• Assessment of Fecal Exposure Pathways in Low-Income Urban Neighborhoods in Accra, Ghana: Rationale, Design, Methods, and Key Findings of the SaniPath Study.

      Robb, Katharine; Null, Clair; Teunis, Peter; Yakubu, Habib; Armah, George; Moe, Christine L (2017-10)
      Rapid urbanization has contributed to an urban sanitation crisis in low-income countries. Residents in low-income, urban neighborhoods often have poor sanitation infrastructure and services and may experience frequent exposure to fecal contamination through a range of pathways. There are little data to prioritize strategies to decrease exposure to fecal contamination in these complex and highly contaminated environments, and public health priorities are rarely considered when planning urban sanitation investments. The SaniPath Study addresses this need by characterizing pathways of exposure to fecal contamination. Over a 16 month period, an in-depth, interdisciplinary exposure assessment was conducted in both public and private domains of four neighborhoods in Accra, Ghana. Microbiological analyses of environmental samples and behavioral data collection techniques were used to quantify fecal contamination in the environment and characterize the behaviors of adults and children associated with exposure to fecal contamination. Environmental samples (n = 1,855) were collected and analyzed for fecal indicators and enteric pathogens. A household survey with 800 respondents and over 500 hours of structured observation of young children were conducted. Approximately 25% of environmental samples were collected in conjunction with structured observations (n = 441 samples). The results of the study highlight widespread and often high levels of fecal contamination in both public and private domains and the food supply. The dominant fecal exposure pathway for young children in the household was through consumption of uncooked produce. The SaniPath Study provides critical information on exposure to fecal contamination in low-income, urban environments and ultimately can inform investments and policies to reduce these public health risks.
    • Space-time analysis of pneumonia hospitalisations in the Netherlands.

      Benincà, Elisa; van Boven, Michiel; Hagenaars, Thomas; van der Hoek, Wim (2017)
      Community acquired pneumonia is a major global public health problem. In the Netherlands there are 40,000-50,000 hospital admissions for pneumonia per year. In the large majority of these hospital admissions the etiologic agent is not determined and a real-time surveillance system is lacking. Localised and temporal increases in hospital admissions for pneumonia are therefore only detected retrospectively and the etiologic agents remain unknown. Here, we perform spatio-temporal analyses of pneumonia hospital admission data in the Netherlands. To this end, we scanned for spatial clusters on yearly and seasonal basis, and applied wavelet cluster analysis on the time series of five main regions. The pneumonia hospital admissions show strong clustering in space and time superimposed on a regular yearly cycle with high incidence in winter and low incidence in summer. Cluster analysis reveals a heterogeneous pattern, with most significant clusters occurring in the western, highly urbanised, and in the eastern, intensively farmed, part of the Netherlands. Quantitatively, the relative risk (RR) of the significant clusters for the age-standardised incidence varies from a minimum of 1.2 to a maximum of 2.2. We discuss possible underlying causes for the patterns observed, such as variations in air pollution.
    • Urban Chikungunya in the Middle East and North Africa: A systematic review.

      Humphrey, John M; Cleton, Natalie B; Reusken, Chantal B E M; Glesby, Marshall J; Koopmans, Marion P G; Abu-Raddad, Laith J (2017-06)
      The epidemiology of Chikungunya virus (CHIKV) in the Middle East and North Africa (MENA) is not well characterized despite increasing recognition of its expanding infection and disease burden in recent years.