Displaying publications 81 - 100 of 169 in total

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  1. Environmental factors in the relationship between breastfeeding and infant mortality: the role of sanitation and water in Malaysia
    Butz WP, Habicht JP, DaVanzo J
    Am J Epidemiol, 1984 Apr;119(4):516-25.
    PMID: 6711541
    Mothers' recall data collected in Malaysia in 1976-1977 are analyzed to study correlates of mortality of 5471 infants. Respondent population is 1262 women living in 52 primary sampling units of Peninsular Malaysia. Lengths of unsupplemented and supplemented breastfeeding and presence of piped household water and toilet sanitation are related to infant mortality in regressions that also control other correlates. The analysis is disaggregated into three periods of infancy. Through six months of feeding, unsupplemented breastfeeding is more strongly associated with fewer infant deaths than is supplemented breastfeeding. Type of sanitation is generally more strongly associated with mortality than is type of water supply. The effects of breastfeeding and the environmental variables are shown to be strongly interactive and to change systematically during the course of infancy. Breastfeeding is more strongly associated with infant survival in homes without piped water or toilet sanitation. In homes with both modern facilities, supplemented breastfeeding has no significant effect, and unsupplemented breastfeeding is statistically significant only for mortality in days 8-28. Presence of modern water and sanitation systems appears unimportant for mortality of infants who are breastfed without supplementation for six months.
    Matched MeSH terms: Water Supply*
  2. Maternal literacy modifies the effect of toilets and piped water on infant survival in Malaysia
    Esrey SA, Habicht JP
    Am J Epidemiol, 1988 May;127(5):1079-87.
    PMID: 3358408 DOI: 10.1093/oxfordjournals.aje.a114884
    The effect of toilets, piped water, and maternal literacy on infant mortality was analyzed using data from the Malaysian Family Life Survey collected in 1976-1977. The effect of toilets and piped water on infant mortality was dependent on whether or not mothers were literate. The impact of having toilets was greater among the illiterate than among the literate, but the impact of piped water was greater among the literate than among the illiterate. The effect on the infant mortality rate for toilets decreased from 130.7 +/- 17.2 deaths in the absence of literate mothers to 76.2 +/- 25.9 deaths in the presence of literate mothers. The reduction in the mortality rate for maternal literacy dropped from 44.4 +/- 14.1 deaths without toilets to -10.1 +/- 23.9 deaths with toilets. Reductions in mortality rates for piped water increased from 16.7 +/- 12.7 deaths without literate mothers to 36.8 +/- 21.0 deaths with literate mothers. Similarly, reductions in the mortality rate for maternal literacy rose from 44.4 +/- 14.1 deaths in the absence of piped water to 64.5 +/- 19.5 deaths in the presence of piped water. The results from a logistic model provided inferences similar to those from ordinary least squares. The authors infer that literate mothers protect their infants especially in unsanitary environments lacking toilets, and that when piped water is introduced, they use it more effectively to practice better hygiene for their infants.
    Matched MeSH terms: Water Supply*
  3. Diarrhoeal diseases in rural Malaysia: risk factors in young children
    Lye MS
    Ann Acad Med Singap, 1984 Apr;13(2):156-62.
    PMID: 6497315
    A survey was conducted in six selected rural villages to obtain baseline data on socioeconomic status, nutrition, environmental sanitation and behavioural aspects in relation to diarrhoeal diseases, using a standard questionnaire. Subsequent to this, children 0-4 years of age were followed weekly for six months for diarrhoeal disease. Eleven variables representing socioeconomic status, nutritional status, housing condition, environmental sanitation, mother's knowledge and beliefs were investigated using stepwise logistic regression to determine significant predictors of diarrhoeal disease. Children who were below two years of age, living in conditions of poor sanitation and poor quality water supply, whose houses were prone to flooding and who had mothers whose sanitary habits were not influenced by their religious beliefs, were at significantly greater risk of diarrhoeal disease.
    Matched MeSH terms: Water Supply/standards
  4. Effect of iodination of a village water-supply on goitre size and thyroid function
    Maberly GF, Eastman CJ, Corcoran JM
    Lancet, 1981 Dec 05;2(8258):1270-2.
    PMID: 6118679
    An iodinator was fitted to the existing gravity-fed water-supply of a remote village in Sarawak, Malaysia, where goitre was endemic. Within nine months, the prevalence of goitre had been reduced from 61% to 30%, with 79% of goitres showing visible reduction in size. All subjects were clinically euthyroid before and nine months after the start of iodination, although pre-treatment serum thyroid-stimulating hormone (TSH) concentrations varied from normal up to 24 mU/l. Before treatment basal serum triiodothyronine (T3) and thyroxine (T4) concentrations were typical of endemic goitre with a low mean serum T4 (80 +/- 30 [SD] nmol/l) and a slightly raised mean serum T3 (2.3 +/- 0.7 nmol/l). After iodination, circulating TSH concentration was generally undetectable (less than 0.1 mU/l), mean T3 concentration was unchanged, but the mean T4 rose significantly to 109 +/- 41 nmol/l (p less than 0.01). Urinary iodine concentrations fluctuated; this largely reflected intermittent blockage of the iodinator, but concentrations became consistent with a return to the iodine-replete state. There was no evidence of the Jod Basedow effect in the group studied. Iodinated water was more convenient to distribute than iodised salt and is less likely to cause Jod Basedow phenomenon than are injections of iodised oil. Moreover, iodination of water is effective in killing most microorganisms and this additional benefit could contribute significantly to village health.
    Matched MeSH terms: Water Supply*
  5. Engineering and malaria control: learning from the past 100 years
    Konradsen F, van der Hoek W, Amerasinghe FP, Mutero C, Boelee E
    Acta Trop, 2004 Jan;89(2):99-108.
    PMID: 14732233
    Traditionally, engineering and environment-based interventions have contributed to the prevention of malaria in Asia. However, with the introduction of DDT and other potent insecticides, chemical control became the dominating strategy. The renewed interest in environmental-management-based approaches for the control of malaria vectors follows the rapid development of resistance by mosquitoes to the widely used insecticides, the increasing cost of developing new chemicals, logistical constraints involved in the implementation of residual-spraying programs and the environmental concerns linked to the use of persistent organic pollutants. To guide future research and operational agendas focusing on environmental-control interventions, it is necessary to learn from the successes and failures from the time before the introduction of insecticides. The objective of this paper is to describe the experiences gained in Asia with early vector control interventions focusing on cases from the former Indian Punjab, Malaysia and Sri Lanka. The paper deals primarily with the agricultural engineering and land and water management vector control interventions implemented in the period 1900-1950. The selected cases are discussed in the wider context of environment-based approaches for the control of malaria vectors, including current relevance. Clearly, some of the interventions piloted and implemented early in the last century still have relevance today but generally in a very site-specific manner and in combination with other preventive and curative activities. Some of the approaches followed earlier on to support implementation would not be acceptable or feasible today, from a social or environmental point of view.
    Matched MeSH terms: Water Supply*
  6. Fulltext Socio-Economic Factors Related to Drinking Water Source and Sanitation in Malaysia
    Kong YL, Anis-Syakira J, Fun WH, Balqis-Ali NZ, Shakirah MS, Sararaks S
    Int J Environ Res Public Health, 2020 10 29;17(21).
    PMID: 33137998 DOI: 10.3390/ijerph17217933
    Access to improved water and sanitation is essential. We describe these practices in Malaysia using data from a nationwide community survey and used logistic regression to assess the determinants. Of the 7978 living quarters (LQs), 58.3% were in urban areas. About 2.4%, 0.5% and 27.4% of LQs had non-improved water sources, non-improved toilet types and improper domestic waste disposal, respectively. Open burning was practiced by 26.1%. Water source was a problem for long houses (10.5%), squatters (8.5%) and shared houses (4.0%). Non-improved toilet types were 11.9% for squatters and 4.8% for shared houses. Improper domestic waste disposal practices were higher for occupants of village houses (64.2%), long houses (54.4%), single houses (45.8%) and squatters (35.6%). An increase in education or income level was associated with a decrease in improper domestic waste disposal methods. House type significantly affected water and sanitation after adjusting for the effects of other variables. Lower household income was associated with non-improved toilet types and improper domestic waste disposal. Lower education and rural location influenced domestic waste disposal. The water and toilet facilities in Malaysia were generally good, while domestic waste management practices could be improved. There remain pockets of communities with environmental challenges for the nation.
    Matched MeSH terms: Water Supply*
  7. Iodization of village water supply in the control of endemic iodine deficiency in rural Sarawak, Malaysia
    Foo LC, Zainab T, Goh SY, Letchuman GR, Nafikudin M, Doraisingam P, et al.
    Biomed Environ Sci, 1996 Sep;9(2-3):236-41.
    PMID: 8886337
    A simple water iodizing system, which incorporates the Venturi principle in combination with the controlled release mechanism of a silicone-sodium iodide elastomer, for the iodization of rural piped-water supply in the control of endemic iodine deficiency has been developed and its effectiveness evaluated in three Iban longhouse villages in the iodine-deficient district of Lubok Antu, Sarawak. Urines were collected for iodine assays from women aged 15-40 years before and at 6 and 12 months after the connection of the iodinating device; goiter assessment was performed on the women at the start and end of the 1-year study. Water samples were collected for iodine assays at 2-weekly intervals. In all three villages, significant and sustained increases in median urinary iodine excretions, reaching levels recommended for an iodine-sufficient population, were observed; goitre prevalences were reduced in all the villages (by 22.6% to 35.8%). The iodine levels in the water ranged from 34 micrograms/l to 212 micrograms/L. In the control village, median urinary iodine excretions remained essentially unchanged but a small increase in goiter prevalence was observed. The iodized water was well received by the villagers and no adverse effects of water iodization were observed. The system functioned unattended throughout the one year period. The cost of providing supplemental iodine via the iodizing device is approximately 60 cents (U.S.) per family per year which is affordable by either the Government or the villagers. It is concluded that the iodizing system offers a new cost-effective strategy for the control of endemic iodine deficiency in Sarawak and may have applications in other areas with similar water sources.
    Matched MeSH terms: Water Supply*
  8. Fulltext Presence of rotavirus and free-living amoebae in the water supplies of Karachi, Pakistan
    Yousuf FA, Siddiqui R, Khan NA
    Rev Inst Med Trop Sao Paulo, 2017 Jun 01;59:e32.
    PMID: 28591260 DOI: 10.1590/S1678-9946201759032
    Rotavirus and pathogenic free-living amoebae are causative agents of important health problems, especially for developing countries like Pakistan where the population has limited access to clean water supplies. Here, we evaluated the prevalence of rotavirus and free-living amoebae (Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri) in drinking water supplies of Karachi, Pakistan. Six water filtration plants that supply drinking water to the population of Karachi were investigated. Additionally, drinking water samples from households were analyzed for the presence of rotavirus and free-living amoebae. Rotavirus was present in 35% of the water samples collected from water filtration plants; however, domestic tap water samples had a prevalence of only 5%. Out of 20 water samples from filtration plants, 13 (65%) were positive for Acanthamoeba spp., and one (5%) was positive for B. mandrillaris. Out of 20 drinking water samples collected from different areas of Karachi, 35% were positive for Acanthamoeba spp. Rotavirus was detected in 5% of the drinking water samples tested. Overall, these findings showed for the first time the presence of rotavirus, in addition to pathogenic free-living amoebae in drinking water supplies of Karachi that could be an important public health risk for the affected population.
    Matched MeSH terms: Water Supply*
  9. Fulltext Occurrence of multiclass endocrine disrupting compounds in a drinking water supply system and associated risks
    Wee SY, Aris AZ, Yusoff FM, Praveena SM
    Sci Rep, 2020 10 20;10(1):17755.
    PMID: 33082440 DOI: 10.1038/s41598-020-74061-5
    Contamination by endocrine disrupting compounds (EDCs) concerns the security and sustainability of a drinking water supply system and human exposure via water consumption. This study analyzed the selected EDCs in source (river water, n = 10) and supply (tap water, n = 155) points and the associated risks. A total of 14 multiclass EDCs was detected in the drinking water supply system in Malaysia. Triclosan (an antimicrobial agent) and 4-octylphenol (a plasticizer) were only detected in the tap water (up to 9.74 and 0.44 ng/L, respectively). Meanwhile, chloramphenicol and 4-nonylphenol in the system were below the method detection limits. Bisphenol A was observed to be highest in tap water at 66.40 ng/L (detection: 100%; median concentration: 0.28 ng/L). There was a significant difference in triclosan contamination between the river and tap water (p water supply system regarding treatment sustainability and water security. Further exploration of smart monitoring and management using Big Data and Internet of Things and the need to invent rapid, robust, sensitive, and efficient sensors is warranted.
    Matched MeSH terms: Water Supply*
  10. Assessment of groundwater salinity and quality in Gaza coastal aquifer, Gaza Strip, Palestine: An integrated statistical, geostatistical and hydrogeochemical approaches study
    Abu-Alnaeem MF, Yusoff I, Ng TF, Alias Y, Raksmey M
    Sci Total Environ, 2018 Feb 15;615:972-989.
    PMID: 29751448 DOI: 10.1016/j.scitotenv.2017.09.320
    A comprehensive study was conducted to identify the salinization origins and the major hydrogeochemical processes controlling the salinization and deterioration of the Gaza coastal aquifer system through a combination approaches of statistical and geostatistical techniques, and detailed hydrogeochemical assessments. These analyses were applied on ten physicochemical variables for 219 wells using STATA/SE12 and Surfer softwares. Geostatistical analysis of the groundwater salinity showed that seawater intrusion along the coastline, and saltwater up-coning inland highly influenced the groundwater salinity of the study area. The hierarchical cluster analysis (HCA) technique yielded seven distinct hydrogeochemical signature clusters; (C1&C2: Eocene brackish water invasion, C3 saltwater up-coning, C4 human inputs, C5 seawater intrusion, C6 & C7 rainfall and mixing inputs). Box plot shows a wide variation of most of the ions while Chadha's plot elucidates the predominance of Na-Cl (71.6%) and Ca/Mg-Cl (25%) water types. It is found that, the highest and the lowest levels of salinization and the highest level of nitrate pollution were recorded in the northern area. This result reflects the sensitivity of this area to the human activities and/or natural actions. Around 90.4% of the wells are nitrate polluted. The main source of nitrate pollution is the sewage inputs while the farming inputs are very limited and restricted mostly in the sensitive northern area. Among the hydrogeochemical processes, ion exchange process was the most effective process all over the study area. Carbonate dissolution was common in the study area with the highest level in clusters 6, 7, 4 and 2 in the north while Gypsum dissolution was significant only in cluster 1 in the south and limited in the other clusters. This integrated multi-techniques research should be of benefit for effective utilization and management of the Gaza coastal aquifer system as well as for future work in other similar aquifers systems.
    Matched MeSH terms: Water Supply/statistics & numerical data*
  11. The impact of a reduction in fluoride concentration in the Malaysian water supply on the prevalence of fluorosis and dental caries
    Mohd Nor NA, Chadwick BL, Farnell DJJ, Chestnutt IG
    Community Dent Oral Epidemiol, 2018 10;46(5):492-499.
    PMID: 30019792 DOI: 10.1111/cdoe.12407
    OBJECTIVE: To assess the prevalence and severity of dental fluorosis and caries among Malaysian children following the reduction in fluoride concentration from 0.7 to 0.5 parts per million (ppm) in the public water supply.

    METHODS: This study involved lifelong residents aged 9- and 12-year-olds in fluoridated and nonfluoridated areas in Malaysia (n = 1155). In the fluoridated area, children aged 12 years and 9 years were exposed to 0.7 and 0.5 ppm, respectively, at the times when maxillary central incisors developed. Standardized photographs of maxillary central incisors were blind scored for fluorosis using Dean's criteria. Dental caries was examined using ICDAS-II criteria.

    RESULTS: The prevalence of fluorosis (Dean's score ≥ 2) among children in the fluoridated area (35.7%, 95% CI: 31.9%-39.6%) was significantly higher (P 

    Matched MeSH terms: Water Supply/statistics & numerical data
  12. Natural disasters and economic losses: controlling external migration, energy and environmental resources, water demand, and financial development for global prosperity
    Abbas Khan K, Zaman K, Shoukry AM, Sharkawy A, Gani S, Sasmoko, et al.
    Environ Sci Pollut Res Int, 2019 May;26(14):14287-14299.
    PMID: 30864039 DOI: 10.1007/s11356-019-04755-5
    The objective of the study is to examine the impact of natural disasters on external migration, price level, poverty incidence, health expenditures, energy and environmental resources, water demand, financial development, and economic growth in a panel of selected Asian countries for a period of 2005-2017. The results confirm that natural disasters in the form of storm and flood largely increase migration, price level, and poverty incidence, which negatively influenced country's economic resources, including enlarge healthcare expenditures, high energy demand, and low economic growth. The study further presented the following results: i) natural resource depletion increases external migration, ii) FDI inflows increase price level, iii) increase healthcare spending and energy demand decreases poverty headcount, iv) poverty incidence and mortality rate negatively influenced healthcare expenditures, v) industrialization increases energy demand, and vi) agriculture value added, fertilizer, and cereal yields required more water supply to produce greater yield. The study emphasized the need to magnify the intensity of natural disasters and create natural disaster mitigation unit to access the human and infrastructure cost and attempt quick recovery for global prosperity.
    Matched MeSH terms: Water Supply/economics
  13. The Sulu-Sulawesi Sea: environmental and socioeconomic status, future prognosis and ameliorative policy options
    DeVantier L, Alcala A, Wilkinson C
    Ambio, 2004 Feb;33(1-2):88-97.
    PMID: 15083654
    The Sulu-Sulawesi Sea, with neighboring Indonesian Seas and South China Sea, lies at the center of the world's tropical marine biodiversity. Encircled by 3 populous, developing nations, the Philippines, Indonesia and Malaysia, the Sea and its adjacent coastal and terrestrial ecosystems, supports ca. 33 million people, most with subsistence livelihoods heavily reliant on its renewable natural resources. These resources are being impacted severely by rapid population growth (> 2% yr-1, with expected doubling by 2035) and widespread poverty, coupled with increasing international market demand and rapid technological changes, compounded by inefficiencies in governance and a lack of awareness and/or acceptance of some laws among local populations, particularly in parts of the Philippines and Indonesia. These key root causes all contribute to illegal practices and corruption, and are resulting in severe resource depletion and degradation of water catchments, river, lacustrine, estuarine, coastal, and marine ecosystems. The Sulu-Sulawesi Sea forms a major geopolitical focus, with porous borders, transmigration, separatist movements, piracy, and illegal fishing all contributing to environmental degradation, human suffering and political instability, and inhibiting strong trilateral support for interventions. This review analyzes these multifarious environmental and socioeconomic impacts and their root causes, provides a future prognosis of status by 2020, and recommends policy options aimed at amelioration through sustainable management and development.
    Matched MeSH terms: Water Supply*
  14. Issues of livelihood, sustainable development, and governance: Bay of Bengal
    Samarakoon J
    Ambio, 2004 Feb;33(1-2):34-44.
    PMID: 15083648
    This article is based on the findings of the Global International Waters Assessment (GIWA) Subregion 53, Bay of Bengal. It introduces the Subregion. The wide disparity in development indicators in the Bay of Bengal Subregion (BOBSR) is presented. The large population of poor people living in South Asia is presented as a factor that needs special attention. The article focuses on the 3 geographic sites selected for detailed analysis: i) the Ganges-Brahmaputra-Meghna river systems; ii) the Merbok Estuary mangroves, Malaysia; and iii) the Sunderbans mangroves, Bangladesh. Integrated water management based upon regional cooperation among Bangladesh, India and Nepal holds opportunities for mutual benefit. Policy options are proposed. For mangrove ecosystems, the impacts of urbanization in Malaysia and the unmanaged expansion of shrimp farming in Bangladesh are analyzed. Improved governance was seen to hold promise for enhancing economic benefits from shrimp farming while safeguarding the natural ecological system. However, these measures need to be a part of national efforts to achieve the UN Millennium Development Goals.
    Matched MeSH terms: Water Supply*
  15. Eliminating iodine deficiency in rural Sarawak, Malaysia: the relevance of water iodization
    Foo LC, Mahmud N, Satgunasingam N
    Am J Public Health, 1998 Apr;88(4):680-1.
    PMID: 9551019
    Matched MeSH terms: Water Supply*
  16. Differential preferences of oviposition by Aedes mosquitos in man-made containers under field conditions
    Chua KB, Chua IL, Chua IE, Chua KH
    Southeast Asian J. Trop. Med. Public Health, 2004 Sep;35(3):599-607.
    PMID: 15689073
    A study was made of the oviposit behavior of gravid female Aedes mosquitos in man-made habitats under field conditions. The study showed that the gravid female Aedes mosquitos preferred containers with relatively easy access but not too open to external environmental influence. The dark surface of the containers served as the initial and long-range attractant to the breeding sites. Volatile chemicals generated by the decaying vegetation in the container may serve as a close-range attractant. Finally, the water quality and the quantity of 'food' derived from decaying vegetative matter in the water determined the amount of eggs deposited in each container. The study confirmed previous findings that each gravid female Aedes mosquito had the tendency to lay her eggs in more than one container. However, the results of the study suggests that under favorable conditions, each gravid female Aedes mosquito could be encouraged to lay all her eggs in a single breeding site.
    Matched MeSH terms: Water Supply
  17. A simple biofilter for treatment of pig slurry in Malaysia
    Sommer SG, Mathanpaal G, Dass GT
    Environ Technol, 2005 Mar;26(3):303-12.
    PMID: 15881027
    On commercial pig production farms in South East (SE) Asia, the liquid effluent is often discharged into rivers. The discharge is a hazard to the environment and to the health of people using water from the river either for consumption or for irrigation. Therefore, a simple percolation biofilter for treatment of the liquid effluent was developed. Pig slurry was treated in test-biofilters packed with different biomass for the purpose of selecting the most efficient material, thereafter the efficiency of the biofilter was examined at farm scale with demo biofilters using the most efficient material. The effect of using "Effective Microorganisms" (EM) added to slurry that was treated with biofilter material mixed with Glenor KR+ was examined. Slurry treatment in the test-biofilters indicated that rice straw was better than coconut husks, wood shavings, rattan strips and oil palm fronds in reducing BOD. Addition of EM and Glenor KR+ to slurry and biofilter material, respectively, had no effect on the temperature of the biofilter material or on the concentrations of organic and inorganic components of the treated slurry. The BOD of slurry treated in test biofilters is reduced to between 80 and 637 mg O2 I(-1) and in the demo biofilter to between 3094 and 3376 mg O2 l(-1). The concentration of BOD in the effluent is related to the BOD in the slurry being treated and the BOD concentration in slurry treated in test biofilters was lower than BOD of slurry treated in demo biofilters. The demo biofilter can reduce BOD to between 52 an 56% of the original value, and TSS, COD (chemical oxygen demand) and ammonium (NH4+) to 41-55% of the original slurry. The treated effluent could not meet the standards for discharge to rivers. The composted biofilter material has a high content of nitrogen and phosphorus; consequently, the fertilizer value of the compost is high. The investments costs were 123 US dollar per SPP which has to be reduced if this method should be a treatment option in practise.
    Matched MeSH terms: Water Supply
  18. Progress in public health in the Year of the Goat
    Binns C, Low WY
    Asia Pac J Public Health, 2015 Mar;27(2):121-2.
    PMID: 25834268 DOI: 10.1177/1010539515576167
    Matched MeSH terms: Water Supply
  19. Fluorescence technique for the characterization of natural organic matter in river water
    Ahmad UK, Ulang Z, Yusop Z, Fong TL
    Water Sci Technol, 2002;46(9):117-25.
    PMID: 12448460
    The complex nature of natural organic matter (NOM), and the impact of this matter on drinking water quality have necessitated the characterization studies of NOM. A fluorescence technique for the characterization of NOM in Malaysian river water is reported. Water samples from several river sampling sites were collected and concentrated using a low-pressure reverse osmosis (LPROM). Solid phase extraction (SPE) using C18 extraction cartridges were used to fractionate the water samples into humic and non-humic fractions. To differentiate and classify various types of humic substances, fluorescence was applied in emission, excitation and in synchronous-scan modes. A synchronous spectral profile was found to be able to differentiate humic and fulvic acids better than the emission or excitation spectra. Synchronous excitation spectra showed different spectral patterns for the water samples due to different origin. All water samples showed the presence of both fulvic and humic acids.
    Matched MeSH terms: Water Supply
  20. Mother's milk and sewage: their interactive effects on infant mortality
    Habicht JP, DaVanzo J, Butz WP
    Pediatrics, 1988 Mar;81(3):456-61.
    PMID: 3344191
    If they lived in households without piped water or a toilet, Malaysian infants who did not breast-feed were five times more likely to die after 1 week of age than those who breast-fed, when other significant factors affecting infant mortality were taken into account. This is double the relative risk associated with not breast-feeding for infants born into households with toilets, whether or not they had piped water. Analogously, improvements in toilet sanitation appear to have reduced mortality twice as much among infants who did not breast-feed as among those who did. These findings, from a retrospective survey of infants born to a probability sample of 1,262 women in peninsular Malaysia, confirm the pernicious synergistic effect of poor sanitation and nonbreastfeeding that was postulated previously on theoretical grounds. Promoting and maintaining high initiation of breast-feeding is thus particularly important where poor sanitation is prevalent. Even more affluent areas should not be neglected, however, because socioeconomic improvement, including improved environmental sanitation, is often accompanied by decreased breast-feeding. Although the risk to each nonbreast-fed infant was less in those areas, infants there were less likely to breast-feed in Malaysia, and hence they made up a significant proportion of lives that could be saved by breast-feeding.
    Matched MeSH terms: Water Supply
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