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Group A Streptococcus (GAS) causes a wide range of infections, with substantial morbidity and mortality associated with invasive infections and suppurative complications. The diagnostic accuracy of rapid antigen detection tests (RADTs) is well established in children with pharyngitis, but not in extrapharyngeal infections. To evaluate the diagnostic accuracy of RADTs for identifying GAS in children with extrapharyngeal infections. Systematic review of diagnostic test accuracy. CRD420251108689 (PROSPERO). PubMed and Web of Science (inception to November 2025). Studies evaluating RADTs in children with suspected extrapharyngeal infections due to GAS. Children (0-18 years). TEST: RADTs for GAS. Bacterial culture and PCR. QUADAS-2. Bivariate random-effects meta-analysis of sensitivity and specificity. Heterogeneity was evaluated through prespecified subgroup analyses and meta-regression. Robustness of the results was assessed through sensitivity analyses. We included 16 studies (23 RADT evaluations; 1,737 unique patients; 2,610 test results). Methodological quality varied across studies, with only four studies judged to have an overall low risk of bias. RADTs had a summary sensitivity of 92% (95%CI: 89-94) and a summary specificity of 99% (95%CI: 96-100). Sensitivity was similar across studies, whereas specificity varied according to infection type (p=0.043), infection invasiveness (p < 0.001), and the reference standard used (p < 0.001). Sensitivity analyses restricted to various study subsets yielded consistent results. This systematic review found high sensitivity and very high, but variable, specificity of RADTs for identifying GAS in children with extrapharyngeal infections, particularly in those with pleural empyema. These findings suggest that RADTs may have a role in various clinical scenarios beyond pharyngitis, particularly when rapid results directly influence clinical management, but further high-quality studies are needed to define their precise role in diagnostic pathways for each infection type.
Proper household management of unused and expired medications reduces environmental and public health risks. The aim of this study was to assess household knowledge, attitudes, and disposal practices of unused and expired medications, and identifies factors associated with good disposal practices among households in Bahir Dar City, Northwest Ethiopia. A community-based cross-sectional study was conducted from October 1, 2025, to October 30, 2025. A total of 417 participants were selected using simple random sampling. Data were collected through face-to-face interviews using a pretested, structured questionnaire. Data were entered into Microsoft Excel and analyzed using SPSS version 26. Variables with p-values <0.05 in multivariable logistic regression analysis were considered statistically significant. Among 415 participants, 32.2% had good knowledge, 56.4% had a positive attitude, and 43.4% demonstrated good storage and disposal practices. The majority (89.4%) stored unused and expired medications at home, mainly due to improvement in medical condition (53.4%), intolerable side effects (17.5%), and medication change (14.3%). Analgesics (55.0%) and antibiotics (32.1%) were the most commonly stored medications. Although 75.7% reported disposing of unused and expired medications, poor practices were common. Unused medications were often kept until expiry (53.3%), discarded in household garbage (23.3%), or flushed into toilet or sink (15.4%). Expired medications were mainly discarded in household garbage (70.4%), whereas only 9.2% were returned to pharmacies or health facilities. Good disposal practices were significantly associated with age >35 years (AOR=7.14, 95% CI: 1.29-39.67), health insurance (AOR= 2.97, 95% CI: 1.03-8.55), college or higher education (AOR=2.14, 95% Cl: 1.02- 9.20), good knowledge (AOR = 3.41, 95% CI: 1.44-21.49), and positive attitude (AOR = 4.65, 95% CI: 1.29-16.76). Households in Bahir Dar City had a positive attitude; however, their knowledge and disposal practices were poor. Strengthening public awareness and implementing medication take-back systems are recommended to promote good disposal practices and reduce public health and environmental risks.
Podoconiosis is a preventable Neglected Tropical Disease (NTD) that results in significant lower limb swelling and chronic disability. Its management can be done at home by regularly washing feet with clean water and soap and using protective footwear. This study aimed to explore podoconiosis patients' experiences with access to water, sanitation, and hygiene (WASH) and to identify barriers and facilitators of home-based management (HBM). In this qualitative phenomenological study, participants were recruited following a screening conducted in Butaro Sector (Rwanda) to identify individuals with lower limb lymphedema. Randomly selected individuals underwent a clinical assessment, and only those confirmed to have podoconiosis were invited for an interview. In-depth interviews, supplemented by observation and photographs, were conducted. Transcripts were inductively coded using Dedoose (version 9.0.80) and analyzed through thematic analysis. Overall, 26 interviews were conducted across all five cells of Butaro Sector. Poverty and physical discomfort were major barriers in accessing WASH and HBM essentials, with many relying on family or neighbors for support. Shame, laughter, and discrimination from community members further hindered access to WASH. However, some participants found a financial solution in selling animal and household waste. Moreover, participants demonstrated little or no knowledge about podoconiosis which influenced their treatment choices. Many attributed the disease to witchcraft, blood infection, or God's will. Common care choices included traditional healers, self-care, or health centers. These findings demonstrate the need to integrate community education into podoconiosis management programs to address misconceptions and stigma while promoting income-generating activities to ensure consistent access to HBM essentials.
China's Rural Sanitary Toilet Interventions (2015-present) is a government-led initiative aimed at replacing unhygienic rural toilets with sanitary facilities. This study explores the impact of this policy on pesticide reduction and analyzes the mediating role of health literacy. Based on survey data from 4,277 rural households in 10 provinces, this study employed a three-step method and bootstrap resampling for mediation analysis, used alternative models for robustness checks, and conducted heterogeneity analysis. The significant reduction in pesticide use due to the Rural Sanitary Toilet Interventions project remained robust across different model specifications. Heterogeneity analysis revealed that the policy had a particularly pronounced effect on reducing pesticide use in the lower-middle-income group, while no significant differences were observed in other income groups. The effect was significant in non-plain areas but not statistically significant in plain areas. Mediation analysis confirmed that health literacy played a crucial mediating role in the relationship between policy implementation and the reduction in pesticide use. These findings emphasize the importance of tailoring policies to different income levels and geographical conditions for targeted interventions, as well as the necessity of integrating health education with agricultural practices to promote sustainable agricultural behaviors. This study contributes to the literature by bridging the gap between public health and agricultural sustainability, offering valuable insights for policymakers seeking to promote eco-friendly agricultural transitions.
Hospital restrooms are a weak link in infection control due to high pathogen loads, poor ventilation, and limitations of conventional disinfection. This study developed a smart toilet featuring a novel electrolytic disinfection technology to assess its clinical efficacy in decontaminating restroom surfaces and air, while exploring its potential for microbial control within hospital settings. A prospective controlled experimental study was conducted in four inpatient public restrooms at Zhongnan Hospital of Wuhan University between July and August 2025. The intervention utilized an onsite electrolysis device that electrolyzed a diluted sodium chloride solution to produce neutral electrolyzed water containing hypochlorous acid as the primary biocidal agent. Bench tests confirmed that a concentration of 40 mg/L achieved a 100% kill rate against E. coli within 9 min. The system was integrated into smart toilets. Surface samples (n = 216) and air samples (n = 72) were collected at 0, 5, and 30 min after use. Disinfection qualification rate, bactericidal efficacy, and natural microbial decay were compared against routine cleaning. The surface qualification rate was 53.7% before and 61.1% after the intervention, a difference that was not statistically significant (p > 0.05). The toilet seat (5 min after use) and inner bowl (30 min after use) both reached 100% compliance, whereas the flush button demonstrated limited and inconsistent bactericidal efficacy. The air sterilization rate reached 89.7% at 30 min, which was significantly higher than the natural decay rate of 49.8% in the control group (p < 0.05). This smart toilet with novel electrolytic disinfection technology improves environmental hygiene in hospital restrooms and overcomes key limitations of manual cleaning. Nevertheless, the flush button remains a high risk site because it is not directly subjected to disinfection, thereby necessitating design optimization.
Achieving universal access to safe drinking water and sanitation remains a major challenge in Uganda, where persistent socioeconomic and spatial inequalities limit progress toward Sustainable Development Goal 6. While previous studies have largely focused on localized settings, national-level evidence applying the WHO/UNICEF Joint Monitoring Programme (JMP) service ladder framework is limited. This study aimed to address this gap. This study used secondary data from the 2018–2019 Uganda Malaria Indicator Survey. A total of 8,925 households were included, with data drawn from the Household Recode file. The dependent variables were household sources of drinking water and types of toilet facilities and these were classified according to the WHO/UNICEF JMP service ladder framework into safely managed, basic, limited, unimproved, and no service categories. Independent variables comprised a range of individual and household-level characteristics. Descriptive statistics were used to summarize key variables, while chi-square tests examined bivariate associations between the dependent and independent variables. Multivariable ordinal logistic regression was then applied to estimate the adjusted effects of the determinants on water and sanitation service levels. All analyses accounted for the complex survey design and sampling weights and were conducted using Stata version 18. Most Ugandan households relied on basic drinking water services (67.8%), while safely managed water remained low (8.8%) and was almost absent in regions such as Karamoja. Sanitation access was dominated by limited services (49.7%), with only 43.6% achieving safely managed sanitation. The significant determinants associated with JMP service levels were identified. Higher education, household wealth, male headship, and residence in central and western regions strongly increased the likelihood of accessing higher service levels. Rural areas and refugee settlements consistently exhibited the lowest service levels, reflecting structural deficits in infrastructure, affordability, and service reliability. This study shows that safely managed drinking water and sanitation remain limited in Uganda, with persistent inequalities driven by education, wealth, gender, and region. Targeted investments and pro-poor, equity-focused policies are urgently needed to improve service levels in underserved rural areas and refugee settlements. Strengthening infrastructure, reducing affordability barriers, and supporting context-specific water and sanitation programming will be essential for accelerating progress toward universal and safely managed services.
On February the 7th 2024, BioFire® alerted users to a risk of false-positive norovirus results with the BioFire® FilmArray® Gastrointestinal Panel (BF-GIP) and recommended confirmatory testing. To assess the reliability of BF-GIP norovirus-positive results in children and develop a decision algorithm for managing potential false positives. Between January and June 2025, all BF-GIP norovirus-positive samples were re-tested the same day using the GeneXpert® Norovirus assay (Cepheid®). BF-GIP cycle thresholds (Ct) values and melting curves were analyzed. Of the 1007 BF-GIP performed, 131 were norovirus-positive and 127 were retested by the GeneXpert® Norovirus assay. Overall, 31.5 % (40/127) were discordant. Atypical melting curves (22/40, 55 %), high Ct values (> 25) or "N/A" results were strongly associated with discordance, while Ct ≤ 20 were highly predictive of concordance. Based on these metrics, 58 % of BF-GIP norovirus-positive results could be confidently confirmed or rejected without additional testing. False norovirus-positive results by the BF-GIP are common. An algorithm integrating BF-GIP Ct values and melting curve analysis can reduce unnecessary retesting, streamline laboratory workflow and support accurate diagnosis in pediatric settings.
B-cell acute lymphoblastic leukemia (B-ALL) is a heterogeneous malignancy driven by diverse genetic alterations. Among these, CEBP family genes and ZEB2 are recurrently involved, yet the spectrum of genomic mechanisms and their clinical impact remain incompletely defined. Integrated genomic analyses of a cohort of 992 Philadelphia-negative adult B-ALL patients revealed multiple mechanisms of enhancer hijacking-mediated deregulation of CEBPA, CEBPB, CEBPD, and CEBPE, including IGH and several non-IGH fusions, as well as noncoding mutations in regulatory regions. Combined with gene expression analysis, we identified three distinct subtypes, defined by co-occurring CEBP and ZEB2 p.H1038R alterations (CEBP/ZEB2, n = 18 cases); isolated CEBP alterations (CEBPalt, n = 43), associated with frequent IKZF1 deletions and FLT3 deregulation; and isolated ZEB2 p.H1038R mutation (ZEB2alt, n = 15), associated with various additional genomic hits targeting ZEB2 and enhancing mutant ZEB2 expression. The three subtypes exhibited distinct clinical features, including age distribution (patients with CEBP/ZEB2 and ZEB2alt B-ALL were younger) and sex bias (female and male predominance in CEBPalt and ZEB2alt, respectively). Early treatment responses and outcomes also differed: patients with CEBP/ZEB2 B-ALL had a favorable early response, in contrast to patients with ZEB2alt B-ALL, who had high levels of minimal residual disease and a dismal prognosis. Collectively, our findings define CEBP and ZEB2 alterations as drivers of genetically and clinically distinct subtypes of adult B-ALL and provide a rationale for subtype-specific risk stratification. Preclinical experiments in CEBPalt B-ALL patient-derived xenografts demonstrated sensitivity to FLT3 inhibition, highlighting a potential therapeutic vulnerability.
Menstrual hygiene management (MHM) is essential for adolescent girls to manage menstruation safely and with dignity. However, inadequate facilities and social stigma lead to school absenteeism and educational disadvantages. This study evaluates MHM facilities in schools and explores teachers' perspectives on challenges and solutions in rural and peri-urban Raebareli, India. A convergent parallel design in mixed method study was conducted in four government schools (two rural, two peri-urban) in the Rahi block, Raebareli. A facility assessment checklist, based on India's 2015 MHM guidelines, evaluated toilets, handwashing stations, pad disposal systems, and privacy measures. Teachers' perspectives were explored through focus group discussions with teachers. Data were analyzed using descriptive statistics and inductive thematic analysis. The mixing of the data was at the level of result presentation. Only 50% of schools had adequate girls' toilets, 25% had functional handwashing facilities, and one school had an incinerator for pad disposal. Teachers highlighted inadequate infrastructure, social stigma, lack of policies, and limited training as major barriers. They emphasized the need for awareness programs, improved facilities, administrative support, and a designated nodal teacher for MHM. MHM facilities remain inadequate. Strengthening infrastructure, increasing government support, appointing nodal teachers, and implementing awareness programs are essential to fostering a menstrual-friendly school environment, ultimately improving attendance and educational outcomes for adolescent girls.
The bacterial determinants of Group A Streptococcus (GAS) associated with either invasive (IGASI) or non-invasive (NIGASI) infections remain controversial. From 2014 to 2018, French children hospitalized for an IGASI were enrolled in a prospective multicenter study aimed at identifying bacterial virulence factors and predisposing immunologic and genetic factors. During the same period, age- and date-matched control children with NIGASI were enrolled. Whole genome sequencing was performed for all GAS isolates. The 27 specific single nucleotide polymorphisms characterizing the M1UK lineage were searched among the emm-1 isolates. A total of 192 GAS isolates were sequenced: 94 from the IGASI group and 98 from the NIGASI group. The emm-1 genotype predominated in the IGASI group (36% vs. 11% in NIGASI group, P < .05) and was followed by emm-4, emm-12, and emm-3 (12%, 11%, and 10% respectively). In the NIGASI group, emm-89 predominated (21% vs 7% in the IGASI group, P<.05). Among the 45 emm-1 isolates, 12 (27%) carried the mutations characterizing clone M1UK in both groups (7 in IGASI group and 5 in NIGASI group). The superantigenic toxins SpeA and SpeJ, SIC protein, and FCT type 1 pilus predominated in the IGASI group but were linked to emm-1 strains. Insertions/deletions in the covS regulator gene were observed in 5 invasive isolates versus 1 non-invasive isolate. Genotype emm-1 GAS strains remained the main cause of invasive infections in French children, associated to specific GAS virulence factors, and should be monitored together with the rapid spread of the M1UK lineage. emm-1 GAS strains remained the main cause of invasive infections in French children, and 27% were from the M1UK lineage. The superantigenic toxins SpeA and SpeJ, SIC protein, and FCT type 1 pilus were significantly associated with invasive infections but were linked to emm-1 strains.
The fossorial vole Arvicola terrestris scherman (ATS) is a pest rodent in Central Europe that is subject to cyclical infestations, the frequency of which is steadily increasing in a global context of climate and environmental change. Due to the significant economic, agricultural, and sanitary issues associated with ATS outbreaks, research is being conducted to better understand the physiological, behavioral, and environmental characteristics of these phenomena. The work presented here consisted of comparing ATS males from summer and winter in terms of anatomical, systemic, and testicular gene expression parameters. Interestingly, two reproductive morphs of males with the same anatomical characteristics in terms of overall body weight and coat length were observed during the winter period. One morph is typical of this seasonal breeding species, showing significant winter regression of its reproductive organs, while the other morph is atypical, appearing to having preserved the male reproductive tissues and function. Histological and RNAseq analyses of the testicular tissue clearly define the distinct characteristics of these animals, confirming the maintenance of reproductive capacity in some winter males. Knowledge of these physiological changes is an important factor in defining relevant control strategies.
Understanding toilet avoidance and stool withholding at school is essential, as this can adversely affect children's health and well-being. To assess the prevalence of toilet avoidance and stool withholding at school, and to explore the differences of withholding behavior by gender and geographic location of the school, identify reasons for withholding, and describe physical symptoms and health care utilization. This cross-sectional study used an online questionnaire developed by experts from Amsterdam University Medical Center and the Dutch Digestive Health Fund. Children aged 8 to 16 years from primary schools (aged 8-12 years) and high schools (aged 13-16 years) were recruited by Verian, an external research agency, through a nationwide online panel in the Netherlands. In July 2024, school-aged children completed the questionnaire. The primary outcomes were the prevalence of stool withholding, reasons for withholding, gastrointestinal symptoms, and health care utilization. Secondary outcomes included differences between gender and geographic location of the school, children's reasons for avoiding school toilets, and toilets' perceived cleanliness. To assess potential differences in withholding behavior according to gender and geographic location, a Cochran-Armitage test was performed. A total of 1000 children, 518 aged 8 to 12 years (264 [51.0%] male) and 482 aged 13 to 16 years (234 [48.5%] male) completed the questionnaire. Stool withholding was reported by 265 primary school children (51.2%) and 344 high school children (71.4%), with no significant differences by gender or geographic location. Hygiene and privacy concerns were the most commonly reported reasons for withholding stool with 610 (84.3%) of children accounting for hygiene and 574 (79.3%) citing privacy concerns, and 410 (41.0%) of children rated school toilet cleanliness as insufficient. Abdominal pain was frequently reported (365 of 724 [50.4%]) and 15 of 336 primary school children (4.5%) experienced fecal incontinence. Overall, 42 primary school children (12.5%) had consulted a physician for symptoms related to withholding. In this cross-sectional study, toilet avoidance and stool withholding at school were common among both primary and high school children, mostly due to hygiene and privacy concerns. Improving school toilet facilities may reduce withholding behavior, gastrointestinal symptoms, and related physician visits, thereby supporting children's physical, psychological, and educational well-being.
Latrine use enhances health benefits, safety, dignity, and social status. Despite increased latrine coverage, some children and adults do not consistently use latrines. The present study aimed to describe latrine use and handwashing after urination and defecation by age and time of day, and to explore factors associated with latrine use at each time of day. A cross-sectional, population-based survey was conducted from July 17 to September 21, 2023 in western Kenya, targeting individuals aged 4 years or older (n = 528 analyzed). Overall, latrine use tended to be more frequent among adults than children, for defecation than urination, and during the daytime and early morning compared with at night. Handwashing practices after urination and defecation showed similar patterns. For urination, compared with young adults (18-39 years), young children (4-10 years) were less likely to use latrines across all times of day, with reductions of approximately 60-85%. For defecation, compared with adults (18 + years), young children were even less likely to use latrines across all times of day (approximately 90-95% lower likelihood). Similarly, adolescents (11-17 years) had approximately 75% lower latrine use for defecation at night and early in the morning compared with adults. In contrast, individuals who felt safe walking to the latrine at night were substantially more likely to use latrines for both urination and defecation than those who perceived the walk as neither safe nor unsafe or unsafe. Therefore, simple, low-cost interventions, such as promoting the use of flashlights, constructing latrines closer to households, and better connecting sanitation knowledge to daily practices, are crucial for improving sanitation behaviors.
Research in embodied cognition has consistently shown a close link between action verb processing and action observation, often attributed to shared sensorimotor representations. However, it remains unclear whether this action-language coupling is modulated by social context. The present research addressed this gap by examining the influence of gender stereotypes on action-language processing. In Experiment 1 (N = 40, 20 female), participants performed a primed action-language task in which pictures of stereotype-consistent (e.g., woman knitting) or stereotype-inconsistent (e.g., man knitting) actions preceded action verbs. Response times revealed that stereotype-consistent primes weakened the standard facilitation effect between action observation and language processing, but only for female participants. Experiment 2 used a larger online sample (N = 181, 48 female) and replicated the modulation of the congruence effect, this time across both genders. Together, these findings indicate that socially shared stereotypes can actively moderate embodied action-language interactions, likely through attentional and/or predictive mechanisms, or through the activation of broader, supra-categorical semantic representations via stereotype-congruent cues.
Wastewater surveillance (WWS) at healthcare facilities is a nascent field with knowledge gaps in the feasibility of conducting such surveillance at this specialized facility type, and for how to best implement and interpret wastewater (WW) data. WWS was piloted at skilled nursing facilities, including conducting tracer studies, optimization of a low-flow strainer for autosampler WW collection, and preliminary testing of a WW access survey. An expanded WW access survey with collaboration from additional partners was distributed to 16 post-acute/long-term care facilities. The lessons learned obtained through the pilot 'use cases' demonstrated minimal clogging and consistent collection of WW using a low-flow strainer (±0.36 L) and tracer studies highlighted the importance to confirm facility effluent source with an average visual dye detection between 1.5 and 2.5 min from the toilet flush. The expanded WW access survey assessed the feasibility of WWS regarding physical onsite manhole access, safety aspects, effluent flow, and other factors, where 75% (12 of 16) of surveyed facilities demonstrated feasibility. Healthcare facility-level WWS includes specialized methodological approaches prior to implementation to achieve the intended public health impact. These considerations support the continued overall goal of detecting emerging biological public health threats at healthcare facilities using WWS.
In January 2025, the Escherichia coli National Reference Center of France detected an outbreak of hemolytic uremic syndrome (HUS) in adults, caused by Shiga toxin-producing E. coli negative for locus of enterocyte effacement (LEE). The outbreak included 18 confirmed cases of E. coli infection, 5 probable or possible cases detected by in-house specific PCR, and 2 additional cases from Scotland and Belgium. Whole-genome sequencing identified the outbreak strain as O77 g:K92:H18, belonging to phylogroup D; the strain harbored the Shiga toxin 2 gene variant stx2d-073-C165-02 and a 134-kb plasmid with enterotoxin genes (estb-STb2 and eltAB). Epidemiologic investigation implicated raw-milk cheese as the contamination source. The strain represents a singular hybrid pathotype of Shiga toxin-producing and enterotoxigenic E. coli, expressing a K92 capsule with known cross-immunogenicity to Neisseria meningitidis group C, which could explain the absence of pediatric cases. Related strains have been identified in international databases since 2005, suggesting global emergence.
Water, sanitation, and hygiene (WaSH) programs aim to prevent feco-oral disease transmission, but their effectiveness in low- and middle-income countries is often compromised by frequent exposure to animal feces. In Ethiopia, national initiatives such as the Health Extension Program and Community-Led Total Sanitation and Hygiene program have expanded WaSH coverage but do not currently address animal-associated risks. This study investigated knowledge, attitudes, and practices related to human and animal feces management in Butajira, Gilgel Gibe, and Kilite Awlaelo Health and Demographic Surveillance Sites (HDSS) in Ethiopia. A community-based, cross-sectional study was conducted through random sampling of households in selected kebeles across the three HDSS sites. Eligible households owned up to 60 livestock, including at least one head of cattle. Adult women (n = 1129) were interviewed using a structured questionnaire on WaSH and livestock husbandry, including manure management. Descriptive statistics were used to summarise practices across sites. The median age of participants ranged from 35 to 45 years, with female-headed households most frequent in Butajira (42.2 %). Literacy levels were lowest in Gilgel Gibe (64.1 % illiteracy). Most households accessed improved water sources, though unimproved sources were important in Gilgel Gibe (16.3 %). Improved toilet facilities were most common in Gilgel Gibe (61 %). At least 79 % of respondents reported handwashing after toilet use, with moderate soap use (>73 %). Manure management was primarily the responsibility of adult women (>74 %), often using bare hands. Handwashing with soap after manure handling was common in Kilite Awlaelo (>97 %) but lower in Butajira (86.3 %) and Gilgel Gibe (74.8 %). Awareness of health risks from animal manure was lower than for human feces, especially in Gilgel Gibe (70 %) and Butajira (53.2 %). Similarly, awareness of the benefits of composting or drying manure to prevent germ spread was lower in these sites. Despite high awareness of WaSH-related risks, critical gaps exist in understanding manure-associated health risks, particularly in Butajira and Gilgel Gibe. Targeted interventions are needed to raise awareness and improve manure management, especially among women.
Access to clean water and adequate sanitation is vital for public health. However, the effects of water and sanitation on depressive symptoms remain insufficiently explored among the general population in low- and middle-income countries (LMICs). This study aims to examine the links between sanitation conditions and depressive symptoms, and to evaluate the mediating role of life satisfaction (LS) among adults in Indonesia. We used the fifth wave of the Indonesian Family Life Survey (IFLS-5) dataset with participants aged 15 and above (mean: 37.32 years; SD: 14.93), collected in September 2014/March 2015. Depressive symptoms were measured using the CES-D-10 scale. Five sanitation indicators were included: drinking water, water source, toilet facilities, liquid waste disposal and safe waste disposal methods. Structural equation modelling (SEM) was employed to estimate the direct and indirect pathways linking sanitation factors and depressive symptoms through LS, adjusting for age and sex. The study involved 31,446 participants, of whom 7,312 (23%) were classified as having depressive symptoms. In the first SEM model, drinking water (β = 0.023, p < 0.001), water source (β = 0.033, p < 0.001), toilet facilities (β = 0.039, p < 0.001), sewage disposal (β = 0.027, p < 0.001) and waste disposal method (β = 0.021, p < 0.005) were directly associated with depressive symptoms. In the second SEM model, which included LS as a mediator, the direct effects remained consistent: drinking water (β = 0.013, p < 0.05), water source (β = 0.054, p < 0.001), toilet facilities (β = 0.068, p < 0.001), sewage disposal (β = 0.022, p < 0.001) and waste disposal method (β = 0.046, p < 0.001). Additionally, unimproved sanitation was significantly linked to lower LS and LS was strongly associated with depressive symptoms across all sanitation factors (β ≈ 0.124-0.126, p < 0.001). Poor water and sanitation are associated with a higher risk of depressive symptoms among Indonesian adults, with LS as a partial mediator of this relationship. These findings highlight the need to incorporate water and sanitation improvements into national mental health and public health policies.
Diarrhoea remains a major public health concern among children under five in developing countries due to inadequate sanitation and limited access to clean water. Evidence on specific factors contributing to diarrhoea in Murambi Sector, Gatsibo District, Rwanda, is limited. This study assessed the prevalence of diarrhoea and its associated factors among children under five. A cross-sectional study was conducted with 339 children under five. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0, applying bivariate and multivariable logistic regression. Statistical significance was set at p < 0.05. Among the participants, 56.6% were female. The prevalence of diarrhoea was 14%. Factors significantly associated with diarrhoea included having an improved toilet, presence of a handwashing facility, and washing hands before feeding a child (p < 0.05). Improved sanitation and hand hygiene practices are essential to reduce diarrhoea among children under five in Murambi Sector. These findings support interventions aimed at promoting household hygiene and enhancing access to sanitation facilities.
The recovery of phosphorus from human urine via struvite precipitation has emerged as a promising strategy for sustainable nutrient management. However, limited understanding of the materials' physicochemical properties, phosphorus speciation, and potential contamination by tracing heavy metals continues to hinder their safe application. This study addresses these gaps by systematically characterizing struvite precipitated from source-separated human urine collected from dry toilet facilities and stored at ambient temperature for six months, representing a scarcely explored effluent matrix in nutrient recovery research. The precipitation was driven by natural microbial urease activity and by the addition of magnesium oxide (MgO) without pH adjustment (Mg:P molar ratio of 1.71:2.21). The resulting solids were analyzed via X-ray diffraction (XRD), solid-state phosphorus-31 nuclear magnetic resonance 31P NMR, inductively coupled plasma atomic emission spectrometry (ICP-OES), and the Measurement and Standard Testing (MTP) protocol. Struvite (MgNH₄PO₄∙6H₂O) was identified as the dominant crystalline phase (79.54%), with minor presence of newberyite (MgHPO₄∙3H₂O) revealed by 31P NMR. Heavy metals, including arsenic, cadmium, lead, chromium, and mercury, were detected at concentrations well below regulatory thresholds established by Brazilian legislation. Phosphorus speciation analysis showed a predominance of inorganic forms (70.0 mg∙g⁻1 IP) within the product, which contained 10.2% P. Additionally, 61% of the total phosphorus content was solubilized within 10 days at neutral pH, with the kinetics excellently described by the Elovich model. These findings support the feasibility of converting human urine into a safe, phosphorus-rich fertilizer, advancing circular economy principles towards sustainable sanitation practices.