RESUMEN
Boiling is the most common method of household water treatment in developing countries; however, it is not always effectively practised. We conducted a randomized controlled trial among 210 households to assess the effectiveness of water pasteurization and safe-storage interventions in reducing Escherichia coli contamination of household drinking water in a water-boiling population in rural Peru. Households were randomized to receive either a safe-storage container or a safe-storage container plus water pasteurization indicator or to a control group. During a 13-week follow-up period, households that received a safe-storage container and water pasteurization indicator did not have a significantly different prevalence of stored drinking-water contamination relative to the control group [prevalence ratio (PR) 1·18, 95% confidence interval (CI) 0·92-1·52]. Similarly, receipt of a safe-storage container alone had no effect on prevalence of contamination (PR 1·02, 95% CI 0·79-1·31). Although use of water pasteurization indicators and locally available storage containers did not increase the safety of household drinking water in this study, future research could illuminate factors that facilitate the effective use of these interventions to improve water quality and reduce the risk of waterborne disease in populations that boil drinking water.
Asunto(s)
Agua Potable/microbiología , Infecciones por Escherichia coli/prevención & control , Pasteurización/métodos , Purificación del Agua/métodos , Calidad del Agua , Escherichia coli/fisiología , Composición Familiar , Humanos , Perú , Población RuralRESUMEN
A novel water quality intervention that consists of point-of-use water disinfection, safe storage and community education was field tested in Bolivia. A total of 127 households in two periurban communities were randomized into intervention and control groups, surveyed and the intervention was distributed. Monthly water quality testing and weekly diarrhoea surveillance were conducted. Over a 5-month period, intervention households had 44% fewer diarrhoea episodes than control households (P = 0.002). Infants < 1 year old (P = 0.05) and children 5-14 years old (P = 0.01) in intervention households had significantly less diarrhoea than control children. Campylobacter was less commonly isolated from intervention than control patients (P = 0.02). Stored water in intervention households was less contaminated with Escherichia coli than stored water in control households (P < 0.0001). Intervention households exhibited less E. coli contamination of stored water and less diarrhoea than control households. This promising new strategy may have broad applicability for waterborne disease prevention.
Asunto(s)
Participación de la Comunidad , Diarrea/prevención & control , Desinfectantes , Educación en Salud/métodos , Purificación del Agua/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Bolivia , Niño , Preescolar , Diarrea/etiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Factores de Riesgo , Microbiología del AguaRESUMEN
In Bolivia, few data are available to guide empiric therapy for bloody diarrhea. A study was conducted between December 1994 and April 1995 to identify organisms causing bloody diarrhea in Bolivian children. Rectal swabs from children <5 years old with bloody diarrhea were examined for Salmonella, Shigella, and Campylobacter organisms; fecal specimens were examined for Entamoeba histolytica. A bacterial pathogen was identified in specimens from 55 patients (41%). Shigella organisms were found in 39 specimens (29%); 37 isolates (95%) were resistant to ampicillin, 35 (90%) to trimethoprim-sulfamethoxazole, and 24 (62%) to chloramphenicol, but all were susceptible to nalidixic acid. Only 1 of 133 stool specimens contained E. histolytica trophozoites. Multidrug-resistant Shigella species are a frequent cause of bloody diarrhea in Bolivian children; E. histolytica is uncommon. Clinical predictors described in this study may help identify patients most likely to have Shigella infection. Laboratory surveillance is essential to monitor antimicrobial resistance and guide empiric treatment.
Asunto(s)
Antibacterianos/farmacología , Diarrea/microbiología , Disentería Bacilar/tratamiento farmacológico , Shigella/efectos de los fármacos , Shigella/aislamiento & purificación , Animales , Antibacterianos/uso terapéutico , Bolivia , Campylobacter/aislamiento & purificación , Infecciones por Campylobacter/tratamiento farmacológico , Infecciones por Campylobacter/microbiología , Preescolar , Diarrea/tratamiento farmacológico , Diarrea/parasitología , Farmacorresistencia Microbiana , Resistencia a Múltiples Medicamentos , Disentería Amebiana/tratamiento farmacológico , Disentería Amebiana/parasitología , Disentería Bacilar/microbiología , Empirismo , Entamoeba histolytica/aislamiento & purificación , Heces/parasitología , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Salmonella/aislamiento & purificación , Infecciones por Salmonella/tratamiento farmacológico , Infecciones por Salmonella/microbiologíaRESUMEN
BACKGROUND: To assess the effectiveness of the cholera prevention activities of the Peruvian Ministry of Health, we conducted a knowledge, attitudes, and practices (KAP) survey in urban and rural Amazon communities during the cholera epidemic in 1991. METHODS: We surveyed heads of 67 urban and 61 rural households to determine diarrhoea rates, sources of cholera prevention information, and knowledge, attitudes, and practices regarding ten cholera prevention measures. RESULTS: Twenty-five per cent of 482 urban and 11% of 454 rural household members had diarrhoea during the first 3-4 months of the epidemic. Exposure to mass media education was greater in urban areas, and education through interpersonal communication was more prevalent in rural villages. Ninety-three per cent of rural and 67% of urban respondents believed they could prevent cholera. The mean numbers of correct responses to ten knowledge questions were 7.8 for urban and 8.2 for rural respondents. Practices lagged behind knowledge and attitudes (mean correct response to ten possible: urban 4.9, rural 4.6). Seventy-five per cent of respondents drank untreated water and 91% ate unwashed produce, both of which were identified as cholera risk factors in a concurrently conducted case-control study. CONCLUSIONS: The cholera prevention campaign successfully educated respondents, but did not cause many to adopt preventive behaviours. Direct interpersonal education by community-based personnel may enhance the likelihood of translating education into changes in health behaviours. Knowledge, attitudes, and practices surveys conducted with case-control studies during an epidemic can be an effective method of refining education/control programmes.
PIP: The authors conducted a knowledge, attitudes, and practices (KAP) survey in urban and rural Amazon communities during the 1991 cholera epidemic to assess the effectiveness of the Peruvian Ministry of Health's cholera prevention activities. Diarrhea rates, sources of cholera prevention information, and knowledge, attitudes, and practices regarding 10 cholera prevention measures were determined by surveying the heads of 67 urban and 61 rural households. 25% of 482 urban and 11% of 454 rural household members had diarrhea during the first 3-4 months of the epidemic. Exposure to mass media education was greater in urban areas, while education through interpersonal communication prevailed in rural villages. 93% of rural and 67% of urban respondents believed they could prevent cholera. Rural respondents were slightly more knowledgeable than urban respondents about cholera. Overall, however, practices did not reflect their knowledge and attitudes; 75% of respondents drank untreated water and 91% ate unwashed produce.
Asunto(s)
Cólera/prevención & control , Brotes de Enfermedades/prevención & control , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Investigación sobre Servicios de Salud/métodos , Adolescente , Adulto , Anciano , Niño , Preescolar , Cólera/epidemiología , Cólera/terapia , Femenino , Conductas Relacionadas con la Salud , Educación en Salud/organización & administración , Humanos , Lactante , Masculino , Medios de Comunicación de Masas , Persona de Mediana Edad , Perú/epidemiología , Factores de RiesgoRESUMEN
Epidemiologic investigations of the Latin America cholera epidemic have repeatedly implicated untreated drinking water and water touched by hands during storage as important vehicles for disease transmission. To prevent such transmission, we provided a new narrow-mouthed, plastic, water storage vessel and 5% calcium hypochlorite solution for home disinfection of stored water to a Bolivian Aymara Indian community at risk for cholera. We evaluated acceptance of this intervention and its effect on water quality. Each of 42 families in the study obtained water from a household well; fecal coliform bacteria were found in water from 39 (93%) of 42 wells and 33 (79%) of 42 usual water storage vessels. One group of families received the special vessels and chlorine (group A), a second received only the special vessels (group B), and a third served as a control group (group C). Water samples collected every three weeks from group A special vessels had lower geometric mean fecal coliform colony counts (P < 0.0001) and lower geometric mean Escherichia coli colony counts (P < 0.0001) than water from group B or C vessels. Adequate levels of free chlorine persisted in these vessels for at least 5 hr. The special vessels and chlorine solution were well accepted and continued to be used for at least six months. Use of the vessel and chlorine solution produced drinking water from nonpotable sources that met World Health Organization standards for microbiologic quality.
Asunto(s)
Cólera/prevención & control , Purificación del Agua/métodos , Abastecimiento de Agua/normas , Adolescente , Adulto , Anciano , Bolivia , Compuestos de Calcio , Cólera/transmisión , Recuento de Colonia Microbiana , Recolección de Datos , Escherichia coli/crecimiento & desarrollo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Factores de TiempoAsunto(s)
Cólera/epidemiología , Cólera/prevención & control , Brotes de Enfermedades/prevención & control , América Central/epidemiología , Cólera/transmisión , Contaminación de Alimentos , Humanos , Organización Panamericana de la Salud , Vigilancia de la Población/métodos , Salud Pública/métodos , Saneamiento , Alimentos Marinos/microbiología , América del Sur/epidemiología , Microbiología del Agua , Abastecimiento de AguaRESUMEN
In response to the Latin American cholera epidemic, El Salvador began a prevention programme in April 1991. The first case was confirmed in August, and 700 cases were reported within 3 months. A matched case-control study was conducted in rural La Libertad Department in November 1991. Illness was associated with eating cold cooked or raw seafood (odds ratio [OR] = 7.0; 95% confidence limits [CL] = 1.4, 35.0) and with drinking water outside the home (OR = 8.8; 95% CL = 1.7, 44.6). Assertion of knowledge about how to prevent cholera (OR = 0.2; 95% CL = 0.1, 0.8) and eating rice (OR = 0.2; 95% CL = 0.1, 0.8) were protective. More controls than patients regularly used soap (OR = 0.3; 95% CL = 0.1, 1.0). This study demonstrated three important points for cholera prevention: (1) seafood should be eaten cooked and hot; (2) populations at risk should be taught to treat household drinking water and to avoid drinking water outside the home unless it is known to be treated; and (3) education about hygiene can be an important tool in preventing cholera.
Asunto(s)
Cólera/prevención & control , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Cólera/epidemiología , Cólera/transmisión , Culinaria , El Salvador/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Higiene , Masculino , Persona de Mediana Edad , Factores de Riesgo , Alimentos Marinos , Abastecimiento de AguaRESUMEN
Epidemic cholera struck Peru in January 1991 and spread within a month to the Amazon headwaters. A case-control study was done in the Amazonian city of Iquitos, Peru. Cholera-like illness was associated with eating unwashed fruits and vegetables (odds ratio [OR] = 8.0; 95% confidence limits [CL] = 2.2, 28.9) and drinking untreated water (OR = 2.9; 95% CL = 1.3, 6.4). Consumption of a drink made from toronja, a citrus fruit, was protective against illness (OR = 0.4; 95% CL = 0.2, 0.7). Illness was inversely associated with the quantity of toronja drink consumed (P < .01). Produce has not previously been convincingly documented as a risk factor for cholera; this study underscores the importance of washing produce before eating it. Acidic juices, such as toronja drink (pH 4.1), inhibit vibrio growth and may make contaminated water safer. Wild citrus fruits such as toronja are abundant, cheap, and popular in the Amazon region. Promoting the consumption of toronja drink may be a useful cholera prevention strategy in this region.
Asunto(s)
Cólera/epidemiología , Brotes de Enfermedades , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Estudios de Casos y Controles , Niño , Preescolar , Cólera/prevención & control , Cólera/transmisión , Frutas , Humanos , Perú/epidemiología , Factores de Riesgo , VerdurasRESUMEN
Epidemic cholera struck Peru in January 1991, and spread rapidly. The national cholera case-fatality rate (CFR) was less than 1% in the first six months of the epidemic, but in some rural areas, the CFR exceeded 10%. We investigated cholera mortality in the rural Amazon region, an area with a CFR of 6.3%. We conducted a case-control study, comparing 29 decedents with 61 survivors of recent cholera-like diarrheal illness in 12 villages with a combined CFR of 13.5%. Of 29 decedents, 28 (96%) died in the village or en route to a health facility. Death occurred within 36 hours of illness onset for 83% of the decedents. In 11 (92%) villages, the first or second recognized case was fatal. Death was associated with receiving treatment only at home (odds ratio indeterminate; 95% confidence interval 3.5, indeterminate). Treatment with oral rehydration salts (ORS) was not protective against death for patients who received treatment only at home. Treatment with homemade sugar-salt solution (SSS) was also not protective; fewer than one-third of respondents knew the correct SSS recipe. Most decedents experienced multiple barriers to health care. Cholera victims died rapidly and early in village outbreaks, and few patients had access to health care. Provision of threatened villages with ORS supplies and education in their use before cholera strikes is essential to reducing cholera mortality in this region.
Asunto(s)
Cólera/mortalidad , Brotes de Enfermedades , Fluidoterapia/métodos , Adolescente , Adulto , Anciano , Carbohidratos , Estudios de Casos y Controles , Niño , Preescolar , Cólera/epidemiología , Cólera/terapia , Femenino , Servicios de Atención de Salud a Domicilio , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Perú/epidemiología , Soluciones para Rehidratación/normas , Población Rural , Cloruro de Sodio , Transporte de PacientesRESUMEN
Desde el inicio de la epidemia de cólera en el Perú el Programa de entrenamiento en Epidemiología de Campo de la Oficina General de Epidemiología del Ministerio de Salud ha desarrollado diversas investigaciones con el propósito de mejorar la efectividad de las medidas de intervención para el control del problema. A través de la aplicación y diseños metodológicos estandarizados en las áreas más afectadas, se ha encontrado que la seroprevalencia de infección por Vibrio cholerae alcanza a 25-30 de cada 100 habitantes. Los factores de riesgo más significativos incluyen consumo de agua no tratada y de alimentos sanitariamente deficientes. La severidad de cuadro clínico colérico está asociada significativamente con la presencia de grupo sanguíneo "O". La letalidad del cólera está asociada con el tratamiento intradomiciliario del enfermo y la automedicación familiar. El desconocimiento acerca de los modos de contagio, tratamiento y prácticas preventivas incrementa el riesgo de enfermar con cólera. Finalmente, la magnitud del cólera en la población infantil parece ser mayor en el escenario comunitario que en el hospitalario. Los estudios epidemiológicos en el campo pueden ayudar a identificar medidas de control más específicas y más efectivas