Bruce H. Keswick

Clinical effects of diaper types on the skin of normal infants and infants with atopic dermatitis.

Cloth diapers, cellulose core diapers (conventional disposable diapers), and cellulose core diapers containing absorbent gelling material were examined for their effects on diaper rash and skin microbiology of normal infants and infants with atopic dermatitis in a 26-week double-blind clinical trial. Infants with atopic dermatitis wearing the diapers containing absorbent gelling material had significantly lower diaper rash grades than infants with atopic dermatitis wearing cloth diapers at five of eight grading visits. Infants with atopic dermatitis wearing conventional cellulose core diapers had statistically less rash at one of eight visits. There was no statistically significant difference between diaper types at three of the eight visits. At no time did the cloth group have less diaper rash than the conventional cellulose or absorbent gelling material disposable diaper group. A statistical correlation between the severity of general atopic dermatitis outside the diaper area and the diaper rash condition under the diaper occurred only in the atopic dermatitis group wearing cloth diapers. Isolation of microorganisms from the intact, uninvolved skin surface both inside and outside the diaper showed no biologically significant changes in the presence or numbers of selected skin organisms. Repeated isolation, at multiple grading visits of Staphylococcus aureus from uncompromised skin inside the diaper area was infrequent but correlated with the diagnosis of atopic dermatitis when observed.

Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: cluster randomised controlled trial.

Abstract Objective To compare the effect on prevalence of diarrhoea and mortality of household based treatment of drinking water with flocculant-disinfectant, sodium hypochlorite, and standard practices in areas with turbid water source in Africa. Design Cluster randomised controlled trial over 20 weeks. Setting Family compounds, each containing several houses, in rural western Kenya. Participants 6650 people in 605 family compounds. Intervention Water treatment: flocculant-disinfectant, sodium hypochlorite, and usual practice (control). Main outcome measures Prevalence of diarrhoea and all cause mortality. Escherichia coli concentration, free residual chlorine concentration, and turbidity in household drinking water as surrogates for effectiveness of water treatment. Results In children < 2 years old, compared with those in the control compounds, the absolute difference in prevalence of diarrhoea was –25% in the flocculant-disinfectant arm (95% confidence interval –40 to –5) and –17% in the sodium hypochlorite arm (–34 to 4). In all age groups compared with control, the absolute difference in prevalence was –19% in the flocculant-disinfectant arm (–34 to –2) and –26% in the sodium hypochlorite arm (–39 to –9). There were significantly fewer deaths in the intervention compounds than in the control compounds (relative risk of death 0.58, P = 0.036). Fourteen per cent of water samples from control compounds had E coli concentrations < 1 CFU/100 ml compared with 82% in flocculant-disinfectant and 78% in sodium hypochlorite compounds. The mean turbidity of drinking water was 8 nephelometric turbidity units (NTU) in flocculant-disinfectant households, compared with 55 NTU in the two other compounds (P < 0.001). Conclusions In areas of turbid water, flocculant-disinfectant was associated with a significant reduction in diarrhoea among children < 2 years. This health benefit, combined with a significant reduction in turbidity, suggests that the flocculant-disinfectant is well suited to areas with highly contaminated and turbid water.

Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial

Objectivesu2002 To evaluate the effectiveness of point of use water treatment with flocculent‐disinfectant on reducing diarrhoea and the additional benefit of promoting hand washing with soap.

Effect of point-of-use disinfection, flocculation and combined flocculation-disinfection on drinking water quality in western Kenya.

Aims:u2002 Point‐of‐use drinking water disinfection with sodium hypochlorite has been shown to improve water quality and reduce diarrhoeal disease. However, the chlorine demand of highly turbid water may render sodium hypochlorite less effective.

Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water

OBJECTIVEnTo examine the effect of a new point-of-use treatment for drinking-water, a commercially developed flocculant-disinfectant, on the prevalence of diarrhoea in children.nnnMETHODSnWe conducted a randomized controlled trial among 514 rural Guatemalan households, divided into 42 neighbourhood clusters, for 13 weeks, from 4 November 2002 through 31 January 2003. Clusters assigned to water treatment with the flocculant-disinfectant were compared with those using their usual water-handling practices. The longitudinal prevalence of diarrhoea was calculated as the proportion of total days with diarrhoea divided by the total number of days of observation. The prevalence of diarrhoea was compared using the Wilcoxon rank-sum test.nnnFINDINGSnThe 1702 people in households receiving the disinfectant had a prevalence of diarrhoea that was 40% lower than that among the 1699 people using standard water-handling practices (0.9% versus 1.5%; P = 0.001). In households using the flocculant-disinfectant, children < 1 year of age had a 39% lower prevalence of diarrhoea than those in households using their standard practices (3.7% versus 6.0%; P = 0.005).nnnCONCLUSIONnIn settings where families rarely treat drinking-water, we introduced a novel flocculant-disinfectant that reduced the longitudinal prevalence of diarrhoea, especially among children aged < 1 year, among whom diarrhoea has been strongly associated with mortality. Successful introduction and use of this product could contribute to preventing diarrhoeal disease globally.

Efficacy of Organic Acids in Hand Cleansers for Prevention of Rhinovirus Infections

ABSTRACT Direct hand-to-hand contact is an important mechanism of transmission of rhinovirus infection. The rhinoviruses are inactivated at a low pH. A survey of organic acids in vitro revealed that these compounds have antirhinoviral activity that persists for at least 3 h after application to the skin. In additional studies of salicylic acid (SA) and pyroglutamic acid (PGA), the hands of volunteers were contaminated with rhinovirus at defined times after application of the acid, and then volunteers attempted to inoculate the nasal mucosa with one hand and quantitative viral cultures were done on the other hand. In one study, 3.5% SA or 1% SA with 3.5% PGA was compared with controls 15 min after application to assess the efficacy of the inactivation of virus and prevention of infection. Virus was recovered from the hands of 28 out of 31 (90%) of the volunteers in the control group compared to 4 out of 27 (15%) and 0 out of 27 in the groups administered 3.5 and 1% SA, respectively (P < 0.05). Rhinovirus infection occurred in 10 out of 31 (32%) of the controls and 2 out of 27 (7%) of volunteers in both treatment groups (P < 0.05 compared with control). In a second study, the efficacy of 4% PGA was evaluated 15 min, 1 h, and 3 h after application. Significantly fewer volunteers had positive hand cultures at all time points compared with the control group, but the proportion that developed rhinovirus infection was not significantly reduced. These results suggest the feasibility of the prevention of rhinovirus transmission by hand treatments that are virucidal on contact and have activity that persists after application.

Leg wash protocol to assess the skin moisturization potential of personal cleansing products.

Many personal cleansers claim to provide a skin moisturization benefit, but there has been relatively little discussion in the scientific literature of the clinical methods that provide the basis for such claims. We have developed a leg wash method to assess the dry skin improvement potential of personal cleansing products. The protocol is performed on ’natural’ dry leg skin to avoid potential confounds that may result from applying cleansers to soap‐damaged skin. Washes are conducted over a period of days or weeks, with visual and instrumental assessments performed at various times throughout the period to characterize products’ short‐term and cumulative skin effects. Studies conducted with a variety of personal cleansing technologies demonstrate the method’s ability to discriminate products on the basis of their dry skin improvement potential. Further, results from a series of eleven leg wash studies conducted with the same treatment pair under different test conditions (time of year, test facility, expert grader) demonstrate the protocol’s robustness. The data generated under this protocol show that personal cleansing products differ widely in their ability to improve dry skin. Our results indicate that there is a wide range of efficacy among moisturizing personal cleansing products, with some products delivering a significant dry skin improvement benefit even for periods as long as 24 hours.

Determinants of Use of Household-level Water Chlorination Products in Rural Kenya, 2003–2005

Household-level water treatment products provide safe drinking water to at-risk populations, but relatively few people use them regularly; little is known about factors that influence uptake of this proven health intervention. We assessed uptake of these water treatments in Nyanza Province, Kenya, November 2003–February 2005. We interviewed users and non-user controls of a new household water treatment product regarding drinking water and socioeconomic factors. We calculated regional use-prevalence of these products based on 10 randomly selected villages in the Asembo region of Nyanza Province, Kenya. Thirty-eight percent of respondents reported ever using household-level treatment products. Initial use of a household-level product was associated with having turbid water as a source (adjusted odds ratio [AOR] = 16.6, p = 0.007), but consistent usage was more common for a less costly and more accessible product that did not address turbidity. A combination of social marketing, retail marketing, and donor subsidies may be necessary to extend the health benefits of household-level water treatment to populations most at risk.

Evaluation of antibacterial soap in the management of lymphoedema in Leogane, Haiti

In areas endemic for lymphatic filariasis, progression of lymphoedema is associated with recurrent bacterial acute dermatolymphangioadenitis (ADLA). The role of antibacterial soap in preventing ADLA is unknown. In a randomized double-blinded clinical trial in Leogane, Haiti, lymphoedema patients washed affected legs with antibacterial (n = 97) or plain soap (n = 100). Reported ADLA incidence (by recall) before the study was 1.1 episodes per person-year, compared to 0.40 assessed during the 12-month study. ADLA incidence was significantly associated with age, illiteracy and lymphoedema stage, but not with soap type. Washing with soap, regardless of its antibacterial content, can help decrease ADLA incidence. (ClinicalTrials.gov identifier number NCT00139100.).

Flocculant-disinfectant point-of-use water treatment for reducing arsenic exposure in rural Bangladesh

We introduced flocculant-disinfectant water treatment for 12 weeks in 103 households in Bangladesh to assess if drinking water would be chemically and microbiologically improved and the body burden of arsenic reduced. The median concentration of arsenic in tubewell water decreased by 88% after introduction of the flocculant-disinfectant from 136 μg/l at baseline to 16 (p < 0.001). The median concentration of total urinary arsenic decreased 42% from 385 μg/g creatinine at baseline to 225 μg/g creatinine after intervention (p < 0.001). Among 206 post-intervention drinking water samples that were reportedly treated on the date the sample was collected, 99 (48%) lacked residual free chlorine and 100 (49%) were contaminated with thermotolerant coliforms. The flocculant-disinfectant markedly reduced arsenic in drinking water, but treated drinking water was frequently contaminated with fecal organisms. The lesser reduction in urinary arsenic compared to water arsenic and the health consequences of this reduction require further research.