Malnourished children in low-income contexts usually suffer from environmental enteric dysfunction, which is damage to the intestines caused by chronic exposure to bacterial pathogens from feces hypothesized to contribute to stunting. Many intervention studies are piloting "Baby water, sanitation, and hygiene (WASH)" to help rural farming families reduce infant and young children's (IYC's) exposure to human and free-range livestock feces. One proposed Baby WASH intervention is a play-yard, which consists of a baby-proofed structure (i.e., playpen) that caregivers can place IYC into while doing chores around the household yard. This article describes the pilot development and assessment of a community-built Baby WASH play-yard and a plastic play-yard intervention with 21 caregivers of 6- to 24-month-old IYC in rural Zambia. A modified Trials of Improved Practices approach was used to conduct three visits in each household: an introductory visit during which play-yard use was explained, a second visit consisting of a semi-structured interview and a session of behavioral counseling, and a final visit which included a 2-hour observation of play-yard use. The second and final visits also included 24-hour recalls, and all three visits included spot observations of play-yard use. Reports from caregivers suggest that the community-built play-yard protected IYC from ingesting soil and livestock feces. Barriers to intervention use included caregivers' WASH beliefs and practices, community reactions, and play-yard maintenance. More work is needed to examine the role of women's time use in their home environment, community reactions to the intervention, and the biological efficacy to reduce microbial ingestion.

Undernourished children in low-income contexts often suffer from environmental enteric disorder-damage to the intestines probably caused by chronic exposure to bacterial pathogens from feces. We aimed to identify strategies for reducing infants and young children's (IYC) exposure to human and animal feces in rural farming families by conducting direct observation of 30 caregiver-infant dyads for 143 hours and recording water, sanitation, and hygiene (WASH)-related behaviors to identify possible pathways of fecal-oral transmission of bacteria among IYC in rural Zambia. In addition to mouthing visibly dirty hands, toys, sibling's body parts, and food, 14 IYC actively ingested 6.1 ± 2.5 (mean ± standard deviation [SD]) pieces of soil and stones and one ingested animal feces 6.0 ± 0 times in the span of 5 hours. Ninety-three percent (21 of 30) of mothers reported observing the index-child eating soil and 17% (5 of 30) of mothers reported observing the index-child eating chicken feces. Adult and child handwashing was uncommon, and even though 70% (28 of 30) of households had access to a latrine, human feces were found in 67% of homestead yards. Most animals present in the household were un-corralled, and the highest observable counts of feces came from chickens, pigs, and cattle. To protect IYC in low-income communities from the exploratory ingestion of feces and soil, Baby WASH interventions will need to interrupt fecal-oral microbial transmission vectors specific to IYC with a focus on feasibility, caregiver practices, and local perceptions of risk.

Running Title: Boston DeclarationWord Count: 689 (not including the table) 2 Nearly three out of every four deaths globally in 2017 were caused by non-communicable diseases (NCDs). 1 Many countries have made progress reducing NCD risk factors such as tobacco use, hyperlipidemia, and hypertension, but no countries have successfully reversed the increasing trends in diabetes prevalence and mortality from diabetes is increasing. 1 This represents a massive global health failure considering the fact that type 2 diabetes is largely preventable with lifestyle modification and that cost-effective treatments exist for both type 2 and type 1 diabetes. 2 Specific concern is needed for type 1 diabetes, which without insulin, it is fatal.In parallel, forced migration has reached a record high with 68.5 million people displaced from their homes around the world, 85% being hosted in low or middle-income countries such as, Uganda, Lebanon, and Pakistan, and 65% occurring in protracted refugee situations. 3 In addition, there are over 100 million conflict-affected non-displaced people and 175 million people who are affected by natural disasters annually. 4 These individuals are particularly vulnerable in crises due to disrupted health services and unpredictable-and often unhealthy-food supplies, which may exacerbate their condition and lead to complications.To date, diabetes and other NCDs have largely been underserved in humanitarian settings. 5,6,7 The true scope of the problem has not been established and it is not known which interventions are efficacious, feasible, and cost-effective in these contexts. With respect to type 1 diabetes, arguably the most immediately life-threatening NCD, the supply and cost of insulin, blood glucose monitoring and diagnostic tools are barriers for both humanitarian responders and their host countries, as well as patient adherence, life expectancy, quality of life, follow-up and provider training in diabetes care.In order to begin to address these major gaps, on 4-5 April 2019, Harvard University convened a meeting of humanitarian and other actors in global health to discuss the immediate needs and barriers to tackling diabetes in humanitarian crises, and to adopt a unified, action-oriented agenda to address this pressing global health issue (http://globalendocrinology.bwh.harvard.edu/symposium). Whilst it was recognised that there are substantial gaps in care for diabetes in all low-resource settings, 8 not just humanitarian crises, and that many other NCDs (e.g., cardiovascular disease, chronic obstructive pulmonary disease and asthma) are also prevalent globally and inadequately addressed in humanitarian settings, 9 we chose to prioritize efforts on diabetes in humanitarian crises, for the following reasons:First, because people with type 1 diabetes who cannot access insulin and continuity of care in a crisis are at acute risk of death. The principles of the Humanitarian Charter and United Nations Universal Declaration of Human Rights include the right to life with dignity. 10 The human rig...

We used a community surveillance system to gather information regarding pregnancy outcomes and the cause of death for women of reproductive age (WRA) in Kanchanpur, Nepal. A total of 784 mother groups participated in the collection of pregnancy outcomes and mortality data. Of the 273 deaths among WRA, the leading causes of death reported were chronic diseases (94, 34.4%) poisoning, snake bites, and suicide (grouped together; 55, 20.1%), and accidents (29, 10.6%), while maternal mortality accounted for 7%. Nevertheless, the calculated maternal mortality ratio was quite high (259.3 per 100,000 live births).

Background: Category II tuberculosis (TB) patients (i.e. re-treatment TB patients) are at an increased risk for defaulting on treatment compared to Category I TB patients. Therefore, extra steps need to be taken to help Category II TB patients follow through with their treatment. The goal of this study was to examine the effectiveness of three different types of interventions to help improve treatment success rates among Category II patients. Materials and Methods: Three different interventions that were implemented among Category II TB patients in the Bardhaman, Hugli, Malda and Murshidabad districts in West Bengal, India, were: 1) setting up group patient provider meetings (PPMs), 2) making home visits and reinforcing the message of full course of treatment, and 3) linking poor TB patients to social welfare schemes (SWSs) to incentivize them to complete treatment. Results: PPMs and SWSs improved treatment success rates among Category II patients. The treatment success rates for patients who received PPMs and patients who received SWSs were 94.2% and 90.7%, respectively, compared to the 74.5% treatment success rate of patients who received no intervention. The effectiveness of home visits, however, depended on the number of home visits the patient received. Conclusion: PPMs and SWSs improve treatment success among Category II TB patients and may easily be incorporated in Directly Observed Treatment, Short-Course programming as feasible ways. A conclusion regarding home visits, however, could not be drawn from this study.