Effects of a Water, Sanitation and Hygiene Mobile Health Program on Respiratory Illness in Bangladesh: A Cluster-Randomized Controlled Trial of the CHoBI7 Mobile Health Program

Acute respiratory infections are a leading cause of morbidity and mortality among young children globally. The objective of this study was to evaluate the impact of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) handwashing with soap and water treatment mobile health (mHealth) program on respiratory illness among diarrhea patients and their household members in urban Dhaka, Bangladesh. A cluster-randomized controlled trial of the CHoBI7 mHealth program was conducted among diarrhea patient households in Dhaka, Bangladesh. Patients were randomized to three arms: standard recommendation on oral rehydration solution use, health facility delivery of CHoBI7 plus mHealth (weekly voice and text messages) (no home visits), and health facility delivery of CHoBI7 plus two home visits and mHealth. Respiratory symptoms were assessed during monthly clinical surveillance over the 12-month surveillance period. Respiratory illness was defined as rapid breathing, difficulty breathing, wheezing, or coughing. Two thousand six hundred twenty-six participants in 769 households were randomly allocated to three arms: 849 participants to the standard message arm, 886 to mHealth with no home visits arm, and 891 to the mHealth with two home visits. Compared with the standard message arm, participants in the mHealth with no home visits arm (Prevalence Ratio [PR]: 0.88 [95% CI: 0.79, 0.98]), and the mHealth with two home visits arm (PR: 0.88 [95% CI: 0.79, 0.98]) had significantly lower respiratory illness prevalence over the 12-month program period. Our findings demonstrate that the CHoBI7 mHealth program is effective in reducing respiratory illness among diarrhea patient households.

Antibacterial Efficacy and Phytochemical Screening of Ocimum gratissimum Leaf Extracts against Some Selected Bacteria Isolated from Stool Samples of Diarrhea Patients

This study investigated the antibacterial activity of Ocimum gratissimum leaf extracts on antibiotic resistant bacteria from stool samples of diarrhea patient attending specialist hospitals in Ondo State, Nigeria. O. gratissimum leaf extracted with acetone, methanol and hot water solvents were assayed for qualitative and quantitative phytochemicals. Bioactive extracts were partially purified using standard chromatographic techniques. The crude and purified acetone extract had inhibitory effect on Escherichia coli (13.00±0.58 and 26.67±0.33 mm) according to CLSI, 2014 standard. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of purified acetone extract were 12.5 and 25 mg/ml respectively. Saponin had the highest quantity (42.50±0.32 mg/ml) on acetone extract while tannin had the lowest (1.29±0.01 mg/ml). O. gratissimum leaf acetone extract could be promising candidate in the treatment of diarrhea infection which is a major concern in paediatric medicine. Keywords: Diarrhea, Ocimum gratissimum L., Antibacterial

Psychosocial Factors Mediating the Effect of the CHoBI7 Mobile Health Program on Handwashing With Soap and Household Stored Water Quality: A Randomized Controlled Trial

Household members of diarrhea patients are at higher risk of developing diarrheal diseases (>100 times for cholera) than the general population during the 7 days after the diarrhea patient is admitted at a health facility. There is growing evidence demonstrating that theory-driven water, sanitation, and hygiene (WASH) interventions are likely to yield greater behavior change than those based on health education alone. The Cholera Hospital-Based Intervention for 7-Days (CHoBI7) mobile health (mHealth) program is a theory-driven WASH intervention initially delivered to a diarrhea patient by a health promoter during a health facility visit and reinforced through weekly voice and text messages. In the recent randomized controlled trial (RCT) of the CHoBI7-mHealth program in Bangladesh, this intervention significantly reduced diarrheal disease and stunting, and increased handwashing with soap and stored drinking water quality over the 12-month program period. The aim of this study was to assess the underlying mechanism of change of this intervention. Handwashing with soap was measured by 5-hour structured observation. Stored drinking water quality was assessed by the presence of Escherichia coli during unannounced spot checks. Psychosocial factors were measured among 1,468 participants in the CHoBI7-mHealth RCT. Perceived susceptibility, response efficacy, self-efficacy, dirt reactivity, and diarrhea knowledge were mediators of the CHoBI7-mHealth program’s effect on stored drinking water quality at the 1-week follow-up. Self-efficacy, response efficacy, and diarrhea knowledge were mediators of the intervention’s effect on handwashing with soap habit maintenance and stored drinking water quality at the 12-month follow-up. This study demonstrates how theory-driven approaches for intervention design can facilitate WASH behavior change.

Effects of a Water, Sanitation, and Hygiene Mobile Health Program on Diarrhea and Child Growth in Bangladesh: A Cluster-randomized Controlled Trial of the Cholera Hospital-based Intervention for 7 Days (CHoBI7) Mobile Health Program

Background The Cholera Hospital-Based Intervention for 7 Days (CHoBI7) mobile health (mHealth) program was a cluster-randomized controlled trial of diarrhea patient households conducted in Dhaka, Bangladesh. Methods Patients were block-randomized to 3 arms: standard message on oral rehydration solution use; health facility delivery of CHoBI7 plus mHealth (no home visits); and health facility delivery of CHoBI7 plus 2 home visits and mHealth. The primary outcome was reported diarrhea in the past 2 weeks collected monthly for 12 months. The secondary outcomes were stunting, underweight, and wasting at a 12-month follow-up. Analysis was intention-to-treat. Results Between 4 December 2016 and 26 April 2018, 2626 participants in 769 households were randomly allocated to 3 arms: 849 participants to the standard message arm, 886 to mHealth with no home visits arm, and 891 to the mHealth with 2 home visits. Children <5 years had significantly lower 12-month diarrhea prevalence in both the mHealth with 2 home visits arm (prevalence ratio [PR]: 0.73 [95% confidence interval {CI}, .61–.87]) and the mHealth with no home visits arm (PR: 0.82 [95% CI, .69–.97]). Children <2 years were significantly less likely to be stunted in both the mHealth with 2 home visits arm (33% vs 45%; odds ratio [OR]: 0.55 [95% CI, .31–.97]) and the mHealth with no home visits arm (32% vs 45%; OR: 0.54 [95% CI, .31–.96]) compared with children in the standard message arm. Conclusions The CHoBI7 mHealth program lowered pediatric diarrhea and stunting among diarrhea patient households. Clinical Trials Registration NCT04008134.

DESCRIPTION OF FAECAL CULTURE RESULTS IN DIARRHEA PATIENT DUE TO ANTIBIOTIC USE

DESCRIPTION OF FAECAL CULTURE RESULTS IN DIARRHEA PATIENT DUE TO ANTIBIOTIC USE 1Suci Tresna, IGAA Putri Sri Rejeki1 Puspa Wardhani1 1Clinical Pathology Spesialization Programme, Department of Clinical Pathology Faculty of Medicine Airlangga University-DR Soetomo Hospital Surabaya 2Department of Clinical Pathology, Faculty of Medicine Airlangga UniversityDr. Soetomo Hospital, Surabaya ABSTRACT Background : Diarrhea infection is common in developing countries and causes death of around 3 million people every year. Diarrhea is also the second leading cause of death in infants. Riskesdas in 2013 showed 30,775 cases of diarrhea. Causes such as bacterial infections Salmonella, shigella, Vibrio, Entamoeba and Yersinia. Other influences can occur due to viral and fungal infections. Diarrhea is a nosocomial infection that is common in hospitalized patients due to long-term use of antibiotics caused by Clostridium difficile. This study was a follow-up study of diarrhea patients who received antibiotic therapy for more than 2 days with the results of C.difficile negative toxin, then continued with faecal culture examination. This study aims is to look the description causes of diarrhea other than c.difficile in patients that receiving long-term antibiotic therapyMethods: This research is experimental descriptive. Samples were taken from 30 diarrhea patients with 2 x 24 hours of antibiotic use who were hospitalized in the ICU, Dr. Soetomo Hospital Surabaya from August 2017-May 2018. Samples with negative C.difficile toxin results are then followed by faecal culture examination using conventional methods.Results: The results of culture examination from 30 samples there were 3 samples with positive culture results ESBL, 25 other samples showed negative culture results.Conclusion: The results of faecal culture examination showed a description causes of the diarrhea in patients that receiving antibiotic therapy is pathogenic E.coli (ESBL). The possibility of other causes that cannot be detected from the culture such as viral and fungal infections still requires further research.