SUMMARY Cryptosporidiosis is one of the most important causes of moderate to severe diarrhea and diarrhea-related mortality in children under 2 years of age in low- and middle-income countries. In recent decades, genotyping and subtyping tools have been used in epidemiological studies of human cryptosporidiosis. Results of these studies suggest that higher genetic diversity of Cryptosporidium spp. is present in humans in these countries at both species and subtype levels and that anthroponotic transmission plays a major role in human cryptosporidiosis. Cryptosporidium hominis is the most common Cryptosporidium species in humans in almost all the low- and middle-income countries examined, with five subtype families (namely, Ia, Ib, Id, Ie, and If) being commonly found in most regions. In addition, most Cryptosporidium parvum infections in these areas are caused by the anthroponotic IIc subtype family rather than the zoonotic IIa subtype family. There is geographic segregation in Cryptosporidium hominis subtypes, as revealed by multilocus subtyping. Concurrent and sequential infections with different Cryptosporidium species and subtypes are common, as immunity against reinfection and cross protection against different Cryptosporidium species are partial. Differences in clinical presentations have been observed among Cryptosporidium species and C. hominis subtypes. These observations suggest that WASH (water, sanitation, and hygiene)-based interventions should be implemented to prevent and control human cryptosporidiosis in low- and middle-income countries.

Molecular Epidemiology of Human Cryptosporidiosis in Low- and Middle-Income Countries.

The public health significance of latrines discharging to groundwater used for drinking.

Healthcare-associated infections (HAI) especially outbreaks of multi-drug-resistant organisms within hospitals are recognized as a major contributor to morbidity and mortality of hospitalized patients. The healthcare environment can act as an amplifier of HAI during outbreaks. The risk of acquiring HAI are 20 times higher in Low-and-middle-income countries. The purpose of this article is to review the challenges associated with controlling environmental contamination in low and lower-middle income countries (LMIC), highlighting possible solutions. This is a narrative review. A literature search was carried out in Google scholar, PubMed, Science Direct, EBSCOHOST, CENGAGE, Scopus, ProQuest, Clinical Key and African journals online using the key words - Health care Associated Infections (HCAIs) in LMICs, Challenges of HAIs in LMIC, Challenges of Prevention and Control of HAIs in LMICs, Environment of care and infection transmission, Contaminated environment and HAIs. From the accessed databases, 1872 articles related to environmental sources of contamination in healthcare settings were found. Of these, only 530 articles focused on LMICs. However, only 186 articles met the inclusion criteria studies published in English, conducted between 2000 and 2019 and exploring environmental sources of contamination in LMIC healthcare settings). The sources of environmental contamination in healthcare are numerous and commonly associated with poor governance, Inadequate infrastructure, human capacity and inadequate funding. Low awareness exists at all levels as to the role of the environment in healthcare outcomes and may explain in part the low priority given for funding. Leadership and trained personnel, both Infection prevention and control practitioners and cleaners are crucial to drive and sustain the process to reduce environmental contamination in healthcare environments.

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Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - a narrative review.

Water, Sanitation and Hygiene (WASH) programs in schools can increase the health, dignity and comfort of students and teachers. Understanding the costs of WASH facilities and services in schools is one essential piece for policy makers to utilize when budgeting for schools and helping to make WASH programs more sustainable. In this study we collected data from NGO and government offices, local hardware shops and 89 rural primary schools across three Kenyan counties. Current expenditures on WASH, from school and external (NGO, government, parent) sources, averaged 1.83 USD per student per year. After reviewing current expenditures, estimated costs of operations and maintenance for bringing schools up to basic WASH standards, were calculated to be 3.03 USD per student per year. This includes recurrent costs, but not the cost of installing or setting up WASH infrastructure, which was 18,916 USD per school, for a school of 400 students (4.92 USD per student, per year). These findings demonstrate the need for increases in allocations to schools in Kenya, and stricter guidance on how money should be spent on WASH inputs to enable all schools to provide basic WASH for all students.

https://www.mdpi.com/1660-4601/13/7/637/pdf

The Life-Cycle Costs of School Water, Sanitation and Hygiene Access in Kenyan Primary Schools

This study explicates the scope of published literature on the influence of attitudes and perceptions on the intention to use human excreta and human excreta derived materials in agriculture. Using a scoping review methodology, search results from Scopus and Web of Science were screened and synthesized using the DistillerSR web-based application. Out of the 1192 studies identified, 22 published articles met the inclusion criteria. Additional studies were identified by keyword enrichment, hand-searching, and snowballing in other electronic data bases. The benefit perception of the soil health, income, and yield was the main driver for positive attitudes. Perceived health risk and socio-cultural factors were reported as the main barriers to the use of human excreta derived materials in agriculture. Limited information, availability, collection, transport, and storage were the other reported perceived barriers. The influence of socioeconomic and demographic factors on farmers’ attitudes and perceptions was inconclusive, which is potentially attributed to contextual and methodological differences. Social and behavior change communication through community mass campaigns and targeting interventions segregated by socioeconomic and demographic contexts is recommended for development interventions. Future empirical studies could focus on the influence of crop types, treatment processes, food preparation and processing on attitudes and perceptions.

/pdf/attitudes-and-perceptions-on-the-agricultural-use-of-human-2sr4jhrdel.pdf

Attitudes and Perceptions on the Agricultural Use of Human Excreta and Human Excreta Derived Materials: A Scoping Review

Despite the success of recent efforts to increase access to improved water, sanitation, and hygiene (WASH) globally, approximately one-third of schools around the world still lack adequate WASH services. A lack of WASH in schools can lead to the spread of preventable disease and increase school absences, especially among women. Inadequate financing and budgeting has been named as a key barrier for integrating successful and sustainable WASH programs into school settings. For this reason, the purpose of this review is to describe the current knowledge around the costs of WASH components as well as financing models that could be applied to WASH in schools. Results show a lack of information around WASH costing, particularly around software elements as well as a lack of data overall for WASH in school settings as compared to community WASH. This review also identifies several key considerations when designing WASH budgets or selecting financing mechanisms. Findings may be used to advise future WASH in school programs.

https://www.mdpi.com/1660-4601/14/4/442/pdf

Richa Desai

Papers

A Systematic Review: Costing and Financing of Water, Sanitation, and Hygiene (WASH) in Schools.