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Salmonella is a major bacterial concern for public health globally. Although there are limited documentation on the prevalence of Salmonella species in Cambodia's food chain, some reports indicate that salmonellosis is a severe gastrointestinal infection in its population and especially in children. To investigate the presence of Salmonella spp., 285 food samples (75 meat, 50 seafood, and 160 leafy green vegetable samples) were randomly collected from various local markets in Phnom Penh capital and nearby farms in Cambodia. Concurrently, field observations were conducted to collect data on food hygiene and practices among the relevant actors. All food samples were analyzed using bacterial culture and plate counts, and the findings were confirmed serially with biochemical, serological, and PCR tests. The observational data on food hygiene and practices from farm to market revealed that the spread of Salmonella in the food-value chain from farm to market could pose health risks to consumers. The overall prevalence of Salmonella spp. was 48.4% (138/285), while the prevalence in meat, seafood, and vegetables was 71% (53/75), 64% (32/50), and 33% (53/160), respectively. Mean Salmonella plate count ranged from 1.2 to 7.40 log10 CFU/g, and there was no significant difference in bacterial counts between meat, seafood, and vegetable samples (p > 0.05). The most common serogroups among the isolated Salmonella spp. were B and C. These results suggest that a large proportion of meat, seafood, and vegetable products sold at local markets in Phnom Penh are contaminated with Salmonella spp. This is likely linked to inadequate hygiene and sanitation practices, including handling, storage, and preservation conditions. Observations on farms suggested that the prevalence of Salmonella in vegetables sold at the market could be linked to contamination relating to agricultural practices. Thus, controlling the spread of foodborne salmonellosis through the food-value chain from farms and retailers to consumers is warranted to enhance food safety in Cambodia.

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BACKGROUND: School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance. METHODS: The WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2-4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7-16) in an 'open cohort'. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March-June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat. RESULTS: Of 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94-112), 5987 enrolled at study initiation (23rd November-22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71-1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84-1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83-1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0-100 scale; 95% CI 0.05-6.59), and no evidence of effects on other secondary outcomes. CONCLUSIONS: This large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT05024890.

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A group of helminthic and intestinal protozoa causes intestinal parasitic infections (IPIs), affecting more than 2.5 billion people worldwide. IPIs are diseases closely associated with poor hygiene and sanitation, concentrated in underdeveloped regions and among populations with low socioeconomic status. Consequently, most prevalence is in Sub-Saharan Africa and Asia, with local habits or risk factors that could affect its prevalence. The aim of this study was to determine how hygienic practices, sanitation, and local behavior of eating raw meat (hinasumba) contributed to the prevalence of IPI. A cross-sectional study was conducted in the Simalungun District of North Sumatera Province, involving 428 people of Batak Simalungun. There were 15 villages randomly selected across the district based on the local registry, which consequently, non-purposive sampling was conducted. Face-to-face interviews assessed various risk factors, such as demographic characteristics, water source, traditional raw meat consumption, or hinasumba as local risk factors, hygienic practices, and sanitation. The findings indicated that an overall prevalence rate of IPI was 42.9%, consisting of 87.5% with helminthic infection and 12.5% with protozoal infection. More than half of IPI cases were associated with Taenia sp. infections (21.8%), followed by hookworms' infections with a 6.1% positivity rate. Based on multivariate analysis, farming and consuming traditional delicacies, namely hinasumba, increased the likelihood of IPI occurrence among the population by 1.7 and 3 times, respectively. It can be concluded that the high prevalence of taeniasis in the study area was associated with local behavior and hinasumba consumption, which may contribute to determining the dominance of specific IPI species.

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BACKGROUND: A surgical site infection (SSI) is a postoperative infection that occurs at or near the surgical incision. SSIs significantly increase morbidity, mortality, length of hospital stay, and healthcare costs. The World Health Organization (WHO) has established hospital hygiene precaution guidelines for the prevention of SSIs, which were enhanced during the COVID-19 pandemic. The current study aims to explore the effect of the COVID-19 pandemic on SSI incidence among initially uninfected postoperative patients. We hypothesize that these enhanced precautions would reduce the incidence of SSIs. MATERIALS AND METHODS: A retrospective study comparing surgical outcomes before and during the pandemic. Patients who had abdominal surgery between June and December 2019 (Non-COVID-19) or between February and June 2020 (COVID-19) were included. The two groups were matched in a 1:1 ratio based on age, Sex, acuity (elective or emergent), surgical approach, and comorbidities. Electronic medical records were reviewed to identify SSIs and hospital readmissions within 30 days after surgery. Pearson's chi-square test and Fisher's exact test were used. RESULTS: Data was collected and analyzed from 976 patients who had surgery before the COVID-19 pandemic (non-COVID group) and 377 patients who had surgery during the pandemic (COVID group). After matching, there were 377 patients in each group. In our study, we found 23 surgical site infections (SSIs) in both laparoscopic and open surgeries. The incidence of SSIs was significantly higher in the non-COVID period compared to the COVID period [17 cases (4.5%) vs. 6 cases (1.6%), respectively, p = 0.032], especially in non-COVID open surgeries. The incidence of SSIs in laparoscopic surgeries was also higher during the non-COVID period, but not statistically significant. CONCLUSIONS: Enhanced hygiene precautions during the COVID -19 pandemic may have reduced SSIs rates following abdominal surgery.

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Unsafe patient care in hospitals, especially in low- and middle-income countries, is often caused by poor infection prevention and control (IPC) practices; insufficient support for water, sanitation, and hygiene (WASH); and inadequate waste management. We looked at the intersection of IPC, WASH, and the global initiative of improving health care quality, specifically around maternal and newborn care in Bangladesh health facilities. We identified 8 primary quality improvement and IPC/WASH policy and guideline documents in Bangladesh and analyzed their incorporation of 30 subconditions under 5 critical conditions: water; sanitation; hygiene; waste management/cleaning; and IPC supplies, guidelines, training, surveillance, and monitoring. To determine how Bangladesh health care workers implemented the policies, we interviewed 33 informants from 16 public and private facilities and the national level. Bangladesh's 8 primary guidance documents covered 55% of the 30 subconditions. Interviews showed that Bangladesh health facility staff generally rely on eight tools related to quality improvement (five); IPC (two); and supportive supervision (one) plus a robust supervision mechanism. The stakeholders identified a lack of human resources and environmental hygiene infrastructure and supplies as the main gaps in providing IPC/WASH services. We concluded that the Bangladesh government had produced substantial guidance on using quality improvement methods to improve health services. Our recommendations can help identify strategies to better integrate IPC/WASH in resources including standardizing guidelines and tools within one toolkit. Strategizing with stakeholders working on initiatives such as universal health coverage and patient safety to integrate IPC/WASH into quality improvement documents is a mutually reinforcing approach.

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BACKGROUND: Inadequate water supply, poor sanitation and hygiene (WASH) facilities in schools, insufficient puberty education and a lack of hygienic menstrual hygiene management (MHM) items (absorbents) cause girls in developing countries like Ethiopia to view menstruation as shameful and uncomfortable. However, there was little evidence of female MHM practice and associated factors among secondary school girls in eastern Ethiopia. OBJECTIVE: To assess MHM practice and associated factors among secondary school girls in eastern Ethiopia. DESIGN: Institutional-based cross-sectional study design was conducted. METHODS: A total of 473 secondary schoolgirls were selected using a stratified sampling technique. Data were collected using a self-administered structured questionnaire, double-entered to Epidata version 3.1 and exported to SPSS version 26 for analysis. Descriptive analysis was computed using frequency, percentage, mean and standard deviations. Multivariable logistic regression was applied to assess the association of the school water, sanitation and hygiene facilities with MHM. Adjusted odd ratio (AOR) with its 95% confidence interval was computed to show the strength of the association between dependent and independent variables. The goodness of fit of the model was tested by the Hosmer-Lemeshow goodness of fit test. RESULTS: Out of 473 study participants, 72.93% of them (95% CI: 68.74-76.76) reported good MHM practices. The study also found that availability of continuous water supply (AOR = 2.40, 95% CI: (1.42-4.01)); types of toilet (AOR = 2.01, 95% CI: (1.20-3.40)), confined space (AOR = 3.02, 95% CI: (1.49-4.76)) and having females' toilets alone inside in the school (AOR = 2.70, 95% CI: (1.20-4.40)) were significantly associated with female students' good MHM practice. CONCLUSION: The survey revealed that some of the secondary schoolgirls practiced poor menstrual hygiene management (MHM), which needs further improvement. The study also found that the availability of continuous water supply in the school, types of toilet facility in the school, availability of private space to manage periods at school, learning about MHM in schools and availability of female toilets kept locked inside were factors significantly associated with MHM practice of students, which require integration of Zonal Health and education bureau to jointly work towards the improvement of school WASH facilities.

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BACKGROUND: Although menstruation is a monthly biological phenomenon, it is shrouded in stigma and shame which directly impacts health, education, gender equality, decent work, and economic growth. However, there is scarce evidence on how personal agency, an individual's ability to access resources, may act as a protective factor to adequate menstrual health and hygiene practices. Therefore, we assess the association between attitudes toward menstruation and personal agency among very young adolescent girls. METHODS: We use cross-sectional data from the Global Early Adolescent Study in São Paulo, Brazil, among 10- to 14-year-old girls who have experienced menarche (n = 325) and completed a home-based self-administered questionnaire in 2021. "Attitudes toward menstruation" was created based on five indicators on a Likert scale, with a higher score indicating more positive attitudes. The main covariate was personal agency, comprised of three scales and modeled as three continuous variables: voice, decision-making power, and freedom of movement. Data were analyzed using multivariable linear regression. RESULTS: Attitudes toward menstruation mean score was 12.5 (range 5-19). Older adolescents (12-14 years-old) had higher mean scores (more positive) than younger adolescents (10-11 years-old) on attitudes toward menstruation, whereas no other sociodemographic or menstrual health indicator (knowledge or access to products) were associated with attitudes toward menstruation. In the multiple regression model, older age and higher freedom of movement remained positively associated with attitudes toward menstruation (ßadjust = 0.5; 95%CI 0.1 to 0.8). CONCLUSION: Positive attitudes toward menstruation are associated with higher freedom of movement among very young Brazilian adolescent girls. The promotion of personal agency should be recognized as key strategies to accelerate young girls' positive approaches to their own menstruation and, consequently, well-being.

Menstrual Health and Hygiene Attitudes are associated with Personal AgencyOur results show that positive attitudes toward menstruation among very young adolescent girls are associated with personal agency, measured through freedom of movement. This information can inform strategies to accelerate young girls' positive approaches to their own menstruation and, consequently, well-being.

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Você sabia que a higiene íntima masculina é fundamental na prevenção de doenças, inclusive do câncer? No Coisa de Homem, desta quarta-feira (5), vamos falar sobre a importância da higienização peniana.

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Você sabia que a higiene íntima masculina é fundamental na prevenção de doenças, inclusive do câncer? No Coisa de Homem, desta quarta-feira (5), vamos falar sobre a importância da higienização peniana.

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Ensuring proper menstrual hygiene management remains a significant challenge for young women in India. The term "exclusive use of hygienic period products during menstruation" refers to relying solely on period products like sanitary pads, tampons, or menstrual cups. Poor menstrual hygiene practices not only increase the risk of reproductive tract infections but also lead to various negative health outcomes, including discomfort and potential complications. This study explores factors associated with the exclusive use of period products during menstruation aged 15-24, investigates geographic disparities, examines rural-urban gaps, and assesses inequality in India. Utilizing data from the fifth National Family Health Survey (NFHS-5), responses from 2,41,180 women aged 15 to 24 were analysed using logistic regression and multivariate decomposition analyses to explore socioeconomic predictors. Moran's I statistics also assessed spatial dependency, while Lorenz curves and Gini coefficients measured inequality. Quintile and LISA maps visualized regional disparities. The study found that 76.15% of women in India reported exclusive use of hygienic period products during menstruation. Rural areas reported a lower percentage of exclusive use of hygienic period products (72.32%) during menstruation compared to urban areas (89.37%). Key factors associated with the exclusive use of hygienic period products among 15-24-year-old women in India include age, education, place of residence, wealth, access to media, and healthcare discussions. Geographically, central districts exhibited the lowest coverage (< 65%), while the Southern region reported the highest (> 85). The GINI coefficient of 0.39 highlighted moderate inequality in distribution. Decomposition analysis revealed that household wealth contributed 49.25% to rural-urban differences, followed by education (13.41%), media access (7.97%), and region (4.97%). This study highlights significant regional disparities and low utilization of hygienic period products among young women in India, particularly in central districts. Policymakers should prioritize interventions targeting these regions, addressing socio-economic disparities. Strategies to promote education, improve media access, and enhance household wealth can facilitate menstrual hygiene adoption. Initiatives to reduce sanitary napkin costs and increase accessibility, particularly in rural areas, are crucial to mitigating geographical disparities nationwide.

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BACKGROUND: The positive changes in hygienic living conditions are commonly believed to explain secular changes in body height and the age of maturity. However, it is difficult to estimate the separate impacts of these factors due to the lack of social and economic data and variations in the sources of information. We hypothesized that final male body height could be associated with various socioeconomic indicators, such as the development of the medical care system, the quality of nutrition, and the level of sanitary and hygienic conditions. Moreover, we hypothesized that male body height could be associated with the level of morbidity in the region during the time of conscript childhood (from 1 to 7 years old). MATERIALS AND METHODS: We used two main sources of information in the analyses. The first is the data from the Statistical Reference Book published by the Central Statistical Committee in 1929. The second is the annual data from the Statistical Reference Book published in the Russian Empire. Since the conscripts were born between 1906 and 1909, we used datasets from 1910 to 1913. To analyze the data, we used a method of analyzing interacting variables called St. Nicolas House Analysis (SNHA). RESULTS: Our analyses revealed direct associations between the morbidity of some diseases and male body height and other anthropometric parameters. CONCLUSIONS: There are associations between conscript final body height and the morbidity of influenza, dysentery and some venereal diseases, such as chancroid and syphilis. There were no associations between conscript final body height and the level of morbidity during childhood. However, other final parameters, such as BMI, weight, and chest circumference, could be associated with the morbidity of malaria, scabies, scurvy, and scarlet fever during childhood. The prevalence of these diseases could be strongly connected with unfavorable living conditions. The results are similar for both urban and rural areas.

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BACKGROUND: Students in school are more likely to be sick from communicable diseases like diarrheal illnesses, acute respiratory infections, and other illnesses linked to poor personal hygiene. Poor hygiene practices are common among school children and put their health at risk, which in turn has several consequences. These include significant school absences, transmission of infectious diseases to other students, and missed workdays for parents and guardians. However, there is limited evidence on the level of personal hygiene practice and its associated factors among school students. Thus, this study was aimed at determining personal hygiene practice level and its associated factors among elementary school grade (5-8) students in Fiche town, Oromia, Ethiopia, in 2022. METHODS: A cross-sectional study design was conducted from April 29 to May 29, 2022, in Fiche town, Oromia regional state, among 534 elementary school students. A multi-stage probability sampling technique was used to select the individual students. A structured questionnaire was used to collect the data. The data was entered into epi-data version 4.6 and analyzed by SPSS version 26.0. Variables that scored a p-value less than 0.2 during bivariate analysis were included in multilevel logistic regression models to determine factors associated with personal hygiene practice. The odds ratio with a 95% confidence interval was estimated, and the level of significance was set at [Formula: see text] 0.05. RESULTS: The magnitude of good personal hygiene (scored above the mean) was 59.2% (95% confidence interval (CI)) (55.1-63.0). A considerable proportion of students scored more than 50% in latrine use (62.5%), regular hand-washing (55.4%), and oral hygiene (55.20%) practices. Being female, having good personal hygiene knowledge, doing hygiene inspections at school, and having latrine accessibility was significantly associated with good personal hygiene among elementary school students. CONCLUSION: Considerable proportion of elementary school students in Fiche town have score poor personal hygiene practice. Interventions aimed that target improving knowledge of personal hygiene and hygiene inspection at school are crucial to enhance the personal hygiene among elementary school students.

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BACKGROUND: Inadequate menstrual hygiene management can result in physical, social, psychological, and educational challenges for schoolgirls. To address these issues, researchers have conducted intervention studies, but the impact on school attendance has varied. This review has systematically collected and evaluated evidence about the effects of menstrual hygiene interventions on schoolgirls. METHOD: A systematic search of the literature was done and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement). Both peer-reviewed journals and gray literature were searched using PubMed and Google Scholar. The search included individual, or cluster randomized controlled trials, and quasi-experimental studies, and covered the period from the date of indexing until January 3, 2023. RESULT: A review of sixteen trial studies showed that menstrual hygiene interventions have a positive effect on schoolgirls' school attendance, performance, and dropout rates, as well as on their menstrual knowledge, attitudes, practices, and emotional well-being. There was a low to medium risk of bias in most of the studies. Additionally, the literature overlooked the impact of interventions that involve parental and male engagement, interventions correcting community misperceptions about menstruation, and the impact of infrastructure improvements on water, sanitation, and hygiene. CONCLUSION: Interventions aimed at improving menstrual hygiene management can enhance schoolgirls' educational outcomes, and can improve their menstrual knowledge, attitudes, and practices by helping them manage their periods more effectively. Most interventions have focused on the provision of menstrual products and menstrual education but have neglected improvements in the physical environment at home and school and the social norms surrounding menstruation. Trial studies should take a holistic approach that considers the total socio-cultural environment in which menstrual hygiene management takes place, thus enabling stakeholders and policymakers to develop sustainable, long-term solutions to these problems.

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There is currently no single, easy-to-use, reliable indicator to assess whether a face has been washed with soap in the context of trachoma elimination. This study aimed to compare survey report, script-based pictorial recall and facial cleanliness indicators as alternatives to structured observation for measuring face washing behaviour. This method validation study was nested in the Stronger-SAFE trial, Oromia Region, Ethiopia. Structured observation was conducted in randomly selected households for three hours from dawn. The primary caregiver in each household participated in a survey to capture (self)-reported behaviour and/or script-based pictorial recall, a routine-based diary activity to covertly capture information on face washing behaviour of themself and any children aged 1-12. Children 4-12 years old directly participated in the survey and pictorial recall in a subset of households. The facial cleanliness of children aged 1-12 was assessed qualitatively and using the quantitative Personal Hygiene Assessment Tool (qPHAT). Prevalence estimates, sensitivity, specificity and predictive values were computed for each behavioural indicator with observation data as the gold standard. The appropriateness of script-based pictorial recall was assessed using baseline and 3-month follow-up data. Baseline data were collected from 204 households in 68 clusters. Survey estimates of face washing and face washing with soap among caregivers and children were 32% to 60% and 5% to 31% higher than observed behaviour, respectively. Face washing prevalence estimates from pictorial recall were lower than survey estimates and comparable with observations for some face washing with soap indicators (0.3% to 13% higher than observations). Specificity of pictorial recall indicators was high (85% to 99%), but the sensitivity was low (0% to 67%), resulting in a low positive predictive value for all indicators. Both qualitative facial cleanliness indicators and qPHAT scores were poorly correlated with observed face washing earlier that morning. Pictorial recall overestimated face washing with soap among both caregivers and children following intervention delivery but not at baseline. Survey (self)-reported data on face washing is highly inaccurate. Script-based pictorial recall does not correctly classify those who wash their face with soap, and is subject to differential bias following intervention exposure, and facial cleanliness is a poor indicator of recent face washing in settings where faces become rapidly dirty again after washing. Alternatives to structured observation cannot be recommended to monitor the effectiveness of face washing interventions in community settings. Trial Registration ISRCTN registry ISRCTN40760473, https://doi.org/10.1186/ISRCTN40760473.

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OBJECTIVES: This multicountry analysis aimed to assess the prevalence of key hygiene prevention behaviours and their determinants, associated with international non-governmental organisation (WaterAid) hygiene behaviour change programmes for COVID-19 prevention. The goal of this analysis is to inform future outbreak preparedness and pandemic response in low and middle-income countries. DESIGN: Cross-sectional study. SETTING: Households in seven countries where WaterAid implemented a first-phase COVID-19 response programme in 2020 (Ethiopia, Ghana, Nepal, Nigeria, Rwanda, Tanzania and Zambia). PARTICIPANTS: 3033 adults (1469 men and 1564 women, alternately sampled from one household to the next to maintain gender balance) in specific programme areas (211 villages) surveyed between October and November 2020. PRIMARY OUTCOME MEASURES: Self-reported primary outcomes were: a composite measure of HWWS for prevention of respiratory infection/COVID-19 (total of 5 key moments); respondent increased HWWS behaviour after the COVID-19 pandemic; respondent always wears a mask in public spaces; respondent always practices physical distancing in public spaces. RESULTS: Most respondents (80%) reported increasing their handwashing behaviour after the pandemic, but practice of HWWS at COVID-19-specific prevention moments was low. Mask wearing (58%) and physical distancing (29%) varied substantially between countries. Determinants of key behaviours were identified, including age and socioeconomic status, perceived norms, self-regulation and the motive of protecting others. Incidence rate ratios or odds ratios and 95% CIs for a range of psychosocial determinants for each of the four primary outcomes are reported. CONCLUSIONS: These findings highlight that leveraging behaviour-specific emotional drivers and norms, reducing common barriers and promoting targeted messages about specific behaviours and actions individuals can take to reduce risk are necessary to support large-scale behaviour change. Learning from the COVID-19 response to more effectively integrate novel behaviours into existing health promotion will be vital for disease prevention and outbreak resilience.

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BACKGROUND: Menstruation is a normal biological process experienced by more than 300 million women globally every day. Women require clean menstrual absorbents that can be changed as often as needed in a private and safe place with proper hygiene and disposal facilities. These needs must be met consistently throughout the duration of the menstrual cycle. Access to menstrual needs is crucial for women's health, wellbeing, and dignity. This study assessed the prevalence and factors associated with unmet need for menstrual hygiene management (MHM) in Ethiopia, Kenya, Uganda, Burkina Faso, Ghana, and Niger. METHODS: We used data from the Performance Monitoring for Action (PMA) 2020 surveys. We defined the unmet need for MHM as the "lackof resources, facilities and supplies for MHM." Sample characteristics were summarised using frequencies and percentages, while prevalence was summarised using proportions and their respective confidence intervals (CI). Factors associated with unmet need for MHM were assessed using multilevel logistic regression models. RESULTS: The study included 18,048 women of reproductive age from the six countries. The prevalence of unmet need for MHM was highest in Burkina Faso (74.8%), followed by Ethiopia (69.9%), Uganda (65.2%), Niger (57.8%), Kenya (53.5%), and lowest in Ghana (34.2%). Unmet need for MHM was consistently higher among uneducated and multiparous women, those who reused MHM materials, practiced open defecation, and lived in rural areas across all six countries. The odds of unmet need for MHM were higher among younger women under 35 years, unmarried women, those with lower education levels, and those from poorer households. Similarly, the reuse of MHM materials, use of shared or non-improved toilet facilities, and open defecation increased the odds of unmet need for MHM. In contrast, the presence of handwashing facilities reduced the odds of unmet need for MHM. CONCLUSION: More than half of the women in five of the six countries have an unmet need for MHM, with significantly higher odds among younger women, those with low wealth status, the unmarried, and those with inadequate access to sanitary facilities. This study highlights the state of period poverty in Sub-Saharan Africa. Efforts to end period poverty should consider MHM needs as an integrated whole, as addressing each need in isolation is insufficient.

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BACKGROUND: The sixth United Nations Sustainable Development Goal emphasises universal access to clean water, sanitation and hygiene (WASH) to ensure human well-being as a fundamental human right for sustainable development. In Zimbabwe, WASH reforms began more than a century ago from the preindependence to postindependence era. However, countries face pressing challenges in improving their related health outcomes. Therefore, this scoping review aims to explore WASH status and how it influences health outcomes in Zimbabwe. METHODS AND ANALYSIS: The leading databases to be searched for relevant sources published in English with an unrestricted search back until May 2024 include PubMed, EBSCO, SAGE, SpringerLink, Cochrane Library, ScienceDirect, Scopus, Web of Science and African Journals Online. A search string was developed for retrieving literature, and reports from key stakeholders in the WASH sector will be included in this study as grey literature. The study will employ a two-step screening process for identifying relevant literature incorporating Cohen's kappa coefficient statistics to estimate the inter-rater reliability between two independent reviewers using Mendeley and Rayyan software. The Strengthening the Reporting of Observational Studies in Epidemiology checklist for observational studies and the Consolidated Standards of Reporting Trials checklist for randomised controlled trials will be used for the quality checks. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will guide this study in terms of data collection, extraction and analysis from relevant literature. Data charting was used to present and interpret the findings. The entire process is scheduled to commence in June 2024, with the manuscript anticipated to be submitted to a journal in October 2024. ETHICS AND DISSEMINATION: This review will use only published data; therefore, no ethical clearance is required. The findings will be disseminated to relevant stakeholders through peer-reviewed journals, meetings, conferences, seminars and forums.

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Background: Water, sanitation, and hygiene (WaSH) are crucial determinants of human health. However, the spatio-temporal trends in the global burden of disease attributable to unsafe WaSH remain poorly understood. This study aimed to estimate the disease burden attributable to unsafe WaSH from 1990 to 2019 using data from the Global Burden of Disease (GBD) Study 2019, providing new insights into the associated health conditions. Methods: We extracted data on deaths and disability-adjusted life years (DALYs) attributable to unsafe WaSH from 1990 to 2019 from the GBD 2019. The disease burden was evaluated by region, sociodemographic index (SDI), sex, age, risk factor, and specific disease. Results: Globally, unsafe WaSH was responsible for 1 656 887.37 (95% uncertainty interval (UI) = 1 198 864.94, 2 312 688.33) deaths in 2019, a 49% decrease from 1990. The global age-standardised DALY rate due to unsafe WaSH was 1244.29 (95% UI = 993.20, 1544.13) per 100 000 in 2019, a 66% reduction since 1990. Western sub-Saharan Africa had the highest age-standardised death rate (ASDR) and age-standardised DALY rate in both 1990 and 2019. Among the 21 regions studied, only high-income North America witnessed an increasing ASDR from 1990 to 2019. Countries and territories in low SDI regions had higher ASDRs and age-standardised DALY rates. U-shaped associations were observed between the estimated annual percentage change (EAPC) of ASDR, EAPC of age-standardised DALY rate, and SDI. Both rates were slightly lower in females, with the burden concentrated in those under five and over 80 years old. In 2019, unsafe water source and diarrhoeal diseases remained the leading risk factor and cause of unsafe WaSH-related disease burden, respectively. Conclusions: Despite substantial improvements in hygiene awareness and health education, unsafe WaSH persists as a significant global health risk and a major contributor to the burden of diarrhoeal diseases. Disparities across regions and age groups remain evident. Increased efforts are needed to raise awareness and strengthen water and sanitation infrastructure, particularly in low SDI settings, to mitigate the health risks associated with unsafe WaSH.

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PURPOSE: To verify possible complaints, voice and aerodigestive symptoms, singing voice handicap, and knowledge of vocal health and hygiene in Candomblé religious leaders in Brazil. METHODS: The study comprised 112 individuals who filled out a questionnaire with their identification and characterization, the stratified classification of their professional activities, and their self-perception of voice. Three self-assessment protocols - VoiSS, QSHV, and MSHI - were also used. RESULTS: The self-assessment of voice ranged from average to good. VoiSS mean total score was 23.04, which is above the cutoff. QSHV mean score was 23.54 points, which is near the cutoff. MSHI mean score (the perception of singing voice handicap) was 25.66 points. There was a substantially strong positive correlation between VoiSS and MSHI total scores (0.789; p<0.001). Women had higher limitation scores (p=0.012) and total scores (p=0.012) in VoiSS and higher handicap scores (p=0.038) in MSHI. Level I professionals - vocal elite (singers and actors) - had significantly higher QSHV scores than those in levels IV (p=0.010) and V (p=0.008). Most respondents had not visited an otorhinolaryngologist (89.29%) within the last year and had not been submitted to speech therapy (83.04%) for voice complaints. CONCLUSION: Candomblé leaders, particularly women, perceived voice symptoms and singing voice handicaps, with no relationship with their knowledge of vocal health and hygiene. Despite the complaints, most subjects reported not having visited health professionals responsible for voice care within the last year.

OBJETIVO: Verificar a autopercepção de sintomas vocais e aerodigestivos, desvantagem vocal no canto e o conhecimento em saúde e higiene vocal em líderes religiosos do Candomblé do Brasil. MÉTODO: Participaram deste estudo 112 indivíduos, que preencheram virtualmente um questionário de identificação, caracterização, classificação das atividades profissionais em níveis e autoavaliação vocal no momento atual, além de três protocolos de autoavaliação: Escala de Sinais e Sintomas (ESV), Questionário de Saúde e Higiene Vocal (QSHV) e Índice de Desvantagem para o Canto Moderno (IDCM). Foram utilizados os testes de correlação de Spearman, teste de Mann-Whitney e teste de Kruskal-Wallis. RESULTADOS: A autoavaliação vocal no momento atual variou de razoável a boa. A média do escore total na ESV foi de 23,04, acima da nota de corte. O QSHV apresentou valor médio de 23,54 pontos, próximo à nota de corte. O Índice de Desvantagem para o Canto Moderno (IDCM) mostrou média de 25,66 pontos. Houve correlação positiva de força substancial entre os escores totais da ESV e IDCM (0,789). Mulheres apresentaram maiores escores no ESV total e ESV limitação, além de maior escore no IDCM desvantagem. Profissionais do nível I - elite vocal (cantores e atores) apresentaram escores significativamente maiores para o QSHV que os profissionais do grupo IV (usuário não profissional não-vocal) e os do nível V (pessoas que estão fora do mercado de trabalho). A maioria dos respondentes não consultou Otorrinolaringologista (89,29%) no último ano e nem realizou fonoterapia (83,04%) por queixas vocais. CONCLUSÃO: Líderes do Candomblé apresentaram percepção de sintomas vocais e desvantagem vocal no canto, mais evidente nas mulheres, não havendo relação com o conhecimento de saúde e higiene vocal. Apesar da identificação de sintomas vocais, a maior parte dos sujeitos relatou não ter acessado profissionais de saúde responsáveis por esses cuidados com a voz no último ano.

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BACKGROUND: This paper documents changes in the prevalence and intensity of soil-transmitted helminth (STH) infections in the Geshiyaro project in the Wolaita zone of Southern Ethiopia. METHODS: The Geshiyaro project comprises three intervention arms. Arm 1 is subdivided into the Arm 1 pilot (one district) and Arm 1 (four other districts), both receiving integrated community-wide mass drug administration MDA (cMDA) with intensive water, sanitation, and hygiene (WaSH) interventions. Arm 2 involves 18 districts with cMDA interventions plus the existing government-led One WaSH program, while Arm 3 serves as a control with school-based MDA (sMDA) interventions plus the existing government-led One WaSH program in three districts. The study is designed as a cohort investigation over time, with the establishment of longitudinal sentinel sites where infection levels are assessed annually. A total of 45 longitudinal parasitological surveillance sentinel sites are being used across all three intervention arms to monitor STH prevalence and intensity of infection. From each of the 45 sentinel sites, 150 individuals were randomly selected, stratified by age and gender. The t-test and analysis of variance (ANOVA) were employed to compare infection prevalence and intensity across the three study arms over time. RESULTS: The prevalence of STH decreased significantly from 34.5% (30.6%, 38.5%) in 2019 to 10.6% (8.3%, 13.4%) in 2022/2023 (df = 1, P < 0.0001) in the Arm 1 pilot, from 27.4% (25.2%, 29.7%) in 2020 to 5.5% (4.4%, 6.7%) in 2023 (df = 1, P < 0.0001) in Arm 1, from 23% (21.3%, 24.8%) in 2020 to 4.5% (3.7%, 5.3%) in 2023 (df = 1, P < 0.001) in Arm 2, and from 49.6% (47.4%, 51.7%) in 2021 to 26.1% in 2023 (df = 1, P < 0.0001) in Arm 3. The relative reduction in the prevalence of any STH was the highest in the arms employing cMDA, namely Arm 2, with a decrease of 82.5% (79.3%, 84.2%), followed by Arm 1 with a reduction of 80.1% (75.3%, 84.6%), and then the Arm 1 pilot with a decrease of 69.4% (60.1%. 76.6%). Arm 3 employing sMDA had the lowest decrease, with a reduction of 46.9% (43.6%, 51%). The mean intensity of infection (based on Kato-Katz egg count measures) for Ascaris lumbricoides species, which was the dominant STH species present in the study area, decreased significantly in Arms 1 and 2, but only slightly in Arm 3. The prevalence of hookworm and Trichuris trichiura infections were found to be very low in all arms but also decreased significantly. CONCLUSIONS: The reduction in the prevalence and intensity of STH in Arms 1 and 2 revealed steady progress towards transmission interruption based on cMDA intervention, but additional efforts with MDA coverage and WaSH interventions are needed to achieve a prevalence threshold < 2% based on the quantitative polymerase chain reaction (qPCR) diagnostic method.

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