proportion of people who rely on shared toilets is highest in sub-Saharan Africa. The authors urge the consideration of local perceptions and cultural barriers to shared sanitation.

Background: Sri Lanka has reduced its overall suicide rate by 70% over the last two decades through means restriction, through a series of government regulations and bans removing highly hazardous pesticides from agriculture. We aimed to identify the key pesticide(s) now responsible for suicides in rural Sri Lanka to provide data for further pesticide regulation.Methods: We performed a secondary analysis of data collected prospectively during a cluster randomized controlled trial in the Anuradhapura district of Sri Lanka from 2011 to 16. The identity of pesticides responsible for suicides were sought from medical or judicial medical notes, coroners' records, and the person's family. Trend analysis was done using a regression analysis with curve estimation to identify relative importance of key pesticides.Results: We identified 337 suicidal deaths. Among them, the majority 193 (57.3%) were due to ingestion of pesticides while 82 (24.3%) were due to hanging. A specific pesticide was identified in 105 (54.4%) of the pesticide suicides. Ingestion of carbosulfan or profenofos was responsible for 59 (56.2%) of the suicides with a known pesticide and 17.5% of all suicides. The increasing trend of suicides due to carbosulfan and profenofos over time was statistically significant (R square 0.846, F 16.541, p 0.027).Conclusion: Ingestion of pesticides remains the most important means of suicides in rural Sri Lanka. The pesticides that were once responsible for most pesticide suicides have now been replaced by carbosulfan and profenofos. Their regulation and replacement in agriculture with less hazardous pesticides will further reduce the incidence of both pesticide and overall suicides in rural Sri Lanka. [ABSTRACT FROM AUTHOR]

Introduction: The agricultural Green Revolution in the 1950s and 60s is thought to have averted many deaths from famine. However, it also introduced highly hazardous pesticides such as parathion and endrin into poor rural communities that were totally unequipped to store or use them safely. Pesticide self-poisoning rapidly became one of the two most common global means of suicide. Thus far, no attempt has been made to enumerate the total number of deaths that have occurred subsequent to the Green Revolution. Objective: To calculate plausible estimates for the total global number of pesticide suicides that have occurred since 1960. Methods: We performed a literature review on Medline and Embase databases to July 2019 to find papers that reported national or global numbers of pesticide suicides. We restricted our search to papers published in English. We used the search terms: pesticide) OR insecticide) OR paraquat) OR organophosphate) OR organophosphorus) OR agrochemical) AND suicide) OR "") OR deliberate) AND poison in all fields. These searches identified 2,144 papers; a further 8 citations were added through the searching of reference lists and our own paper collections. 2,136 papers were excluded as they contained no data on pesticide suicide, or were case reports, case series, or related to specific socio-demographic groups, or were non-human studies. This left 16 papers giving country specific or global pesticide suicide data. Long-term national trend in pesticide suicides: We found studies from one low- and middle-income country (Sri Lanka) that recorded long-term trends in suicide throughout the Green Revolution. These data showed a steady increase in suicides from 1960 to the early 1970s, with a more rapid increase from 1979 to 1984. The number of suicides plateaued until 1995, when they started a steady almost linear decrease that has continued at least until 2015. We used the Sri Lankan epidemiology as a model of the incidence of pesticide suicides in other low- and middle-income countries. Data from Bangladesh suggested that the decrease might have started in 2002. Estimating global numbers since 1960: Starting from a conservative estimate of zero deaths in 1960, the best estimate of the total global burden of pesticide suicides from 1960 to 2018 is 14,272,105 or 14,936,000 (depending on whether a fall in incidence began in 1995 or 2002), with a plausible range of 9,859,667 to 17,303,333 deaths. These are likely underestimates because suicide is illegal in many countries, and most pesticide suicides occur in poor rural areas without effective death registration systems. Conclusions: Pesticide self-poisoning has been a major clinical and public health problem in rural Asia for decades, while being long ignored. Most pesticide suicides are relatively impulsive with little planning: in the absence of highly hazardous pesticides, many people would have survived their suicidal impulse, gone on to find support amongst family, community, and health services, and lived a full life. Pesticide suicides must therefore be considered a category 4 occupation condition following Schilling's classification - if they had not been brought into rural communities for agricultural use, pesticide suicides would not have occurred. Preventing these deaths should be a global public health priority. [ABSTRACT FROM AUTHOR]

The author focuses on the major global public health problem of self-poisoning with pesticides. The pesticide industry advocates the use of locked boxes to prevent pesticide poisoning, but no studies have been conducted to determine the effectiveness of this strategy. In the long term, the author believes that policymakers should consider solutions that may not be as attractive to the pesticide industry.

Background: DDT was among the initial persistent organic pollutants listed under the Stockholm Convention and continues to be used for control of malaria and other vector-borne diseases in accordance with its provisions on acceptable purposes. Trends in the production and use of DDT were evaluated over the period 2001-2014. Results: Available data on global production of DDT showed a 32% decline over the reporting period, from 5144 to 3491 metric tons of active ingredient p.a. Similarly, global use of DDT, for control of malaria and leishmaniasis, showed a 30% decline over the period 2001-2014, from 5388 metric tons p.a. to 3772 metric tons p.a. India has been by far the largest producer and user of DDT. In some countries, DDT is used in response to the development of resistance in malaria vectors against pyrethroid and carbamate insecticides. Some other countries have stopped using DDT, in compliance to the Convention, or in response to DDT resistance in malaria vectors. Progress has been made in establishing or amending national legal measures on DDT, with the majority of countries reportedly having measures in place that prohibit, or restrict, the production, import, export and use of DDT. Limitations in achieving the objectives of the Stockholm Convention with regard to DDT include major shortcomings in periodic reporting by Parties to the Stockholm Convention, and deficiencies in reporting to the DDT Register. Conclusion: Global production and global use of DDT have shown a modest decline since the adoption of the Stockholm Convention. [ABSTRACT FROM AUTHOR]

Background: Agricultural pesticide poisoning is a major contributor to the global burden of suicide. Over the last decade there has been a marked decrease in the incidence of suicide worldwide. It is unclear whether pesticide poisoning still plays a significant role in the global incidence of suicide.Methods: WHO method-specific suicide data were supplemented by a systematic review of the literature between 2006 and 2015, including searches of thirteen electronic databases and Google, citation searching and a review of reference lists and personal collections. Our primary outcome was the proportion of total suicides due to pesticide poisoning. Weighted estimates were calculated for seven WHO regional and income strata.Results: We identified data from 108 countries (102 from WHO data, 6 from the literature). A conservative estimate based on these data indicates that there were approximately 110,000 pesticide self-poisoning deaths each year from 2010 to 2014, comprising 13.7% of all global suicides. A sensitivity analysis accounting for under-reporting of suicides in India resulted in an increased estimate of 168,000 pesticide self-poisoning deaths annually, that is, 19.7% of global suicides. The proportion of suicides due to pesticide self-poisoning varies considerably between regions, from 0.9% in low- and middle-income countries in the European region to 48.3% in low- and middle-income countries in the Western Pacific region.Limitations: High quality method-specific suicide data were unavailable for a number of the most populous countries, particularly in the African and Eastern Mediterranean regions. It is likely we have underestimated incidence in these regions.Conclusion: There appears to have been a substantial decline in fatal pesticide self-poisoning in recent years, largely driven by a reduction in overall suicide rates in China. Nonetheless, pesticide self-poisoning remains a major public health challenge, accounting for at least one-in-seven suicides globally. [ABSTRACT FROM AUTHOR]

Risky alcohol use is a major public health problem globally and in Sri Lanka. While a reduction in alcohol consumption can result in physical, mental, and social benefits, behaviour change is difficult to achieve. Effective, context-adapted interventions are required to minimise alcohol-related harm at a community level. THEATRE is a complex, community-based intervention evaluating whether a promising Sri Lankan pilot study that utilised arts-based research to moderate alcohol use can be scaled up. While the scaled-up pilot study protocol is presented elsewhere, the aim of this protocol paper is to describe the intervention programme theory and evaluation design, and modifications made to the study resulting from COVID-19 and the financial crisis. Drawing on the Behaviour Change Wheel (BCW) and Theoretical Domains Framework, behaviour change theories are presented with potential pathways to guide implementation and evaluation. Alcohol consumption patterns and context of drinking is detailed. The multifaceted intervention targets individuals and communities using arts-based interventions. Four of nine BCW functions are employed in the design of the intervention: education, persuasion, modelling and enablement, and training. Modifications made to the study due to COVID-19 and the financial crisis are described. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (ERC/2018/21—July 2018 and Feb 2022) and the University of Sydney (2019/006). Findings will be disseminated locally to community members and key stakeholders and via international peer-reviewed publications. [ABSTRACT FROM AUTHOR]

To understand how the digitalization of higher education influences the inter-relationship between students, teachers, and their broader contexts, research must account for the social, cultural, political, and embodied aspects of teaching and learning in digital environments. Digital ethnography is a research method that can generate rich contextual knowledge of online experiences. However, how this methodology translates to higher education is less clear. In order to explore the opportunities that digital ethnography can provide in higher education research, this paper presents a methodological review of previous research, and discusses the implications for future practice. Through a systematic search of five research databases, we found 20 papers that report using digital ethnographies to explore teaching and learning in higher education. The review synthesizes and discusses how data collection, rigour, and ethics are handled in this body of research, with a focus on the specific methodological challenges that emerge when doing digital ethnographic research in a higher education setting. The review also identifies opportunities for improvement—especially related to participant observation from the student perspective, researcher reflexivity in relation to the dual teacher-researcher role, and increased diversity of data types. This leads us to conclude that higher education research, tasked with understanding an explosion of new digital practices, could benefit from a more rigorous and expanded use of digital ethnography. [ABSTRACT FROM AUTHOR]

Global efforts to control Aedes mosquito-transmitted pathogens still rely heavily on insecticides. However, available information on vector resistance is mainly restricted to mosquito populations located in residential and public areas, whereas commercial settings, such as hotels are overlooked. This may obscure the real magnitude of the insecticide resistance problem and lead to ineffective vector control and resistance management. We investigated the profile of insecticide susceptibility of Aedes aegypti mosquitoes occurring at selected hotel compounds on Zanzibar Island. At least 100 adults Ae. aegypti females from larvae collected at four hotel compounds were exposed to papers impregnated with discriminant concentrations of DDT (4%), permethrin (0.75%), 0.05 deltamethrin (0.05%), propoxur (0.1%) and bendiocarb (0.1%) to determine their susceptibility profile. Allele-specific qPCR and sequencing analysis were applied to determine the possible association between observed resistance and presence of single nucleotide polymorphisms (SNPs) in the voltage-gated sodium channel gene (VGSC) linked to DDT/pyrethroid cross-resistance. Additionally, we explored the possible involvement of Glutathione-S-Transferase gene (GSTe2) mutations for the observed resistance profile. In vivo resistance bioassay indicated that Ae. aegypti at studied sites were highly resistant to DDT, mortality rate ranged from 26.3% to 55.3% and, moderately resistant to deltamethrin with a mortality rate between 79% to and 100%. However, genotyping of kdr mutations affecting the voltage-gated sodium channel only showed a low frequency of the V1016G mutation (n = 5; 0.97%). Moreover, for GSTe2, seven non-synonymous SNPs were detected (L111S, C115F, P117S, E132A, I150V, E178A and A198E) across two distinct haplotypes, but none of these were significantly associated with the observed resistance to DDT. Our findings suggest that cross-resistance to DDT/deltamethrin at hotel compounds in Zanzibar is not primarily mediated by mutations in VGSC. Moreover, the role of identified GSTe2 mutations in the resistance against DDT remains inconclusive. We encourage further studies to investigate the role of other potential insecticide resistance markers. Author summary: Available information on mosquito resistance to insecticides is mainly restricted to residential and public areas, whereas commercial settings, such as hotels are overlooked. This may hide the real size of an insecticide resistance problem and lead to ineffective mosquito control. We investigated insecticide susceptibility of Aedes aegypti mosquitoes occurring at selected hotel compounds on Zanzibar Island. We also looked at whether resistance occurred in mosquitoes with gene mutations for two proteins (voltage-gated sodium channels and glutathione-S-transferase) that are known to cause resistance to insecticides in other parts of the world. The Ae. aegypti mosquitoes collected from hotels were highly resistant to DDT, and moderately and possibly resistant to deltamethrin and propoxur, respectively. However, resistance to these insecticides was not linked to mutations in either of the studied genes. The presence of insecticide resistance in Ae. aegypti in hotel compounds on Zanzibar is concerning and shows that these areas can act as sources of resistant mosquitoes. More needs to be done to establish the underlying causes for insecticide resistance in hotel Ae. aegypti populations, and this information can then be used to design measures that prevent resistance from becoming more widespread on Zanzibar. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "The role of alcohol use in pesticide suicide and self-harm: a scoping review" published in the journal Social Psychiatry & Psychiatric Epidemiology. The correction states that the funding information section was missing from the original article and should have included acknowledgement of funding from the Centre for Pesticide Suicide Prevention, which is funded by a grant from Open Philanthropy at the recommendation of GiveWell. The original article has been corrected. The authors of the article are Lisa Schölin, K. S. Kylie Lee, Leslie London, Melissa Pearson, Fredrick Otieno, Manjula Weerasinghe, Flemming Konradsen, Michael Eddleston, and Jane Brandt Sørensen. [Extracted from the article]

Effective, low-cost clinical interventions to improve facility-based care during childbirth are critical to reduce maternal and perinatal mortality and morbidity in low-resource settings. While health interventions for low- and lower-middle-income countries are often developed and implemented top-down, needs and circumstances vary greatly across locations. Our pilot study in Zanzibar improved care through locally co-created intrapartum clinical practice guidelines (CPGs) and associated training (the PartoMa intervention). This intervention was context-tailored with health-care providers in Zanzibar and now scaled up within five maternity units in Dar es Salaam, Tanzania. This PartoMa Scale-up Study thereby provides an opportunity to explore the co-creation process and modification of the intervention in another context and how scale-up might be successfully achieved. The overall protocol is presented in a separate paper. The aim of the present paper is to account for the Scale-up Study's programme theory and qualitative methodology. We introduce social practice theory and argue for its value within the programme theory and towards qualitative explorations of shifts in clinical practice. The theory recognizes that the practice we aim to strengthen – safe and respectful clinical childbirth care – is not practiced in a vacuum but embedded within a socio-material context and intertwined with other practices. Methodologically, the project draws on ethnographic and participatory methodologies to explore current childbirth care practices. In line with our programme theory, explorations will focus on meanings of childbirth care, material tools and competencies that are being drawn upon, birth attendants' motivations and relational contexts, as well as other everyday practices of childbirth care. Insights generated from this study will not only elucidate active ingredients that make the PartoMa intervention feasible (or not) but develop the knowledge foundation for scaling-up and replicability of future interventions based on the principles of co-creation and contextualisation. [ABSTRACT FROM AUTHOR]

While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained. Trial registration number: NCT04685668 [ABSTRACT FROM AUTHOR]

Assessment was done on the microbiological quality of water in hand-dug wells in urban communities in Kumasi, Ghana. A total of 256 water samples were taken from eight wells and examined for faecal coliforms, enterococci and helminths. High contamination levels were recorded in the wells, more so in the wet season, with faecal coliforms levels between 6.44 and 10.19 log units and faecal enterococci between 4.23 and 4.85 CFU per 100 ml. Influence on protection and lining of wells on water quality was not pronounced but mechanization reduced contamination significantly by about 3 log units. This study shows a stronger influence of poor sanitation and improper placement of wells on water quality compared to improvements made from lining and protection of wells. In the race to increase access to drinking water in poor urban settlements, quality of groundwater could be a major barrier, if provision of drinking water is not matched with improvements in sanitation and urban planning. [ABSTRACT FROM AUTHOR]

This paper discusses two prominent perspectives in the debate on risk reduction in wastewater irrigation; reliance on conventional wastewater treatment and the multiple-barrier approach. The treatment perspective is based on water-quality standards for wastewater irrigation with treatment considered the ultimate risk reduction measure. The somewhat broader multiple-barrier perspective supports the use of a combination of pre-farm, on-farm and post-farm barriers, including, where possible, wastewater treatment, to meet required health targets. The discussion in this paper shows that each perspective has strengths and limitations. Rather than being opposing philosophies, they both support health risk reduction but in different ways depending on the level of the country in the sanitation ladder. Since each perspective has limitations, the recommendation is to capitalize on their strengths and explore synergies to optimize their applications for optimum risk reduction. [ABSTRACT FROM AUTHOR]

Irrigation water used for growing vegetables in urban areas in many low-income countries is contaminated with untreated wastewater. Many wastewater treatment methods are economically prohibitive and continued use of such irrigation water pose health risks for vegetable consumers and farmers. As part of a larger study on possible interventions for health risk reduction, the potential of simple interventions was explored. Column slow sand filters with three levels of sand depths (0.5 m, 0.75 m and 1 m) and fabric filters made of nylon, cotton and netting were assessed. More than 600 water samples were analyzed for helminth eggs and thermotolerant coliforms. Flow rates were also measured. From slow sand filters, 71-96% of helminths and 2 log units (from 7 to 5 log units) of thermotolerant coliforms were removed. Sand depths had no significant influence in the removal. Lower removal rates were achieved by fabric filters, with an average removal of 12-62% for helminth eggs and 1 log unit for thermotolerant coliforms. Nylon filters had higher removal rates especially for helminth eggs (58%). Average flow rates for sand filters were 3 m per day and fabric filters had steady flows of about 1.5 liters per second, but flow reduced with time in cotton filters. The simple filters tested improved the microbial quality of irrigation water and could easily be used in combination with other interventions to further reduce health risks. The unit cost of the filters tested also appear acceptable to farmers and some incentives like better prices will motivate many farmers to invest in such simple interventions. [ABSTRACT FROM AUTHOR]

Background: Following the tsunami, a detailed overview of the area specific transmission levels is essential in assessing the risk of malaria in Sri Lanka. Recent information on vector insecticide resistance, parasite drug resistance, and insights into the national policy for malaria diagnosis and treatment are important in assisting national and international agencies in their control efforts. Methods: Monthly records over the period January 1995 - October 2004 of confirmed malaria cases were used to perform an analysis of malaria distribution at district spatial resolution. Also, a focused review of published reports and routinely collected information was performed. Results: The incidence of malaria was only 1 case per thousand population in the 10 months leading up to the disaster, in the districts with the highest transmission. Conclusion: Although relocated people may be more exposed to mosquito bites, and their capacity to handle diseases affected, the environmental changes caused by the tsunami are unlikely to enhance breeding of the principal vector, and, given the present low parasite reservoir, the likelihood of a malaria outbreak is low. However, close monitoring of the situation is necessary, especially as December - February is normally the peak transmission season. Despite some losses, the Sri Lanka public health system is capable of dealing with the possible threat of a malaria outbreak after the tsunami. The influx of foreign medical assistance, drugs, and insecticides may interfere with malaria surveillance, and the long term malaria control strategy of Sri Lanka, if not in accordance with government policy. [ABSTRACT FROM AUTHOR]

Background: A field survey was performed to investigate local environmental factors promoting occurrence and abundance of Aedes aegypti and Ae. bromeliae mosquitoes at hotel compounds in the south-east coastal region of Zanzibar Island. Methods: The potential risk factors were determined using generalized linear mixed models. Aedes (Stegomyia) spp. indices such as container index (CI) and pupae per container (PPC) index were also estimated. Results: Aedes aegypti and Ae. bromeliae were the most abundant vector species, accounting for 70.8% of all Aedes mosquitoes collected. The highest CI was observed for plastic containers irrespective of the season, whereas the highest PPC was observed for coconut shells and aluminium containers in the rainy and dry seasons, respectively. The risk of Aedes mosquito occurrence and abundance were significantly associated with presence of plastic containers, coconut shells, used tyres and steel containers. These were discarded in shaded places, in the open and gardens, or found in plant nurseries. Conclusion: This study shows that Aedes species of global health significance occur at hotel compounds on this part of Zanzibar Island. The occurrence and abundance are sustained by the presence of abundant and poorly managed solid wastes and containers used for gardening tasks. This highlights an urgent need for the adoption of area-wide environmentally sustainable Aedes mosquito management interventions that also integrate solid waste management and ornamental plant production practices for reducing the risk of arboviral disease epidemics. [ABSTRACT FROM AUTHOR]

Background: A field survey was performed to investigate local environmental factors promoting occurrence and abundance of Aedes aegypti and Ae. bromeliae mosquitoes at hotel compounds in the south-east coastal region of Zanzibar Island. Methods: The potential risk factors were determined using generalized linear mixed models. Aedes (Stegomyia) spp. indices such as container index (CI) and pupae per container (PPC) index were also estimated. Results: Aedes aegypti and Ae. bromeliae were the most abundant vector species, accounting for 70.8% of all Aedes mosquitoes collected. The highest CI was observed for plastic containers irrespective of the season, whereas the highest PPC was observed for coconut shells and aluminium containers in the rainy and dry seasons, respectively. The risk of Aedes mosquito occurrence and abundance were significantly associated with presence of plastic containers, coconut shells, used tyres and steel containers. These were discarded in shaded places, in the open and gardens, or found in plant nurseries. Conclusion: This study shows that Aedes species of global health significance occur at hotel compounds on this part of Zanzibar Island. The occurrence and abundance are sustained by the presence of abundant and poorly managed solid wastes and containers used for gardening tasks. This highlights an urgent need for the adoption of area-wide environmentally sustainable Aedes mosquito management interventions that also integrate solid waste management and ornamental plant production practices for reducing the risk of arboviral disease epidemics. [ABSTRACT FROM AUTHOR]

Soil-transmissible helminthes (STH) infections are among the most common sanitation-related public health problems in poor periurban settlements of tropical regions of low- and middle-income countries. In Ghana, research studies documenting the incidence rate, intensity, and occupational risk factors of STH infections among adults are scanty. A prospective cohort study of 261 waste handlers was conducted to investigate this. Stool samples were collected after 90 and 180 days of treatment with albendazole (400 mg per dose). The geometric mean intensity of STH among waste handlers after 180 days of treatment was 2.8 eggs/gram (light intensity), with an incidence rate of 1.5%. The proportion of waste handlers with light intensity STH infections was 4.8%. The odds of STH infection among female waste handlers were 80% lower when compared with male waste handlers (aOR = 0.2; 95% CI: 0.0-0.8). Waste handlers who used rubber gloves when working were 80% (aOR = 0.2: 95% CI: 0.2-1.9) protected from STH infections compared with those who did not use gloves. Infections with STH among the 261 waste handlers significantly correlated with the type of waste handling activities (LR χ2 = 15.3; p=0.033) with the highest proportion of infection found among transporters, 2 (40%). Waste handlers should receive periodic antihelminthic treatment, at least once every six months, practice adequate hand hygiene, and use suitable personal protective equipment during work. [ABSTRACT FROM AUTHOR]

Platforms on social media are increasingly used for public health research. While social media provides an exceptional opportunity to explore communication about public health topics, this practice is not without ethical dilemmas. Our aim was to identify and unfold some of these dilemmas and to suggest possible solutions and ways forward for future research.Using our own research within a closed forum for people experiencing suicidal thoughts as a case, we explored certain dilemmas and possible answers relating to whether what is to be researched falls under a public or private social media domain; we investigated avenues for obtaining access to participants in an evolving online environment; how to secure informed consent from participants; and ways of ensuring anonymity.We provide recommendations and reflections that we hope will offer inspiration for researchers embarking on similar social media public health research within and beyond suicide research.The ethical framework commonly referred to in health research, based on confidentiality, anonymity, informed consent and doing no harm must be adjusted to be relevant for a social media context where technologies and regulations are constantly being altered. [ABSTRACT FROM AUTHOR]

Resource-deprived coastal peri-urban settlements in Southern Ghana are characterized by indiscriminate solid waste disposal and open defecation practices. Persons engaged in waste handling in such communities perform their activities with little or no personal protective equipment. They are thus confronted with the risk of faecal pollution of the hands and other bodily parts. A mixed method approach was used to investigate 280 waste handlers performing different activities to estimate recent faecal pollution of their hands and to observe the utilization of personal protective equipment and sanitation/hygiene facilities during work. The log concentration of E. coli on hands of waste handlers after work (8.60 ± 4.20 CFU/hand, mean ± standard deviation) was significantly higher compared with the E. coli log concentration before work (2.95 ± 1.89 CFU/hand, mean ± standard deviation) (p<0.001). The odds of faecal pollution was significantly higher (aOR 4.2; 95% CI: 1.9–9.1) for workers aged 35 years and above compared with those less than 35 years; and for workers at public toilet facilities (aOR 3.0; 95% CI: 1.0–8.4) compared with those who worked for private waste handling companies. Female workers were, however, 60% less likely (aOR 0.4; 95% CI: 0.2–0.8) to experience faecal pollution of their hands compared with males. The workers had limited access to water and sanitation and hygiene facilities, and about one-fifth (n = 59; 21.1%) did not use personal protective equipment during work. Waste handlers should be provided and instructed in proper use of personal protective equipment, have access to sanitation facilities and adopt improved hygiene behaviour to avoid the risk of faecal pollution and associated disease risk. [ABSTRACT FROM AUTHOR]

Objectives: Suicide by pesticide self‐poisoning is a major public health challenge in low‐ and middle‐income countries. While effectiveness studies are required to test alternative prevention approaches, economic evidence is lacking to inform decision‐making in research priority setting. Therefore, this study aimed to estimate the costs of a shop‐based gatekeeper training programme for pesticide vendors seeking to prevent pesticide self‐poisoning in rural Sri Lanka and assess its potential for cost‐effectiveness. Methods: Ex‐ante cost and cost‐effectiveness threshold (CET) analyses were performed from a governmental perspective based on a three‐year analytic horizon, using 'no programme' as a comparator. A programme model targeting all 535 pesticide shops in the North Central Province and border areas was applied. Total programme costs (TPC) were estimated in 2019 USD using an ingredients approach and 3% annual discounting. The Sri Lankan gross domestic product per capita and life years saved were used as CET and effectiveness measure, respectively. Sensitivity analyses were performed. Results: TPC were estimated at 31 603.03 USD. TPC were sensitive to cost changes of training material and equipment and the programme lifetime. The programme needs to prevent an estimated 0.23 fatal pesticide self‐poisoning cases over three years to be considered cost‐effective. In the sensitivity analyses, the highest number of fatal cases needed to be prevented to obtain cost‐effectiveness was 4.55 over three years. Conclusions: From an economic perspective, the programme has a very high potential to be cost‐effective. Research assessing its effectiveness should therefore be completed, and research analysing its transferability to other settings prioritised. [ABSTRACT FROM AUTHOR]