Charles Larson and colleagues find that 23 months into a national campaign to scale up zinc treatment for diarrhea in children under age 5 years, only 10% of children with diarrhea in rural areas and 20%–25% in urban/municipal areas were getting the treatment.

No abstract

Entamoeba histolytica was studied in 33 lactating women and their infants in a periurban village in Bangladesh. Infant-mother pairs were followed for a period of 10-15 months: 67% of mothers excreted E. histolytica during the observation period, the majority for 3 months or more. Only one mother was symptomatic, with a mild, non-dysenteric diarrhoea. 58% of mothers were seropositive, several of them continuously and with a high titre, indicating past invasive infection. 67% had detectable antibodies in breast milk and 36% in saliva. Despite the high prevalence of E. histolytica in these mothers, infants were mostly uninfected: E. histolytica cysts in small numbers were found in only 2 of 1200 samples from infants aged 6 and 10 months. Several of the children were infected with Giardia lamblia. Although lower exposure to E. histolytica than to Giardia may account for the difference in infant infection rates with these parasites, defence mechanisms possibly exist which protect against E. histolytica but are ineffective against Giardia.

A brief post‐disaster study was undertaken soon after the cyclone of 1991 in Bangladesh to make a preliminary assessment of existing environmental health conditions. Eighty affected people and 26 relief personnel from the affected areas were interviewed. Faecal coliform counts, salinity conductivity and pH values were determined for 43 water samples from tubewells and ponds. The quality of 32 samples of water purifying tablets was also tested. Water scarcity was acute, especially water used for washing and personal hygiene. The situation was made worse by the fact that the surface water sources (ponds) which were commonly used for domestic purposes other than drinking were flooded, highly contaminated and regarded as unusable. The user load on existing tubewells doubled, indicating a significantly increased demand for the tubewell water which is commonly used for drinking purposes only. The majority (63 per cent) of the water purifying tablets were found to have lost potency. Sanitation was very poor in households as well as in field clinics and shelters. Most people, including relief personnel, lacked environmental health knowledge. Suggestions regarding immediate preparations for disaster relief include: restoring water systems (tubewells and ponds), training courses for relief personnel, standardizing of water purifying tablets, promoting appropriate water use and its treatment, maintaining sanitation in clinics and shelters and improving the skills and resources of local people to enable them to cope with the situation.

No abstract