No abstract

Mutations of the CFTR gene and the 5T genotype are associated with chronic pancreatitis.

EARLY 2 MILLION CHILDREN die annually from diarrheal disease. 1 A recent metaanalysis concluded that handwashing promotion interventions decrease diarrhea by a mean of 47%. 2 The authors estimate that such interventions could prevent 1 million child deaths per year. 2 However, the systematic meta-analysis and the studies it included summarized the reduction in diarrheal rates among all children or all family members. But all family members are not at equal risk of death from diarrhea. Children younger than 5 years are at much higher risk of death from diarrhea than older children and adults, 1 and infants (younger than 1 year) are at the highest risk of death. Verbal autopsy studies from Egypt, 3 Pakistan, 4 Bangladesh, 5 and Ethiopia 6 report that 43% to 78% of deaths from diarrhea among children younger than 5 years occur in the first year of life.Infants cannot wash their own hands and therefore cannot interrupt the transfer of pathogens between their hands and their mouth. Infants might benefit from a lower rate of diarrheal pathogen transmission from parents and siblings who wash their hands more

Summaryobjectives To evaluate the effectiveness of point of use water treatment with flocculent-disinfectant on reducing diarrhoea and the additional benefit of promoting hand washing with soap.methods The study was conducted in squatter settlements of Karachi, Pakistan, where diarrhoea is a leading cause of childhood death. Interventions were randomly assigned to 47 neighbourhoods. Households in 10 neighbourhoods received diluted bleach and a water vessel; nine neighbourhoods received soap and were encouraged to wash hands; nine neighbourhoods received flocculent-disinfectant water treatment and a water vessel; 10 neighbourhoods received disinfectant-disinfectant water treatment and soap and were encouraged to wash hands; and nine neighbourhoods were followed as controls. Field workers visited households at least once a week from April to December 2003 to promote use of the interventions and to collect data on diarrhoea.results Study participants in control neighbourhoods had diarrhoea on 5.2% of days. Compared to controls, participants living in intervention neighbourhoods had a lower prevalence of diarrhoea: 55% (95% CI 17%, 80%) lower in bleach and water vessel neighbourhoods, 51% (95% CI 12%, 76%) lower in hand washing promotion with soap neighbourhoods, 64% lower (95% CI 29%, 90%) in disinfectant-disinfectant neighbourhoods, and 55% (95% CI 18%, 80%) lower in disinfectantdisinfectant plus hand washing with soap neighbourhoods.conclusions With an intense community-based intervention and supplies provided free of cost, each of the home-based interventions significantly reduced diarrhoea. There was no benefit by combining hand washing promotion with water treatment.