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Abstract

Adequate and appropriate water, sanitation, and hygiene (WaSH) infrastructure is important for reducing pathogen exposures in developing communities. To improve the ability of field practitioners in optimizing WaSH infrastructure within communities, models can provide insight into the complex interactions among WaSH infrastructure, health outcomes, and geographies. This study investigated the significant correlations between WaSH infrastructure variables and three different health outcomes (diarrhea, environmental enteric dysfunction, and stunting) over five geographic regions within Guatemala. Exploratory structural equation modeling was used to build WaSH models from U.S. Agency for International Development (USAID) 2012 Food for Peace Survey data (n = 2,103). The models were then tested using USAID 2013 Western Highlands Integrated Program survey data collected from the same regions (n = 4,633). Our results support that significant WaSH infrastructure variables vary widely over health outcome and geographic region. Improved sanitation had the highest prevalence of significance among all models. The floor transmission route for pathogens was identified as significant across all geographies for child stunting. Additionally, commonalities in potential pathogen transmission routes were identified among environmentally similar geographies. Practitioners and policy makers must account for the specific geography and health outcome to identify which set of WaSH infrastructure interventions are most appropriate at the correct scale.

Abstract

The growth in the number of pools to more than 7.4 million in the U.S. has been accompanied by a rise in recreational water illnesses (RWIs). Effective pool management, though, can mitigate RWI risks. Inadequate management presumably occurs more frequently where training is less formalized and/or pool operation is a minor aspect of the job of the responsible pool manager(s). During summer 2018, weekly evaluations were performed at public venues in Louisville, Kentucky. Disinfectant levels and other items were monitored and compared with venue-specific (pool or spa) criteria. Among 1,312 venue surveys, 1,173 (89.4%) met criteria and 139 (10.6%) did not meet criteria. Overall, multivariable logistic regression showed a significant association between the likelihood of a venue meeting criteria and setting type. Specifically, hotels had 120% increased odds of not meeting criteria (adjusted odds ratio = 2.2; 95% confidence interval [1.3, 3.8]) compared with other settings. Despite spas having an 80% elevated odds of not meeting criteria compared with pools in a univariate analysis, upon adjusting for setting, spas were not associated with an increased risk of not meeting criteria. Research identifying reasons for these differences in meeting criteria between settings would be beneficial for informing public health interventions for aquatic environments.

Abstract

The health burden and resultant economic burden of foodborne norovirus disease among school-age children in the U.S. is unknown but believed to be significant. The economic burden encompasses not only direct medical costs associated with medical care but also indirect costs such as loss of work days and direct nonmedical costs. National passive surveillance data from norovirus outbreaks spanning 2009–2013 were used to identify cases, health outcomes, interventions, and healthcare resource utilization among the school-age population. The cost of supportive care was $2,483,379, outpatient healthcare was $57,672, hospitalization was $48,670, and emergency care was $38,336. The cost of providing supportive care (direct nonmedical costs) was relatively low. When indirect costs were factored in, however, the total cost of care escalated, which illustrates the high burden of loss of productivity. It is important to incorporate the indirect and direct nonmedical costs of disease to more accurately characterize the total economic burden of a disease.

This article characterizes the patterns of environmental health literature from 1993 to 2012 by using bibliometric techniques based on databases of the Science Citation Index and the Social Science Citation Index. “Research article” was the most widely used document type, accounting for 71.7% of the total records (5,053), and 94.9% of these articles were published in English. The number of environmental health publications is growing along with an increasing level of communication. The U.S. was the largest contributing country with the highest h-index (85) and the most publications (1,854), followed by the UK and Canada. Environmental Health Perspectives and the Journal of Environmental Health were the top two most productive journals. The most cited article in each main research area is also listed. The authors’ study not only identifies global characteristics in environmental health research, but also influences researchers’ selection of future studies and publications.