RESUMO
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.
Assuntos
Água Potável/microbiologia , Infecções por Escherichia coli/prevenção & controle , Pasteurização/métodos , Purificação da Água/métodos , Qualidade da Água , Escherichia coli/fisiologia , Características da Família , Humanos , Peru , População RuralRESUMO
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.
Assuntos
Participação da Comunidade , Diarreia/prevenção & controle , Desinfetantes , Educação em Saúde/métodos , Purificação da Água/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Bolívia , Criança , Pré-Escolar , Diarreia/etiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Microbiologia da ÁguaRESUMO
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.
Assuntos
Cólera/prevenção & controle , Surtos de Doenças/prevenção & controle , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Cólera/epidemiologia , Cólera/terapia , Feminino , Comportamentos Relacionados com a Saúde , Educação em Saúde/organização & administração , Humanos , Lactente , Masculino , Meios de Comunicação de Massa , Pessoa de Meia-Idade , Peru/epidemiologia , Fatores de RiscoRESUMO
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.
Assuntos
Cólera/prevenção & controle , Purificação da Água/métodos , Abastecimento de Água/normas , Adolescente , Adulto , Idoso , Bolívia , Compostos de Cálcio , Cólera/transmissão , Contagem de Colônia Microbiana , Coleta de Dados , Escherichia coli/crescimento & desenvolvimento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de TempoAssuntos
Cólera/epidemiologia , Cólera/prevenção & controle , Surtos de Doenças/prevenção & controle , América Central/epidemiologia , Cólera/transmissão , Contaminação de Alimentos , Humanos , Organização Pan-Americana da Saúde , Vigilância da População/métodos , Saúde Pública/métodos , Saneamento , Alimentos Marinhos/microbiologia , América do Sul/epidemiologia , Microbiologia da Água , Abastecimento de ÁguaRESUMO
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.
Assuntos
Cólera/prevenção & controle , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Cólera/epidemiologia , Cólera/transmissão , Culinária , El Salvador/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Higiene , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Alimentos Marinhos , Abastecimento de ÁguaRESUMO
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.
Assuntos
Cólera/epidemiologia , Surtos de Doenças , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Casos e Controles , Criança , Pré-Escolar , Cólera/prevenção & controle , Cólera/transmissão , Frutas , Humanos , Peru/epidemiologia , Fatores de Risco , VerdurasRESUMO
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.