Anaemia is a severe public health issue among African preschool-aged children, yet little effective progress has been made towards its amelioration, in part due to difficulties in unravelling its complex, multifactorial aetiology. To determine the current anaemia situation and assess the relative contribution of malaria, intestinal schistosomiasis and infection with soil-transmitted helminths, two separate cross-sectional epidemiological surveys were carried out in Uganda including 573 and 455 preschool-aged children (⩽6 years) living along the shores of Lake Albert and on the islands in Lake Victoria, respectively. Anaemia was found to be a severe public health problem in Lake Albert, affecting 68·9% of children (ninety-five percent confidence intervals (95% CI) 64·9–72·7%), a statistically significant higher prevalence relative to the 27·3% detected in Lake Victoria (95% CI: 23·3–31·7%). After multivariate analysis (controlling for sex and age of the child), the only factor found to be significantly associated with increased odds of anaemia in both lake systems was malaria (Lake Albert, odds ratio (OR)=2·1, 95% CI: 1·4–3·2; Lake Victoria, OR=1·9, 95% CI: 1·2–2·9). Thus intervention strategies primarily focusing on very young children and combating malaria appear to represent the most appropriate use of human and financial resources for the prevention of anaemia in this age group and area. Looking to the future, these activities could be further emphasised within the National Child Health DaysPLUS agenda.

The purpose of this study was to assess the feasibility, acceptability and effect of an in-home water chlorination programme in a rural village. Previous studies at this site showed high levels of faecal coliforms in household water, high diarrhoea rates in children, and enterotoxigenic Escherichia coli and rotaviruses were the most common pathogens isolated from patients. Household water came from a pond and was stored in clay pots. No homes had sanitary facilities. A blind, cross-over trial of treatment of household water with inexpensive hypochlorite by a community health worker was carried out over 18 weeks among 20 families. Water in the clay pots was sampled serially, and symptom surveillance was done by medical students. The programme was generally acceptable to the villagers and no change in water use patterns were apparent. The mean faecal coliform level in the chlorinated water was significantly less than in the placebo treated samples (70 vs 16000 organisms/dl, P < 0·001). People living in houses receiving placebo treatment had a mean of 11·2 days of diarrhoea per year, and the highest rate of 36·7 was among children less than 2 years old. Diarrhoea rates were not significantly different among the participants while exposed to water treated with hypochlorite. We conclude that a low-cost programme of this type, which utilizes community resources, is logistically feasible, appears to be culturally acceptable in this setting, and can result in a marked reduction in water contamination. The lack of effect on diarrhoea rates suggests that improvement in water quality may affect morbidity only when other variables relating to faecal–oral agent transmission are ameliorated at the same time.

Bovine milk contains a number of indigenous proteolytic enzymes, of which plasmin is the most important (Grufferty & Fox, 1988; Bastian & Brown, 1996; Kelly & McSweeney, 2003). Plasmin (EC 3.4.21.7) is a serine proteinase with pH and temperature optima of 7·5 and 37 °C, respectively. In milk, most of the plasmin is present as its inactive precursor, plasminogen, which is converted to active plasmin by plasminogen activators (PA) present in milk, e.g., urokinase-type (u-PA) and tissue-type PA (t-PA) (Bastian & Brown, 1996). Since plasmin, plasminogen and PA are associated with casein micelles, they are incorporated into cheese curd, while plasmin inhibitors and inhibitors of PA are lost with the whey. Plasmin incorporated in cheese curd acts on its substrate, the caseins, contributing significantly to primary proteolysis during ripening (Upadhyay et al. 2004b).