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  • Interpretation The SMART course can give orthopaedic surgeon

    2019-05-07

    Interpretation The SMART course can give orthopaedic surgeons practising in LMICs the skills and knowledge to successfully perform flaps and reduce amputation. While this reverse transcriptase inhibitors course offers a collaborative, sustainable approach to reduce global surgery disparities in amputation, future investigation into the other modalities to establish soft tissue management capacity in LMICs is warranted. Funding None. Declaration of interests
    Abstract Background As part of the Total Sanitation Campaign (1999–2012), the Indian Government promoted construction and use of tens of millions of household latrines to improve public health in rural communities, areas where tubewells are often the main source of drinking water. In this study, we aimed to identify causes of tubewell contamination with the protozoal diarrhoeal pathogens, Cryptosporidium spp and Giardia spp in a coastal area in Puri District, Odisha, India. Methods We used data from a large-scale cluster randomised controlled trial of health effects of improved household sanitation in Puri District, gathered in 60 villages during the 2012 and 2013 monsoon seasons from June to August. We used multivariable modelling to identify associations between Cryptosporidium spp and Giardia spp contamination and variables such as tubewell characteristics, village socioeconomic characteristics, spatial densities of human and livestock faecal sources around each tubewell including leaching from latrine pits and cowsheds, and meteorological conditions. Findings We included data for 107 deep public and 96 shallow private tubewells of which 36 (18%) were contaminated. We found strong evidence that latrines were the source of contamination of local shallow groundwater used for drinking. Each 10 additional person-years of latrine loading, within 10–15 m of a shallow tubewell increased the odds of Cryptosporidium spp and Giardia spp detection by 21% (OR 1·21, 95% CI 1·06–1·38) and 44% (1·44, 1·12–1·85), respectively. For deep groundwater, the risk of latrine contamination was raised by 1% if the latrines were situated within 150m for Giardia or within 500 m for Cryptosporidium of a deep tubewell (OR 1·01, 95% CI 0·998–1·012, and 1·01, 1·000–1·027, respectively). In deep tubewells, both protozoa were more often detected when the well pad was cracked or missing than when intact (OR 7·10, 95% CI 1·92–20·57 for Cryptosporidium; 5·91, 1·18–29·60 for Giardia). For every three goats in a village, we noted an increased OR of 1·09 (95% CI 1·03–1·14) for Cryptosporidium spp contamination in shallow tubewells. Antecedent rainfall also showed important mediating effects on contamination in shallow tubewells, depending on protozoan species and rainfall mechanism. Interpretation The promotion of latrines to increase the proportion of the population using an improved sanitation facility (MDG 7.9) might increase Cryptosporidium spp and Giardia spp contamination in groundwater drinking sources, especially shallow groundwater. If health gains are to be achieved from improved sanitation for all (SDG 6.2), piped supplies of centrally treated water might need to replace local groundwater drinking sources in settings which are vulnerable to faecal contamination from latrines Funding Bill & Melinda Gates Foundation. Declaration of interests
    Abstract Background Lesotho has a severe shortage of human resources for health. Many young and talented Basotho leave the country each year to attend medical school, but usually they do not return, in part because of the lack of opportunity for continuing education and specialty training in Lesotho. Here, we describe a family medicine specialty training programme (FMSTP), which aims not only to recruit Basotho physicians back to Lesotho but also increase the number of well trained physicians in Lesotho who have the knowledge, skills and commitment to meet the health needs of the people of Lesotho, especially in district hospitals.