Abstract. Inadequate hygiene and sanitation remain leading global contributors to morbidity and mortality in children and adults. One strategy for improving sanitation access is community-led total sanitation (CLTS), in which participants are guided into self-realization of the importance of sanitation through activities called "triggering." This qualitative study explored community members' and stakeholders' sanitation, knowledge, perceptions, and behaviors during early CLTS implementation in Zambia. We conducted 67 in-depth interviews and 24 focus group discussions in six districts in Zambia 12-18 months after CLTS implementation. Triggering activities elicited strong emotions, including shame, disgust, and peer pressure, which persuaded individuals and families to build and use latrines and handwashing stations. New sanitation behaviors were also encouraged by the hierarchical influences of traditional leaders and sanitation action groups and by children's opinions. Poor soil conditions were identified as barriers to latrine construction. Taboos, including prohibition of different generations of family members, in-laws, and opposite genders from using the same toilet, were barriers for using sanitation facilities. CLTS, through community empowerment and ownership, produced powerful responses that encouraged construction and use of latrines and handwashing practices. These qualitative data suggest that CLTS is effective for improving sanitation beliefs and behaviors in Zambia.
ObjectiveTo evaluate current practices and standards of evaluation and treatment of childhood febrile illness in Southern Province, Zambia.MethodsFrom November to December 2013, we conducted a cross-sectional survey of facilities and health workers and we observed the health workers’ interactions with febrile children and their caregivers. The facility survey recorded level of staffing, health services provided by the facility, availability and adequacy of medical equipment, availability of basic drugs and supplies and availability of treatment charts and guidelines. The health worker survey assessed respondents’ training, length of service, access to national guidelines and job aids for managing illnesses, and their practice and knowledge on management of neonatal and child illnesses. We also conducted exit interviews with caregivers to collect information on demographic characteristics, chief complaints, counselling and drug dispensing practices.FindingsThis study included 24 health facilities, 53 health workers and 161 children presenting with fever. Facilities were insufficiently staffed, stocked and equipped to adequately manage childhood fever. Children most commonly presented with upper respiratory tract infections (46%; 69), diarrhoea (31%; 27) and malaria (10%; 16). Health workers insufficiently evaluated children for danger signs, and less than half (47%; 9/19) of children with pneumonia received appropriate antibiotic treatment. Only 57% (92/161) were tested for malaria using either rapid diagnostic tests or microscopy.ConclusionVarious health system challenges resulted in a substantial proportion of children receiving insufficient management and treatment of febrile illness. Interventions are needed including strengthening the availability of commodities and improving diagnosis and treatment of febrile illness.
Objectives. To determine the association between the Center for Disease Control and Prevention's (CDC) Social Vulnerability Index (SVI) with the risk of COVID-19-related mortality. Methods. We merged by county CDC's SVI and the New York Times data on coronavirus cases. We estimated the association between the SVI and risk of death from COVID-19 per 100,000 people in counties with confi rmed cases (n=2,755 U.S. counties) using multivariable Poisson regression. Results. Th e adjusted risk of COVID-19-related death followed a non-linear pattern, with the lowest risk among SVIs from 0.05 to 0.55 (roughly 3.1 to 3.5/ 100,000 people) and highest risk corresponding to SVI=0.95 (6.5/ 100,000). Compared with a SVI=0.35, SVIs of 0.85 and 0.95 were associated with 2.3 (2.1, 2.5) and 3.4 (3.1, 3.7) excess deaths per 100,000, respectively. Conclusions. High social vulnerability is associated with increased risk of COVID-19-related mortality among U.S. counties with confi rmed cases.
Statistical modeling indicated that COVID-19 would have afflicted more than 60% of the US population. Social distancing, self-quarantine, and widespread shutdowns were imposed. The push to stay at home and the decreased availability of exercise facilities have potentially reduced physical activity (PA). The purpose of this observational, correlational study was to determine if there is a relationship between PA level and symptoms of COVID-19. Subjects were asked to complete a single Survey Monkey questionnaire. The survey asked demographic questions, PA behaviors, and questions relating to COVID-19 symptoms. Chi-square analysis was run to determine frequency differences within the PA group and specific COVID-19 symptoms. Hierarchical regression analysis was run to determine if PA was a unique predictor of the number COVID-19 symptoms experienced. Sixty male and 85 female (n = 145) subjects completed this study.
A cluster of malaria cases has been reported in United Kingdom (UK) travellers who have recently returned from a holiday in the Gambia.
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