Community managed rural water supply systems in the Dominican Republic : assessment of sustainability of systems built by the National Institute of Potable Water and Peace Corps, Dominican Republic

In the Dominican Republic economic growth in the past twenty years has not yielded sufficient improvement in access to drinking water services, especially in rural areas where 1.5 million people do not have access to an improved water source (WHO, 2006). Worldwide, strategic development planning in the rural water sector has focused on participatory processes and the use of demand filters to ensure that service levels match community commitment to post-project operation and maintenance. However studies have concluded that an alarmingly high percentage of drinking water systems (20-50%) do not provide service at the design levels and/or fail altogether (up to 90%): BNWP (2009), Annis (2006), and Reents (2003). World Bank, USAID, NGOs, and private consultants have invested significant resources in an effort to determine what components make up an “enabling environment” for sustainable community management of rural water systems (RWS). Research has identified an array of critical factors, internal and external to the community, which affect long term sustainability of water services. Different frameworks have been proposed in order to better understand the linkages between individual factors and sustainability of service. This research proposes a Sustainability Analysis Tool to evaluate the sustainability of RWS, adapted from previous relevant work in the field to reflect the realities in the Dominican Republic. It can be used as a diagnostic tool for government entities and development organizations to characterize the needs of specific communities and identify weaknesses in existing training regimes or support mechanisms. The framework utilizes eight indicators in three categories (Organization/Management, Financial Administration, and Technical Service). Nineteen independent variables are measured resulting in a score of sustainability likely (SL), possible (SP), or unlikely (SU) for each of the eight indicators. Thresholds are based upon benchmarks from the DR and around the world, primary data collected during the research, and the author’s 32 months of field experience. A final sustainability score is calculated using weighting factors for each indicator, derived from Lockwood (2003). The framework was tested using a statistically representative geographically stratified random sample of 61 water systems built in the DR by initiatives of the National Institute of Potable Water (INAPA) and Peace Corps. The results concluded that 23% of sample systems are likely to be sustainable in the long term, 59% are possibly sustainable, and for 18% it is unlikely that the community will be able to overcome any significant challenge. Communities that were scored as unlikely sustainable perform poorly in participation, financial durability, and governance while the highest scores were for system function and repair service. The Sustainability Analysis Tool results are verified by INAPA and PC reports, evaluations, and database information, as well as, field observations and primary data collected during the surveys. Future research will analyze the nature and magnitude of relationships between key factors and the sustainability score defined by the tool. Factors include: gender participation, legal status of water committees, plumber/operator remuneration, demand responsiveness, post construction support methodologies, and project design criteria.

EAU guidelines on surgical treatment of urinary incontinence

CONTEXT The European Association of Urology (EAU) guidelines on urinary incontinence published in March 2012 have been rewritten based on an independent systematic review carried out by the EAU guidelines panel using a sustainable methodology. OBJECTIVE We present a short version here of the full guidelines on the surgical treatment of patients with urinary incontinence, with the aim of dissemination to a wider audience. EVIDENCE ACQUISITION Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches based on Population, Intervention, Comparator, Outcome (PICO) questions. The appraisal of papers was carried out by an international panel of experts, who also collaborated in a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. EVIDENCE SUMMARY The full version of the guidance is available online (www.uroweb.org/guidelines/online-guidelines/). The guidance includes algorithms that refer the reader back to the supporting evidence and have greater accessibility in daily clinical practice. Two original meta-analyses were carried out specifically for these guidelines and are included in this report. CONCLUSIONS These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where high-level evidence is lacking, they present a consensus of expert panel opinion.

La collecte de l'eau: directives pour de bonnes pratiques

La collecte de l’eau est réalisée avec succès depuis des millénaires dans les régions du monde entier – certaines interventions récentes ont également eu un impact local significatif. Pourtant, le potentiel de cette technique reste largement inconnu, non reconnu et non apprécié. Il est temps de transposer à plus grande échelle les « bonnes pratiques » de collecte de l’eau, celles qui ont survécu au temps ou qui ont émergé des nouvelles expériences, après des décennies de focalisation presque exclusive sur la maîtrise des flux d’eau douce dans les rivières et les lacs grâce à des investissements dans des infrastructures d’irrigation.La collecte de l’eau offre des opportunités sous-exploitées pour les systèmes principalement d’exploitation pluviale des zones arides dans le monde en développement. Celle-ci fonctionne mieux précisément dans les zones où la pauvreté rurale est la pire. Quand elle est bien réalisée, son impact est à la fois de réduire la faim et de lutter contre la pauvreté, tout en améliorant la résilience de l’environnement. Ces connaissances sur les technologies de collecte d’eau et sur les milieux dans lesquels elles ont tendance à donner de meilleurs résultats, représentent une véritable richesse cachée. Pour la première fois, ces connaissances sont traitées, rassemblées et rendues disponibles à travers un tel outil organisé, illustré et instructif reliant les technologies aux réseaux des connaissances, outil qui servira aux utilisateurs présumés de ces directives pratiques pour mieux comprendre et mettre en oeuvre leurs choix

[James Edouard de Rothschild] : [Porträt in Eau-fort]

D Mordant sc.

Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology

CONTEXT Most patients with neuro-urological disorders require life-long medical care. The European Association of Urology (EAU) regularly updates guidelines for the diagnosis and treatment of these patients. OBJECTIVE To provide a summary of the 2015 updated EAU Guidelines on Neuro-Urology. EVIDENCE ACQUISITION Structured literature searches in several databases were carried out to update the 2014 guidelines. Levels of evidence and grades of recommendation were assigned where possible. EVIDENCE SYNTHESIS Neurological disorders often cause urinary tract, sexual, and bowel dysfunction. Most neuro-urological patients need life-long care for optimal life expectancy and quality of life. Timely diagnosis and treatment are essential to prevent upper and lower urinary tract deterioration. Clinical assessment should be comprehensive and usually includes a urodynamic investigation. The neuro-urological management must be tailored to the needs of the individual patient and may require a multidisciplinary approach. Sexuality and fertility issues should not be ignored. Numerous conservative and noninvasive possibilities of management are available and should be considered before a surgical approach is chosen. Neuro-urological patients require life-long follow-up and particular attention has to be paid to this aspect of management. CONCLUSIONS The current EAU Guidelines on Neuro-Urology provide an up-to-date overview of the available evidence for adequate diagnosis, treatment, and follow-up of neuro-urological patients. PATIENT SUMMARY Patients with a neurological disorder often suffer from urinary tract, sexual, and bowel dysfunction and life-long care is usually necessary. The update of the EAU Guidelines on Neuro-Urology, summarized in this paper, enables caregivers to provide optimal support to neuro-urological patients. Conservative, noninvasive, or minimally invasive approaches are often possible.

Sur la flore algologique d'eau douce de Bulgarie

Par Dr. St. Petkoff

Suministro de agua potable empresa AGUA-YA

La crisis actual que sufre la Provincia de Mendoza por la falta de agua, hace que este tema sea por demás interesante y problemático. Los pronósticos futuros no son alentadores ya que la falta de conciencia en el uso racional de nuestro vital recurso hace que corramos peligro para el desarrollo en los años venideros. ¿Cómo vamos a actuar y qué medios utilizaremos para revertir esta situación? El propósito de este trabajo de investigación es realizar un análisis sobre la importancia del agua, sus problemas y posibles soluciones, con el fin de lograr un desarrollo sustentable en la provincia de Mendoza.

El agua potable de alta dureza como factor de riesgo para la litiasis renal

El problema planteado en esta investigación es el consumo de agua potable de alta dureza, ¿constituye un factor de riesgo que predispone a la urogénesis de litiasis renal en los habitantes de la ciudad de Malargüe? Los objetivos son: determinar si la ingesta de agua potable de alta dureza es un factor de riesgo predisponente a la urogénesis de litiasis renal en los habitantes de la ciudad de Malargüe, establecer los valores de Ca+ mg/l y la dureza total del agua (Ca CO3mg/l ) de la red, para su comparación con los valores establecidos por el Código Alimentario, OMS y EPAS, describir la prevalencia de litiasis renal por grupo etáreo de la ciudad de Malargüe y comparar el nro. de egresos de pacientes con cálculos renales del Hospital Malargüe con algunos hospitales de la provincia.

Estudio de un sistema de tratamiento de bajo coste para agua potable en contextos de subdesarrollo. Aplicación a Mtanga, Kigoma Rural, Tanzania

La variación en calidad y cantidad de agua a lo largo del año en Tanzania provoca que la población de las zonas rurales se vea sometida a falta de acceso a agua potable. Según la Organización Mundial de la Salud, la distancia a la fuente de agua más próxima debe ser menor a 1000 metros y la espera para obtención del agua no mayor a 30 minutos. A lo largo del artículo se analiza la red de abastecimiento y se presentará el estudio de un sistema de tratamiento de potabilización de agua de bajo coste aplicado a pequeñas comunidades de países en desarrollo. La planta potabilizadora consistirá en un canal sedimentador, un filtro lento de arenas y un sistema de cloración en el depósito. Se analizará cada tratamiento realizado en la planta potabilizadora y su acción sobre la calidad del agua.