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Kikuchi M. Influence of sanitation facilities on diarrhea prevalence among children aged below 5 years in flood-prone areas of Bangladesh: a multilevel analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:97925-97935. [PMID: 37603245 PMCID: PMC10495509 DOI: 10.1007/s11356-023-29373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023]
Abstract
Although the improvement of sanitation facilities has been a major contributor to improving public health, it is not guaranteed to prevent negative health outcomes. This is especially true in areas affected by severe natural disasters, such as flooding or extreme rainfall. Previous studies have examined the association between catastrophic natural disasters and negative health outcomes. However, studies on disaster-prone areas are limited. This study focused on the impact of flood risks and examined whether the improvement of sanitation facilities would be sufficient to suppress the prevalence of diarrhea in flood-prone areas. Two secondary datasets including geodata on flood-prone areas were used for the analysis: one each was obtained from the Bangladesh Demographic and Health Survey and Bangladesh Agricultural Research Council. Two models with categorizations of sanitation facilities based on containment type and excreta flow were applied for analysis. Results showed that the severe flood-prone areas and "diffused" type of sanitation, where the feces are diffused without any containment, had significant positive associations with diarrhea prevalence; however, the interaction between them was negative. Moderate flood-prone areas had a significant positive association with diarrhea prevalence; however, the interaction with unimproved sanitation, which includes containment without clear partition from feces, was significantly negative. These findings indicate that improved sanitation or containment type of sanitation may not positively contribute to the prevention of diarrhea in these severe- and moderate-flood prone areas. The urgent need for alternative sanitation technologies should be addressed in flood-prone regions.
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Affiliation(s)
- Michiko Kikuchi
- Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa City, Chiba Prefecture, 277-8561, Japan.
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52
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Rothstein AP, Jesser KJ, Feistel DJ, Konstantinidis KT, Trueba G, Levy K. Population genomics of diarrheagenic Escherichia coli uncovers high connectivity between urban and rural communities in Ecuador. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023; 113:105476. [PMID: 37392822 PMCID: PMC10599324 DOI: 10.1016/j.meegid.2023.105476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
Human movement may be an important driver of transmission dynamics for enteric pathogens but has largely been underappreciated except for international 'travelers' diarrhea or cholera. Phylodynamic methods, which combine genomic and epidemiological data, are used to examine rates and dynamics of disease matching underlying evolutionary history and biogeographic distributions, but these methods often are not applied to enteric bacterial pathogens. We used phylodynamics to explore the phylogeographic and evolutionary patterns of diarrheagenic E. coli in northern Ecuador to investigate the role of human travel in the geographic distribution of strains across the country. Using whole genome sequences of diarrheagenic E. coli isolates, we built a core genome phylogeny, reconstructed discrete ancestral states across urban and rural sites, and estimated migration rates between E. coli populations. We found minimal structuring based on site locations, urban vs. rural locality, pathotype, or clinical status. Ancestral states of phylogenomic nodes and tips were inferred to have 51% urban ancestry and 49% rural ancestry. Lack of structuring by location or pathotype E. coli isolates imply highly connected communities and extensive sharing of genomic characteristics across isolates. Using an approximate structured coalescent model, we estimated rates of migration among circulating isolates were 6.7 times larger for urban towards rural populations compared to rural towards urban populations. This suggests increased inferred migration rates of diarrheagenic E. coli from urban populations towards rural populations. Our results indicate that investments in water and sanitation prevention in urban areas could limit the spread of enteric bacterial pathogens among rural populations.
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Affiliation(s)
- Andrew P. Rothstein
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Kelsey J. Jesser
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Dorian J. Feistel
- School of a Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Konstantinos T. Konstantinidis
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
- School of a Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Gabriel Trueba
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
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53
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Mertens A, Benjamin-Chung J, Colford JM, Coyle J, van der Laan MJ, Hubbard AE, Rosete S, Malenica I, Hejazi N, Sofrygin O, Cai W, Li H, Nguyen A, Pokpongkiat NN, Djajadi S, Seth A, Jung E, Chung EO, Jilek W, Subramoney V, Hafen R, Häggström J, Norman T, Brown KH, Christian P, Arnold BF. Causes and consequences of child growth faltering in low-resource settings. Nature 2023; 621:568-576. [PMID: 37704722 PMCID: PMC10511328 DOI: 10.1038/s41586-023-06501-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/31/2023] [Indexed: 09/15/2023]
Abstract
Growth faltering in children (low length for age or low weight for length) during the first 1,000 days of life (from conception to 2 years of age) influences short-term and long-term health and survival1,2. Interventions such as nutritional supplementation during pregnancy and the postnatal period could help prevent growth faltering, but programmatic action has been insufficient to eliminate the high burden of stunting and wasting in low- and middle-income countries. Identification of age windows and population subgroups on which to focus will benefit future preventive efforts. Here we use a population intervention effects analysis of 33 longitudinal cohorts (83,671 children, 662,763 measurements) and 30 separate exposures to show that improving maternal anthropometry and child condition at birth accounted for population increases in length-for-age z-scores of up to 0.40 and weight-for-length z-scores of up to 0.15 by 24 months of age. Boys had consistently higher risk of all forms of growth faltering than girls. Early postnatal growth faltering predisposed children to subsequent and persistent growth faltering. Children with multiple growth deficits exhibited higher mortality rates from birth to 2 years of age than children without growth deficits (hazard ratios 1.9 to 8.7). The importance of prenatal causes and severe consequences for children who experienced early growth faltering support a focus on pre-conception and pregnancy as a key opportunity for new preventive interventions.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Jeremy Coyle
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Mark J van der Laan
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Sonali Rosete
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ivana Malenica
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nima Hejazi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Oleg Sofrygin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wilson Cai
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Haodong Li
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anna Nguyen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Nolan N Pokpongkiat
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Stephanie Djajadi
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Anmol Seth
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther Jung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Esther O Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Wendy Jilek
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | | | - Ryan Hafen
- Hafen Consulting, West Richland, WA, USA
| | | | - Thea Norman
- Quantitative Sciences, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
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54
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Jung DK, Tan ST, Hemlock C, Mertens AN, Stewart CP, Rahman MZ, Ali S, Raqib R, Grembi JA, Karim MR, Shahriar S, Roy AK, Abdelrahman S, Shoab AK, Famida SL, Hossen MS, Mutsuddi P, Akther S, Rahman M, Unicomb L, Hester L, Granger DA, Erhardt J, Naved RT, Al Mamun MM, Parvin K, Colford JM, Fernald LC, Luby SP, Dhabhar FS, Lin A. Micronutrient status during pregnancy is associated with child immune status in rural Bangladesh. Curr Dev Nutr 2023; 7:101969. [PMID: 37560460 PMCID: PMC10407622 DOI: 10.1016/j.cdnut.2023.101969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023] Open
Abstract
Background Poor immune function increases children's risk of infection and mortality. Several maternal factors during pregnancy may affect infant immune function during the postnatal period. Objectives We aimed to evaluate whether maternal micronutrients, stress, estriol, and immune status during the first or second trimester of pregnancy were associated with child immune status in the first two years after birth. Methods We conducted observational analyses within the water, sanitation, and hygiene (WASH) Benefits Bangladesh randomized controlled trial. We measured biomarkers in 575 pregnant women and postnatally in their children. Maternal biomarkers measured during the first and second trimester of pregnancy included nutrition status via vitamin D (25-hydroxy-D [25(OH)D]), ferritin, soluble transferrin receptor (sTfR), and retinol-binding protein (RBP); cortisol; estriol. Immune markers were assessed in pregnant women at enrollment and their children at ages 14 and 28 mo, including C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP), and 13 cytokines (including IFN-γ). We generated a standardized sum score of log-transformed cytokines. We analyzed IFN-γ individually because it is a critical immunoregulatory cytokine. All outcomes were prespecified. We used generalized additive models and reported the mean difference and 95% confidence intervals at the 25th and 75th percentiles of exposure distribution. Results At child age 14 mo, concentrations of maternal RBP were inversely associated with the cytokine sum score in children (-0.34 adjusted difference between the 25th and 75th percentile [95% confidence interval -0.61, -0.07]), and maternal vitamin A deficiency was positively associated with the cytokine sum score in children (1.02 [0.13, 1.91]). At child age of 28 mo, maternal RBP was positively associated with IFN-γ in children (0.07 [0.01, 0.14]), whereas maternal vitamin A deficiency was negatively associated with child AGP (-0.07 [-0.13, -0.02]). Maternal iron deficiency was associated with higher AGP concentrations in children at age 14 mo (0.13 [0.04, 0.23]), and maternal sTfR concentrations were positively associated with child CRP concentrations at age 28 mo (0.18 [0, 0.36]). Conclusion Maternal deficiencies in vitamin A or iron during the first 2 trimesters of pregnancy may shape the trajectory of a child's immune status.
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Affiliation(s)
- Da Kyung Jung
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Sophia T. Tan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
| | - Caitlin Hemlock
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Andrew N. Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Christine P. Stewart
- Institute for Global Nutrition, University of California Davis, Davis, CA, United States
| | - Md Ziaur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Shahjahan Ali
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Rubhana Raqib
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Jessica A. Grembi
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
| | - Mohammed Rabiul Karim
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Sunny Shahriar
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Anjan Kumar Roy
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Sarah Abdelrahman
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Abul K. Shoab
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Syeda L. Famida
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Saheen Hossen
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Palash Mutsuddi
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Salma Akther
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Lisa Hester
- Department of Medicine, University of Maryland, Baltimore, MD USA
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California Irvine, Irvine, CA, United States
| | | | | | - Md Mahfuz Al Mamun
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Kausar Parvin
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - John M. Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Lia C.H. Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
| | - Firdaus S. Dhabhar
- Department of Psychiatry & Behavioral Sciences, Department of Microbiology and Immunology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, United States
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55
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Chari S, Mbonane TP, Van Wyk RH. Social and Environmental Determinants of Diarrheal Diseases among Children under Five Years in Epworth Township, Harare. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1173. [PMID: 37508671 PMCID: PMC10378401 DOI: 10.3390/children10071173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
Children five years or younger in low- and middle-income countries (LMICs) are severely affected by diarrheal disease, especially in the sub-Saharan region. Hence, this study aimed at determining the prevalence and determinants of diarrhoea disease among children under 5 years in Epworth Township, Zimbabwe. A descriptive cross-sectional study was conducted at a local clinic in Epworth Township, Harare. A convenience sampling strategy was used to recruit study participants for participation, and 386 children were enrolled in the study. The majority were male children (n = 229; 59.3%), whereas there were more female caregivers (n = 370; 95.9%) than male caregivers (n = 16; 4.1%). The prevalence of diarrhoea disease in the study was 25.1%. The determinants associated with diarrhoea were being partially vaccinated (AOR 2.38, CI: 95% 2.80-8.22), collecting water more than 1 kilometre from a household (AOR 4.55; CI: 95% 2.10-9.85), and using untreated water (AOR 6.22; CI: 95% 2.13-18.20). The age of the caregiver (being older than 21) and using a clean water container (AOR 0.05; CI: 95% 0.02-0.13) were protective factors. Provision of primary health care, especially the prevention of a disease through immunization and rendering environmental health services, could reduce the prevalence of diarrhoea in disadvantaged townships.
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Affiliation(s)
- Sandra Chari
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2000, South Africa
| | - Thokozani Patrick Mbonane
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2000, South Africa
| | - Renay Helouise Van Wyk
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2000, South Africa
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56
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Rahaman MR, Dear K, Satter SM, Tong M, Milazzo A, Marshall H, Varghese BM, Rahman M, Bi P. Short-Term Effects of Climate Variability on Childhood Diarrhoea in Bangladesh: Multi-Site Time-Series Regression Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6279. [PMID: 37444126 PMCID: PMC10341980 DOI: 10.3390/ijerph20136279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
The aim of this study was to estimate the effects of climate on childhood diarrhoea hospitalisations across six administrative divisions in Bangladesh and to provide scientific evidence for local health authorities for disease control and prevention. Fortnightly hospital admissions (August/2013-June/2017) for diarrhoea in children under five years of age, and fortnightly average maximum temperature, relative humidity and rainfall recordings for six administrative divisions were modelled using negative binomial regression with distributed lag linear terms. Flexible spline functions were used to adjust models for seasonality and long-term trends. During the study period, 25,385 diarrhoea cases were hospitalised. Overall, each 1 °C rise in maximum temperature increased diarrhoea hospitalisations by 4.6% (IRR = 1.046; 95% CI, 1.007-1.088) after adjusting for seasonality and long-term trends in the unlagged model. Using lagged effects of maximum temperature, and adjusting for relative humidity and rainfall for each of the six administrative divisions, the relationship between maximum temperature and diarrhoea hospitalisations varied between divisions, with positive and negative effect estimates. The temperature-diarrhoea association may be confounded by seasonality and long-term trends. Our findings are a reminder that the effects of climate change may be heterogeneous across regions, and that tailored diarrhoea prevention strategies need to consider region-specific recommendations rather than relying on generic guidelines.
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Affiliation(s)
- Md Rezanur Rahaman
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2601, Australia
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Keith Dear
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Syed M. Satter
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Michael Tong
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Helen Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia
- Women’s and Children’s Health Network, Adelaide, SA 5006, Australia
| | - Blesson M. Varghese
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Mahmudur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
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Jannat K, Agho KE, Parvez SM, Rahman M, Thomson R, Amin MB, Merom D. The Effects of Yogurt Supplementation and Nutritional Education on Malnourished Infants: A Pilot RCT in Dhaka's Slums. Nutrients 2023; 15:2986. [PMID: 37447313 DOI: 10.3390/nu15132986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Our objective was to quantify the effects of yogurt supplementation and nutrition education over three months on the linear growth of infants at risk of stunting. We conducted a three-arm pilot randomized controlled trial: (1) nutrition education for mothers; (2) nutrition education plus a daily yogurt supplement (50 g) for the index child; and (3) usual care (control). Dyads of children aged 4-6 months and at risk of stunting [length-for-age z-score (LAZ) ≤ -1 SD and >-2 SD] and their mothers with ≤10 years of education were eligible for the study. Participants were recruited from five slum areas in Dhaka, Bangladesh. Intention-to-treat (N = 162) and complete-case analyses (N = 127) showed no between-group statistically significant differences in LAZ or weight-for-age (WAZ). However, the yogurt group showed greater change in linear growth compared to the control (LAZ: mean difference 0.20, 95% CI: -0.06, 0.47, p-value 0.13), which was also slightly greater than the education-only group. Children in the yogurt plus group were five times (95% CI: 0.80, 31.80, p-value 0.09) more likely to meet the minimum dietary diversity (MDD) score compared to the control. A 3-month follow-up of this pilot study did not demonstrate that yogurt was beneficial to linear growth. However, there were encouraging trends that merit replication of the intervention with larger samples and longer follow-ups.
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Affiliation(s)
- Kaniz Jannat
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Kingsley Emwinyore Agho
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Sarker Masud Parvez
- Environmental Interventions Unit, Laboratory of Food Safety and One Health, Infectious Disease Division, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Mahbubur Rahman
- Environmental Interventions Unit, Laboratory of Food Safety and One Health, Infectious Disease Division, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Russell Thomson
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Mohammed Badrul Amin
- Environmental Interventions Unit, Laboratory of Food Safety and One Health, Infectious Disease Division, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Dafna Merom
- Centre for Research in Mathematics and Data Science, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Fontaine F, Turjeman S, Callens K, Koren O. The intersection of undernutrition, microbiome, and child development in the first years of life. Nat Commun 2023; 14:3554. [PMID: 37322020 PMCID: PMC10272168 DOI: 10.1038/s41467-023-39285-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
Undernutrition affects about one out of five children worldwide. It is associated with impaired growth, neurodevelopment deficits, and increased infectious morbidity and mortality. Undernutrition, however, cannot be solely attributed to a lack of food or nutrient deficiency but rather results from a complex mix of biological and environmental factors. Recent research has shown that the gut microbiome is intimately involved in the metabolism of dietary components, in growth, in the training of the immune system, and in healthy development. In this review, we look at these features in the first three years of life, which is a critical window for both microbiome establishment and maturation and child development. We also discuss the potential of the microbiome in undernutrition interventions, which could increase efficacy and improve child health outcomes.
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Affiliation(s)
- Fanette Fontaine
- Food and Agriculture Organization of the United Nations, Rome, Italy
- Université Paris- Cité, 75006, Paris, France
| | - Sondra Turjeman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Karel Callens
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Omry Koren
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
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59
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Holcomb DA, Monteiro V, Capone D, António V, Chiluvane M, Cumbane V, Ismael N, Knee J, Kowalsky E, Lai A, Linden Y, Mataveia E, Nala R, Rao G, Ribeiro J, Cumming O, Viegas E, Brown J. Long-term impacts of an urban sanitation intervention on enteric pathogens in children in Maputo city, Mozambique: study protocol for a cross-sectional follow-up to the Maputo Sanitation (MapSan) trial 5 years postintervention. BMJ Open 2023; 13:e067941. [PMID: 37290945 PMCID: PMC10254709 DOI: 10.1136/bmjopen-2022-067941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION We previously assessed the effect of an onsite sanitation intervention in informal neighbourhoods of urban Maputo, Mozambique on enteric pathogen detection in children after 2 years of follow-up (Maputo Sanitation (MapSan) trial, ClinicalTrials.gov: NCT02362932). We found significant reductions in Shigella and Trichuris prevalence but only among children born after the intervention was delivered. In this study, we assess the health impacts of the sanitation intervention after 5 years among children born into study households postintervention. METHODS AND ANALYSIS We are conducting a cross-sectional household study of enteric pathogen detection in child stool and the environment at compounds (household clusters sharing sanitation and outdoor living space) that received the pour-flush toilet and septic tank intervention at least 5 years prior or meet the original criteria for trial control sites. We are enrolling at least 400 children (ages 29 days to 60 months) in each treatment arm. Our primary outcome is the prevalence of 22 bacterial, protozoan, and soil transmitted helminth enteric pathogens in child stool using the pooled prevalence ratio across the outcome set to assess the overall intervention effect. Secondary outcomes include the individual pathogen detection prevalence and gene copy density of 27 enteric pathogens (including viruses); mean height-for-age, weight-for-age, and weight-for-height z-scores; prevalence of stunting, underweight, and wasting; and the 7-day period prevalence of caregiver-reported diarrhoea. All analyses are adjusted for prespecified covariates and examined for effect measure modification by age. Environmental samples from study households and the public domain are assessed for pathogens and faecal indicators to explore environmental exposures and monitor disease transmission. ETHICS AND DISSEMINATION Study protocols have been reviewed and approved by human subjects review boards at the Ministry of Health, Republic of Mozambique and the University of North Carolina at Chapel Hill. Deidentified study data will be deposited at https://osf.io/e7pvk/. TRIAL REGISTRATION NUMBER ISRCTN86084138.
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Affiliation(s)
- David A Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Vanessa Monteiro
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Drew Capone
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Virgílio António
- Division of Biotechnology and Genetics, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Márcia Chiluvane
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Victória Cumbane
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Nália Ismael
- Division of Biotechnology and Genetics, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Jackie Knee
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Erin Kowalsky
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amanda Lai
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yarrow Linden
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elly Mataveia
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Rassul Nala
- Division of Parasitology, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Gouthami Rao
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jorge Ribeiro
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Edna Viegas
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Hasan MM, Asif CAA, Barua A, Banerjee A, Kalam MA, Kader A, Wahed T, Noman MW, Talukder A. Association of access to water, sanitation and handwashing facilities with undernutrition of children below 5 years of age in Bangladesh: evidence from two population-based, nationally representative surveys. BMJ Open 2023; 13:e065330. [PMID: 37263705 DOI: 10.1136/bmjopen-2022-065330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To examine the association between household access to water, sanitation and handwashing (WaSH) facilities and child undernutrition in Bangladesh. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study of children less than 5 years using data collected from the 2019 Multiple Indicator Cluster Survey (MICS) and the 2017-2018 Bangladesh Demographic and Health Survey (BDHS). OUTCOME MEASURES Stunting, wasting and underweight, defined as a Z-score <-2 SD for height-for-age, weight-for-height and weight-for-age, respectively. We applied hierarchical multiple binary logistic regression models. RESULTS Among 30 514 children 0-59 months, there was a high prevalence of child undernutrition (MICS: 28.0% stunted, 9.8% wasted, 22.6% underweight; BDHS: 30.8% stunted, 8.4% wasted, 21.7% underweight). Most children came from households lacking basic sanitation (MICS: 39.1%, BDHS: 55.3%) or handwashing facilities (MICS: 43.8%, BDHS: 62.6%). Children from households without access to WaSH facilities experienced the highest rates of undernutrition. Exposure-specific adjusted logistic regression models showed that a lack of access to improved water sources was associated with greater odds of wasting (MICS: adjusted OR (AOR) 1.36, 95% CI 1.00 to 1.85, p<0.05); basic sanitation facility with higher rates of stunting (MICS: 1.13, 1.04 to 1.23, p<0.01) and underweight (BDHS: 1.18, 1.02 to 1.37, p<0.05); and a lack of handwashing facilities with stunting (BDHS: 1.27, 1.10 to 1.48, p<0.01) and underweight (MICS: 1.10, 1.01 to 1.19, p<0.05). In fully adjusted models, no basic sanitation facility was associated with higher odds of stunting (MICS: AOR 1.12, 1.03 to 1.22, p<0.01) and a lack of handwashing facilities with higher odds of underweight (BDHS: AOR 1.30, 1.10 to 1.54, p<0.01;MICS: AOR 1.09, 1.01 to 1.19, p<0.05). CONCLUSION These findings demonstrate a significant association between poor household WaSH facilities and high prevalence of child undernutrition. Improving WaSH may help reduce child undernutrition in Bangladesh.
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Affiliation(s)
- Md Mehedi Hasan
- Learning and Reflection Unit, Helen Keller International, Dhaka, Bangladesh
| | | | - Alina Barua
- Learning and Reflection Unit, Helen Keller International, Dhaka, Bangladesh
| | - Archis Banerjee
- Learning and Reflection Unit, Helen Keller International, Dhaka, Bangladesh
| | - Md Abul Kalam
- Learning and Reflection Unit, Helen Keller International, Dhaka, Bangladesh
| | - Abdul Kader
- Learning and Reflection Unit, Helen Keller International, Dhaka, Bangladesh
| | - Tasnuva Wahed
- Learning and Reflection Unit, Helen Keller International, Dhaka, Bangladesh
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Arnold BF, Rerolle F, Tedijanto C, Njenga SM, Rahman M, Ercumen A, Mertens A, Pickering A, Lin A, Arnold CD, Das K, Stewart CP, Null C, Luby SP, Colford JM, Hubbard AE, Benjamin-Chung J. Geographic pair-matching in large-scale cluster randomized trials. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.30.23289317. [PMID: 37205361 PMCID: PMC10187339 DOI: 10.1101/2023.04.30.23289317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Custer randomized trials are often used to study large-scale public health interventions. In large trials, even small improvements in statistical efficiency can have profound impacts on the required sample size and cost. Pair matched randomization is one strategy with potential to increase trial efficiency, but to our knowledge there have been no empirical evaluations of pair-matching in large-scale, epidemiologic field trials. Location integrates many socio-demographic and environmental characteristics into a single feature. Here, we show that geographic pair-matching leads to substantial gains in statistical efficiency for 14 child health outcomes that span growth, development, and infectious disease through a re-analysis of two large-scale trials of nutritional and environmental interventions in Bangladesh and Kenya. We estimate relative efficiencies ≥1.1 for all outcomes assessed and relative efficiencies regularly exceed 2.0, meaning an unmatched trial would have needed to enroll at least twice as many clusters to achieve the same level of precision as the geographically pair-matched design. We also show that geographically pair-matched designs enable estimation of fine-scale, spatially varying effect heterogeneity under minimal assumptions. Our results demonstrate broad, substantial benefits of geographic pair-matching in large-scale, cluster randomized trials.
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Affiliation(s)
- Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Francois Rerolle
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Christine Tedijanto
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Sammy M. Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
| | - Andrew Mertens
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Amy Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA
| | - Audrie Lin
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | | | - Kishor Das
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | | | | | - Stephen P. Luby
- Infectious diseases and Geographic Medicine, Stanford University, Stanford, California
| | - John M. Colford
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Alan E. Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Jade Benjamin-Chung
- Chan Zuckerberg Biohub, San Francisco, CA
- Department of Epidemiology and Population Health, Stanford University, CA, USA
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Islam M, Rahman M, Kafi MAH, Unicomb L, Rahman M, Mertens A, Benjamin-Chung J, Arnold BF, Colford JM, Luby SP, Ercumen A. Assessing sustained uptake of latrine and child feces management interventions: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh 1-3.5 years after intervention initiation. Int J Hyg Environ Health 2023; 250:114149. [PMID: 36913791 PMCID: PMC10186382 DOI: 10.1016/j.ijheh.2023.114149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/27/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND Sanitation interventions typically result in modest increases in latrine access, and any gains in latrine access and use are often not sustained over time. Sanitation programs also rarely include child-focused interventions such as potties. We aimed to assess the sustained effect of a multi-component sanitation intervention on access to and use of latrines and child feces management tools in rural Bangladesh. METHODS We conducted a longitudinal substudy nested within the WASH Benefits randomized controlled trial. The trial provided latrine upgrades, child potties and sani-scoops for feces removal, along with behavior change promotion to encourage use of the delivered hardware. Promotion visits to intervention recipients were frequent during the first 2 years after intervention initiation, decreased in frequency between years 2-3, and ceased after 3 years. We enrolled a random subset of 720 households from the sanitation and control arms of the trial in a substudy and visited them quarterly between 1 and 3.5 years after intervention initiation. At each visit, field staff recorded sanitation-related behaviors through spot-check observations and structured questionnaires. We assessed intervention effects on observed indicators of hygienic latrine access, potty use and sani-scoop use and investigated whether these effects were modified by duration of follow-up, ongoing behavior change promotion and household characteristics. RESULTS The intervention increased hygienic latrine access from 37% among controls to 94% in the sanitation arm (p < 0.001). Access among intervention recipients remained high 3.5 years after intervention initiation, including periods with no active promotion. Gains in access were higher among households with less education, less wealth and larger number of residents. The intervention increased availability of child potties from 29% among controls to 98% in the sanitation arm (p < 0.001). However, fewer than 25% of intervention households reported exclusive child defecation in a potty or had observed indicators of potty and sani-scoop use, and gains in potty use declined over the follow-up period, even with ongoing promotion. CONCLUSION Our findings from an intervention that provided free products and intensive initial behavior change promotion suggest a sustained increase in hygienic latrine access up to 3.5 years after intervention initiation but infrequent use of child feces management tools. Studies should investigate strategies to ensure sustained adoption of safe child feces management practices.
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Affiliation(s)
- Mahfuza Islam
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh.
| | - Mahbubur Rahman
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | | | - Leanne Unicomb
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Mostafizur Rahman
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Jade Benjamin-Chung
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Stephen P Luby
- Woods Institute for the Environment, Stanford University, Stanford, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
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Jensen PKM, Hossain ZZ, Sultana R, Ferdous J, Almeida S, Begum A. Introduction of the Personal Domain in Water Sanitation and Hygiene (WASH), a New Approach to Identify Missing Health Impacts. Trop Med Infect Dis 2023; 8:tropicalmed8050252. [PMID: 37235300 DOI: 10.3390/tropicalmed8050252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
The water sanitation and hygiene (WASH) sector has provided beneficiaries in low and middle-income countries with latrines and clean water for decades. However, we still need good evidence documenting the expected health impact. This paper investigates why we lack this evidence and ways to move forward. Using mTEC agar, we monitored E. coli contamination on selected "hotspot" surfaces within the kitchen environments of 32 low-income households in Dhaka, Bangladesh, every six weeks for two years. Despite being washed, the highest average contamination was found on food plates, at 253 cfu/10 cm2, followed by cutting knives, with 240 cfu/10 cm2. The drinking vessel surfaces and the latrine doorknobs had the lowest contaminations, with E. coli means of 167 and 73 cfu/10 cm2, respectively. These findings imply a need to measure an individual's pathogen exposure as close to the mouth as possible to estimate the true pathogen exposure. The paper proposes introducing the new "personal domain"-the point of consumption-as the physical sphere in which WASH interventions should be assessed. With this approach, we can observe and quantify the different pathogen exposure routes and, with this, further improve WASH interventions.
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Affiliation(s)
- Peter Kjær Mackie Jensen
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 22, 1014 Copenhagen, Denmark
| | - Zenat Zebin Hossain
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 22, 1014 Copenhagen, Denmark
- Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh
- Department of Public Health, School of Pharmacy and Public Health, Independent University, Dhaka 1229, Bangladesh
| | - Rebeca Sultana
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 22, 1014 Copenhagen, Denmark
- icddr,b, Dhaka 1212, Bangladesh
- Institute of Health Economics, University of Dhaka, Dhaka 1000, Bangladesh
| | - Jannatul Ferdous
- Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh
| | - Sara Almeida
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 22, 1014 Copenhagen, Denmark
| | - Anowara Begum
- Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh
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Changes in water treatment, hygiene practices, household floors, and child health in times of Covid-19: A longitudinal cross-sectional survey in Surkhet District, Nepal. Int J Hyg Environ Health 2023; 249:114138. [PMID: 36821912 PMCID: PMC9925420 DOI: 10.1016/j.ijheh.2023.114138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/25/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Consistent and effective practice of water treatment, sanitation, and hygiene (WASH) behaviour is an indispensable requisite for realizing health improvements among children living in low-income areas with challenging hygienic conditions. Sustainably achieving such a behaviour change is challenging but more likely to be realized during epidemics, when health threats are high and the dissemination of information on preventative measures is intense. Our study conducted cross-sectional surveys in Surkhet District Nepal, before and during the Covid-19 pandemic to assess the impact of water safety interventions and hygiene training implemented before and during the pandemic on WASH conditions and practices and to assess the association of these changes with child health. METHODS Information on WASH infrastructure, WASH behaviour, nutrition, and child health, including on parasitic infections, was obtained before and during the Covid-19 pandemic in spring 2018 and spring 2021, from 589 children aged between 6 months and 10 years and their caregivers. Data was collected through quantitative, structured face-to-face interviews, observations, health examinations of children including anthropometric measurements, analysis of children's stool, and water quality analysis. The association of changes in WASH factors with changes in child health was analysed using multivariate generalized estimating equations for repeated measures. RESULTS Water safety management was significantly improved by the introduction of chlorination to piped water supply systems, which served 40% of households. In addition, the percentage of households using a ceramic water filter increased from 12.2% to 34.8%. Large and significant changes were observed in handwashing behaviour (frequency, use of soap and washing at critical times) and infrastructure: 35% of households constructed a new handwashing station. Kitchen and household hygiene also improved. An additional 22% of households improved the cleanliness of the toilet. The number of houses with a cemented floor increased by 20%. WASH changes were significantly associated with improved child health: the chlorination of piped water supply reduced odds ratios for diarrhoea (OR = 0.36, 95% CI = 0.15-0.88, p = 0.025), respiratory difficulties (OR = 0.39, 95% CI = 0.16-0.92, p = 0.033), fever (OR = 0.42, 95% CI = 0.26-0.71, p = 0.001) and cough (OR = 0.58, 95% CI = 0.36-0.93, p = 0.024), and. The frequency of handwashing with soap was associated with significantly reduced odds ratios for infections with Giardia lamblia (OR = 0.68, 95% CI = 0.50-0.91, p = 0.011), stunting and wasting (OR = 0.75, 95% CI = 0.66-0.92, p = 0.003) and fever (OR = 0.85, 95% CI = 0.75-0.96, p = 0.008),. The presence of a handwashing station at baseline was associated with significantly reduced odds ratios for respiratory difficulties (OR = 0.45, 95% CI = 0.26-0.78, p = 0.004). The construction of a handwashing station between baseline and endline was significantly associated with reduced odds ratios for pale conjunctiva (OR = 0.32, 95% CI = 0.17-0.60, p < 0.001), which is a clinical sign of iron deficiency and anaemia, respiratory difficulties (OR = 0.39, 95% CI = 0.17-0.89, p = 0.026) and cough (OR = 0.44, 95% CI = 0.26-0.76, p = 0.003). Using a clean container for the transport of drinking water was significantly associated with reduced odds ratios for infections with Giardia lamblia (OR = 0.39, 95% CI = 0.16-0.93, p = 0.033) and diarrhoea (OR = 0.48, 95% CI = 0.24-0.96, p = 0.038). Similarly, a cemented floor in the household was significantly associated with reduced odd ratios for diarrhoea (OR = 0.38, 95% CI = 0.16-0.87, p = 0.022) and infections with Giardia lamblia (OR = 0.44, 95% CI = 0.19-1.02, p = 0.056). CONCLUSION WASH training and the promotion of preventative measures during the Covid-19 pandemic supported improved water safety management and hygiene behaviour, which resulted in a reduction in infectious diseases among children in the study area.
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Sharma Waddington H, Masset E, Bick S, Cairncross S. Impact on childhood mortality of interventions to improve drinking water, sanitation, and hygiene (WASH) to households: Systematic review and meta-analysis. PLoS Med 2023; 20:e1004215. [PMID: 37079510 PMCID: PMC10118100 DOI: 10.1371/journal.pmed.1004215] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In low- and middle-income countries (L&MICs), the biggest contributing factors to the global burden of disease in childhood are deaths due to respiratory illness and diarrhoea, both of which are closely related to use of water, sanitation, and hygiene (WASH) services by households. However, current estimates of the health impacts of WASH interventions use self-reported morbidity, which may fail to capture longer-term or more severe impacts. Reported mortality is thought to be less prone to bias than other reported measures. This study aimed to answer the question: What are the impacts of WASH interventions on reported childhood mortality in L&MICs? METHODS AND FINDINGS We conducted a systematic review and meta-analysis, using a published protocol. Systematic searches of 11 academic databases and trial registries, plus organisational repositories, were undertaken to locate studies of WASH interventions, which were published in peer review journals or other sources (e.g., organisational reports and working papers). Intervention studies of WASH improvements implemented under endemic disease circumstances in L&MICs were eligible, which reported findings at any time until March 2020. We used the participant flow data supplied in response to journal editors' calls for greater transparency. Data were collected by two authors working independently. We included evidence from 24 randomized and 11 nonrandomized studies of WASH interventions from all global regions, incorporating 2,600 deaths. Effects of 48 WASH treatment arms were included in analysis. We critically appraised and synthesised evidence using meta-analysis to improve statistical power. We found WASH interventions are associated with a significant reduction of 17% in the odds of all-cause mortality in childhood (OR = 0.83, 95% CI = 0.74, 0.92, evidence from 38 interventions), and a significant reduction in diarrhoea mortality of 45% (OR = 0.55, 95% CI = 0.35, 0.84; 10 interventions). Further analysis by WASH technology indicated interventions providing improved water in quantity to households were most consistently associated with reductions in all-cause mortality. Community-wide sanitation was most consistently associated with reductions in diarrhoea mortality. Around one-half of the included studies were assessed as being at "moderate risk of bias" in attributing mortality in childhood to the WASH intervention, and no studies were found to be at "low risk of bias." The review should be updated to incorporate additional published and unpublished participant flow data. CONCLUSIONS The findings are congruent with theories of infectious disease transmission. Washing with water presents a barrier to respiratory illness and diarrhoea, which are the two biggest contributors to all-cause mortality in childhood in L&MICs. Community-wide sanitation halts the spread of diarrhoea. We observed that evidence synthesis can provide new findings, going beyond the underlying data from trials to generate crucial insights for policy. Transparent reporting in trials creates opportunities for research synthesis to answer questions about mortality, which individual studies of interventions cannot be reliably designed to address.
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Affiliation(s)
- Hugh Sharma Waddington
- Environmental Health Group, Department of Disease Control, London School of Hygiene and Tropical Medicine (LSHTM), London International Development Centre (LIDC), London, United Kingdom
| | - Edoardo Masset
- Department of Public Health, Environments and Society, LSHTM, and Deputy Director, Centre of Excellence for Development Impact and Learning (CEDIL), LIDC, London, United Kingdom
| | - Sarah Bick
- Environmental Health Group, Department of Disease Control, LSHTM, London, United Kingdom
| | - Sandy Cairncross
- Environmental Health Group, Department of Disease Control, LSHTM, London, United Kingdom
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Levy K, Garn JV, Cumbe ZA, Muneme B, Fagnant-Sperati CS, Hubbard S, Júnior A, Manuel JL, Mangamela M, McGunegill S, Miller-Petrie MK, Snyder JS, Victor C, Waller LA, Konstantinidis KT, Clasen TF, Brown J, Nalá R, Freeman MC. Study design and rationale for the PAASIM project: a matched cohort study on urban water supply improvements and infant enteric pathogen infection, gut microbiome development and health in Mozambique. BMJ Open 2023; 13:e067341. [PMID: 36863743 PMCID: PMC9990653 DOI: 10.1136/bmjopen-2022-067341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Despite clear linkages between provision of clean water and improvements in child health, limited information exists about the health impacts of large water infrastructure improvements in low-income settings. Billions of dollars are spent annually to improve urban water supply, and rigorous evaluation of these improvements, especially targeting informal settlements, is critical to guide policy and investment strategies. Objective measures of infection and exposure to pathogens, and measures of gut function, are needed to understand the effectiveness and impact of water supply improvements. METHODS AND ANALYSIS In the PAASIM study, we examine the impact of water system improvements on acute and chronic health outcomes in children in a low-income urban area of Beira, Mozambique, comprising 62 sub-neighbourhoods and ~26 300 households. This prospective matched cohort study follows 548 mother-child dyads from late pregnancy through 12 months of age. Primary outcomes include measures of enteric pathogen infections, gut microbiome composition and source drinking water microbiological quality, measured at the child's 12-month visit. Additional outcomes include diarrhoea prevalence, child growth, previous enteric pathogen exposure, child mortality and various measures of water access and quality. Our analyses will compare (1) subjects living in sub-neighbourhoods with the improved water to those living in sub-neighbourhoods without these improvements; and (2) subjects with household water connections on their premises to those without such a connection. This study will provide critical information to understand how to optimise investments for improving child health, filling the information gap about the impact of piped water provision to low-income urban households, using novel gastrointestinal disease outcomes. ETHICS AND DISSEMINATION This study was approved by the Emory University Institutional Review Board and the National Bio-Ethics Committee for Health in Mozambique. The pre-analysis plan is published on the Open Science Framework platform (https://osf.io/4rkn6/). Results will be shared with relevant stakeholders locally, and through publications.
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Affiliation(s)
- Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joshua V Garn
- Division of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | | | | | - Christine S Fagnant-Sperati
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Sydney Hubbard
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - João Luís Manuel
- Beira Operations Research Center, National Health Institute (INS), Ministry of Health of Mozambique, Beira, Mozambique
| | | | - Sandy McGunegill
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Molly K Miller-Petrie
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Jedidiah S Snyder
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Courtney Victor
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Thomas F Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joe Brown
- Environmental Science and Engineering, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Rassul Nalá
- Ministry of Health, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Mertens A, Arnold BF, Benjamin-Chung J, Boehm AB, Brown J, Capone D, Clasen T, Fuhrmeister E, Grembi JA, Holcomb D, Knee J, Kwong LH, Lin A, Luby SP, Nala R, Nelson K, Njenga SM, Null C, Pickering AJ, Rahman M, Reese HE, Steinbaum L, Stewart J, Thilakaratne R, Cumming O, Colford JM, Ercumen A. Effects of water, sanitation, and hygiene interventions on detection of enteropathogens and host-specific faecal markers in the environment: a systematic review and individual participant data meta-analysis. Lancet Planet Health 2023; 7:e197-e208. [PMID: 36889861 PMCID: PMC10009758 DOI: 10.1016/s2542-5196(23)00028-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Water, sanitation, and hygiene (WASH) improvements are promoted to reduce diarrhoea in low-income countries. However, trials from the past 5 years have found mixed effects of household-level and community-level WASH interventions on child health. Measuring pathogens and host-specific faecal markers in the environment can help investigate causal pathways between WASH and health by quantifying whether and by how much interventions reduce environmental exposure to enteric pathogens and faecal contamination from human and different animal sources. We aimed to assess the effects of WASH interventions on enteropathogens and microbial source tracking (MST) markers in environmental samples. METHODS We did a systematic review and individual participant data meta-analysis, which included searches from Jan 1, 2000, to Jan 5, 2023, from PubMed, Embase, CAB Direct Global Health, Agricultural and Environmental Science Database, Web of Science, and Scopus, of prospective studies with water, sanitation, or hygiene interventions and concurrent control group that measured pathogens or MST markers in environmental samples and measured child anthropometry, diarrhoea, or pathogen-specific infections. We used covariate-adjusted regression models with robust standard errors to estimate study-specific intervention effects and pooled effect estimates across studies using random-effects models. FINDINGS Few trials have measured the effect of sanitation interventions on pathogens and MST markers in the environment and they mostly focused on onsite sanitation. We extracted individual participant data on nine environmental assessments from five eligible trials. Environmental sampling included drinking water, hand rinses, soil, and flies. Interventions were consistently associated with reduced pathogen detection in the environment but effect estimates in most individual studies could not be distinguished from chance. Pooled across studies, we found a small reduction in the prevalence of any pathogen in any sample type (pooled prevalence ratio [PR] 0·94 [95% CI 0·90-0·99]). Interventions had no effect on the prevalence of MST markers from humans (pooled PR 1·00 [95% CI 0·88-1·13]) or animals (pooled PR 1·00 [95% CI 0·97-1·03]). INTERPRETATION The small effect of these sanitation interventions on pathogen detection and absence of effects on human or animal faecal markers are consistent with the small or null health effects previously reported in these trials. Our findings suggest that the basic sanitation interventions implemented in these studies did not contain human waste and did not adequately reduce exposure to enteropathogens in the environment. FUNDING Bill and Melinda Gates Foundation and the UK Foreign and Commonwealth Development Office.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA.
| | - Benjamin F Arnold
- Francis I Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Alexandria B Boehm
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Joe Brown
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, Michael Hooker Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Drew Capone
- Department of Environmental and Occupational Health, Indiana University Bloomington, Bloomington, IN, USA
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, NE, Atlanta, GA, USA
| | - Erica Fuhrmeister
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | | | - David Holcomb
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, Michael Hooker Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jackie Knee
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - Laura H Kwong
- Division of Environmental Health Sciences, University of California, Berkeley, CA, USA
| | - Audrie Lin
- Department of Biobehavioral Health, Pennsylvania State University, PA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Rassul Nala
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Kara Nelson
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | | | | | - Amy J Pickering
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, Dhaka, Bangladesh
| | - Heather E Reese
- Department of Environmental Health, Rollins School of Public Health, Emory University, NE, Atlanta, GA, USA
| | - Lauren Steinbaum
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Jill Stewart
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, Michael Hooker Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ruwan Thilakaratne
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
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Dai X, Zhang J, Sun X, Li J, Liu B. Differentiation Governance of Rural Human Settlement Environments in China: Knowledge Mapping and Visualization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4209. [PMID: 36901220 PMCID: PMC10001484 DOI: 10.3390/ijerph20054209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
To further promote the effective governance of rural human settlements in China, it is necessary to summarize and organize the research on rural human settlements that has been undertaken in the last decade. This paper analyzes the current status of rural human settlements research from the perspectives of Chinese literature and English literature. It takes the core documents included in WOS (Web of Science) and CNKI (Chinese National Knowledge Infrastructure) as samples, and produces a visual analysis of the authors, institutions, disciplines, and research hotspots for rural human settlements research with the help of CiteSpace V and other measurement software, focus on identifying the similarities and differences between CNKI and WOS in the study of rural human settlements. The results show that the number of papers is increasing; cooperation between Chinese researchers and institutions needs to be further strengthened; the existing research has achieved interdisciplinary integration; the research hotspots are converging, but China pays more attention to the study of the hard environment, such as the macro level of rural human settlements and the natural ecological environments of residence, and lacks insight into the soft environment, such as the main body of residences, social relations, and individual needs in the urban fringe. This study is conducive to promoting the integrated development of urban and rural areas in China, promoting the revitalization and development of rural areas in China, and achieving social equity.
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Affiliation(s)
- Xin Dai
- Institute of Marxism Chinese Academy of Social Sciences, Beijing 100732, China
| | - Junying Zhang
- School of Public Administration, Yanshan University, Qinhuangdao 066004, China
- Hebei Public Policy Evaluation and Research Center, Qinhuangdao 066004, China
| | - Xuehang Sun
- School of Public Administration, Yanshan University, Qinhuangdao 066004, China
- Hebei Public Policy Evaluation and Research Center, Qinhuangdao 066004, China
| | - Junjie Li
- School of Public Administration, Yanshan University, Qinhuangdao 066004, China
- Hebei Public Policy Evaluation and Research Center, Qinhuangdao 066004, China
| | - Bangfan Liu
- School of Public Administration, Yanshan University, Qinhuangdao 066004, China
- Hebei Public Policy Evaluation and Research Center, Qinhuangdao 066004, China
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Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, Jones MA, Hoffmann TC, Clark J, Beller EM, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2023; 1:CD006207. [PMID: 36715243 PMCID: PMC9885521 DOI: 10.1002/14651858.cd006207.pub6] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review last published in 2020. We include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL, and two trials registers in October 2022, with backwards and forwards citation analysis on the new studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, glasses, and gargling) to prevent respiratory virus transmission. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS We included 11 new RCTs and cluster-RCTs (610,872 participants) in this update, bringing the total number of RCTs to 78. Six of the new trials were conducted during the COVID-19 pandemic; two from Mexico, and one each from Denmark, Bangladesh, England, and Norway. We identified four ongoing studies, of which one is completed, but unreported, evaluating masks concurrent with the COVID-19 pandemic. Many studies were conducted during non-epidemic influenza periods. Several were conducted during the 2009 H1N1 influenza pandemic, and others in epidemic influenza seasons up to 2016. Therefore, many studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Adherence with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included 12 trials (10 cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate-certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate-certainty evidence). Harms were rarely measured and poorly reported (very low-certainty evidence). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; 3 trials, 7779 participants; very low-certainty evidence). N95/P2 respirators compared with medical/surgical masks may be effective for ILI (RR 0.82, 95% CI 0.66 to 1.03; 5 trials, 8407 participants; low-certainty evidence). Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate-certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low-certainty evidence). One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non-inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID-19 patients. Hand hygiene compared to control Nineteen trials compared hand hygiene interventions with controls with sufficient data to include in meta-analyses. Settings included schools, childcare centres and homes. Comparing hand hygiene interventions with controls (i.e. no intervention), there was a 14% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.86, 95% CI 0.81 to 0.90; 9 trials, 52,105 participants; moderate-certainty evidence), suggesting a probable benefit. In absolute terms this benefit would result in a reduction from 380 events per 1000 people to 327 per 1000 people (95% CI 308 to 342). When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.94, 95% CI 0.81 to 1.09; 11 trials, 34,503 participants; low-certainty evidence), and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials, 8332 participants; low-certainty evidence), suggest the intervention made little or no difference. We pooled 19 trials (71, 210 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. Pooled data showed that hand hygiene may be beneficial with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.83 to 0.94; low-certainty evidence), but with high heterogeneity. In absolute terms this benefit would result in a reduction from 200 events per 1000 people to 178 per 1000 people (95% CI 166 to 188). Few trials measured and reported harms (very low-certainty evidence). We found no RCTs on gowns and gloves, face shields, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children. There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory-confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Department for Continuing Education, University of Oxford, Oxford OX1 2JA, UK
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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Citrulline and kynurenine to tryptophan ratio: potential EED (environmental enteric dysfunction) biomarkers in acute watery diarrhea among children in Bangladesh. Sci Rep 2023; 13:1416. [PMID: 36697429 PMCID: PMC9876903 DOI: 10.1038/s41598-023-28114-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
Two emerging biomarkers of environmental enteric dysfunction (EED) include plasma citrulline (CIT), and the kynurenine (KYN): tryptophan (TRP)/ (KT) ratio. We sought to investigate the plasma concentration of CIT and KT ratio among the children having dehydrating diarrhea and examine associations between concentrations of CIT and KT ratio with concurrent factors. For this analysis, we used cross-sectional data from a total of 102, 6-36 months old male children who suffered from non-cholera acute watery diarrhea and had some dehydration admitted to an urban diarrheal hospital, in Bangladesh. CIT, TRP, and KYN concentrations were determined at enrollment from plasma samples using ELIZA. At enrollment, the mean plasma CIT concentration was 864.48 ± 388.55 µmol/L. The mean plasma kynurenine, tryptophan concentrations, and the KT ratio (× 1000) were 6.93 ± 3.08 µmol/L, 33.44 ± 16.39 µmol/L, and 12.12 ± 18.10, respectively. With increasing child age, KYN concentration decreased (coefficient: - 0.26; 95%CI: - 0.49, - 0.04; p = 0.021); with increasing lymphocyte count, CIT concentration decreased (coef.: - 0.01; 95% CI: - 0.02,0.001, p = 0.004); the wasted child had decreased KT ratio (coef.: - 0.6; 95% CI: - 1.18, - 0.02; p = 0.042) after adjusting for potential covariates. The CIT concentration was associated with blood neutrophils (coef.: 0.02; 95% CI: 0.01, 0.03; p < 0.001), lymphocytes (coef.: - 0.02; 95% CI: - 0.03, - 0.02; p < 0.001) and monocyte (coef.: 0.06; 95% CI: 0.01, 0.11; p = 0.021); KYN concentration was negatively associated with basophil (coef.: - 0.62; 95% CI: - 1.23, - 0.01; p = 0.048) after adjusting for age. In addition, total stool output (gm) increased (coef.: 793.84; 95% CI: 187.16, 1400.52; p = 0.011) and also increased duration of hospital stay (hour) (coef.: 22.89; 95% CI: 10.24, 35.54; p = 0.001) with increasing CIT concentration. The morphological changes associated with EED may increase the risk of enteric infection and diarrheal disease among children. Further research is critically needed to better understand the complex mechanisms by which EED biomarkers may impact susceptibility to dehydrating diarrhea in children.
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Bauza V, Ye W, Liao J, Majorin F, Clasen T. Interventions to improve sanitation for preventing diarrhoea. Cochrane Database Syst Rev 2023; 1:CD013328. [PMID: 36697370 PMCID: PMC9969045 DOI: 10.1002/14651858.cd013328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Diarrhoea is a major contributor to the global disease burden, particularly amongst children under five years in low- and middle-income countries (LMICs). As many of the infectious agents associated with diarrhoea are transmitted through faeces, sanitation interventions to safely contain and manage human faeces have the potential to reduce exposure and diarrhoeal disease. OBJECTIVES To assess the effectiveness of sanitation interventions for preventing diarrhoeal disease, alone or in combination with other WASH interventions. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and Chinese language databases available under the China National Knowledge Infrastructure (CNKI-CAJ). We also searched the metaRegister of Controlled Trials (mRCT) and conference proceedings, contacted researchers, and searched references of included studies. The last search date was 16 February 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs, non-randomized controlled trials (NRCTs), controlled before-and-after studies (CBAs), and matched cohort studies of interventions aimed at introducing or expanding the coverage and/or use of sanitation facilities in children and adults in any country or population. Our primary outcome of interest was diarrhoea and secondary outcomes included dysentery (bloody diarrhoea), persistent diarrhoea, hospital or clinical visits for diarrhoea, mortality, and adverse events. We included sanitation interventions whether they were conducted independently or in combination with other interventions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligible studies, extracted relevant data, assessed risk of bias, and assessed the certainty of evidence using the GRADE approach. We used meta-analyses to estimate pooled measures of effect, described results narratively, and investigated potential sources of heterogeneity using subgroup analyses. MAIN RESULTS Fifty-one studies met our inclusion criteria, with a total of 238,535 participants. Of these, 50 studies had sufficient information to be included in quantitative meta-analysis, including 17 cluster-RCTs and 33 studies with non-randomized study designs (20 NRCTs, one CBA, and 12 matched cohort studies). Most were conducted in LMICs and 86% were conducted in whole or part in rural areas. Studies covered three broad types of interventions: (1) providing access to any sanitation facility to participants without existing access practising open defecation, (2) improving participants' existing sanitation facility, or (3) behaviour change messaging to improve sanitation access or practices without providing hardware or subsidy, although many studies overlapped multiple categories. There was substantial heterogeneity amongst individual study results for all types of interventions. Providing access to any sanitation facility Providing access to sanitation facilities was evaluated in seven cluster-RCTs, and may reduce diarrhoea prevalence in all age groups (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.73 to 1.08; 7 trials, 40,129 participants, low-certainty evidence). In children under five years, access may have little or no effect on diarrhoea prevalence (RR 0.98, 95% CI 0.83 to 1.16, 4 trials, 16,215 participants, low-certainty evidence). Additional analysis in non-randomized studies was generally consistent with these findings. Pooled estimates across randomized and non-randomized studies provided similar protective estimates (all ages: RR 0.79, 95% CI 0.66 to 0.94; 15 studies, 73,511 participants; children < 5 years: RR 0.83, 95% CI 0.68 to 1.02; 11 studies, 25,614 participants). Sanitation facility improvement Interventions designed to improve existing sanitation facilities were evaluated in three cluster-RCTs in children under five and may reduce diarrhoea prevalence (RR 0.85, 95% CI 0.69 to 1.06; 3 trials, 14,900 participants, low-certainty evidence). However, some of these interventions, such as sewerage connection, are not easily randomized. Non-randomized studies across participants of all ages provided estimates that improving sanitation facilities may reduce diarrhoea, but may be subject to confounding (RR 0.61, 95% CI 0.50 to 0.74; 23 studies, 117,639 participants, low-certainty evidence). Pooled estimates across randomized and non-randomized studies provided similar protective estimates (all ages: RR 0.65, 95% CI 0.55 to 0.78; 26 studies, 132,539 participants; children < 5 years: RR 0.70, 95% CI 0.54 to 0.91, 12 studies, 23,353 participants). Behaviour change messaging only (no hardware or subsidy provided) Strategies to promote behaviour change to construct, upgrade, or use sanitation facilities were evaluated in seven cluster-RCTs in children under five, and probably reduce diarrhoea prevalence (RR 0.82, 95% CI 0.69 to 0.98; 7 studies, 28,909 participants, moderate-certainty evidence). Additional analysis from two non-randomized studies found no effect, though with very high uncertainty. Pooled estimates across randomized and non-randomized studies provided similar protective estimates (RR 0.85, 95% CI 0.73 to 1.01; 9 studies, 31,080 participants). No studies measured the effects of this type of intervention in older populations. Any sanitation intervention A pooled analysis of cluster-RCTs across all sanitation interventions demonstrated that the interventions may reduce diarrhoea prevalence in all ages (RR 0.85, 95% CI 0.76 to 0.95, 17 trials, 83,938 participants, low-certainty evidence) and children under five (RR 0.87, 95% CI 0.77 to 0.97; 14 trials, 60,024 participants, low-certainty evidence). Non-randomized comparisons also demonstrated a protective effect, but may be subject to confounding. Pooled estimates across randomized and non-randomized studies provided similar protective estimates (all ages: RR 0.74, 95% CI 0.67 to 0.82; 50 studies, 237,130 participants; children < 5 years: RR 0.80, 95% CI 0.71 to 0.89; 32 studies, 80,047 participants). In subgroup analysis, there was some evidence of larger effects in studies with increased coverage amongst all participants (75% or higher coverage levels) and also some evidence that the effect decreased over longer follow-up times for children under five years. There was limited evidence on other outcomes. However, there was some evidence that any sanitation intervention was protective against dysentery (RR 0.74, 95% CI 0.54 to 1.00; 5 studies, 34,025 participants) and persistent diarrhoea (RR 0.57, 95% CI 0.43 to 0.75; 2 studies, 2665 participants), but not against clinic visits for diarrhoea (RR 0.86, 95% CI 0.44 to 1.67; 2 studies, 3720 participants) or all-cause mortality (RR 0.99, 95% CI 0.89 to1.09; 7 studies, 46,123 participants). AUTHORS' CONCLUSIONS There is evidence that sanitation interventions are effective at preventing diarrhoea, both for young children and all age populations. The actual level of effectiveness, however, varies by type of intervention and setting. There is a need for research to better understand the factors that influence effectiveness.
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Affiliation(s)
- Valerie Bauza
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Wenlu Ye
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Jiawen Liao
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Fiona Majorin
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Capone D, Adriano Z, Cumming O, Irish SR, Knee J, Nala R, Brown J. Urban Onsite Sanitation Upgrades and Synanthropic Flies in Maputo, Mozambique: Effects on Enteric Pathogen Infection Risks. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:549-560. [PMID: 36516327 PMCID: PMC9835884 DOI: 10.1021/acs.est.2c06864] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Synanthropic filth flies transport enteric pathogens from feces to food, which upon consumption poses an infection risk. We evaluated the effect of an onsite sanitation intervention─including fly control measures─in Maputo, Mozambique, on the risk of infection from consuming fly-contaminated food. After enumerating flies at intervention and control sites, we cultured fecal indicator bacteria, quantified gene copies for 22 enteric pathogens via reverse transcription quantitative polymerase chain reaction (RT-qPCR), and developed quantitative microbial risk assessment (QMRA) models to estimate annual risks of infection attributable to fly-contaminated foods. We found that the intervention reduced fly counts at latrine entrances by 69% (aRR = 0.31, [0.13, 0.75]) but not at food preparation areas (aRR = 0.92, [0.33, 2.6]). Half of (23/46) of individual flies were positive for culturable Escherichia coli, and we detected ≥1 pathogen gene from 45% (79/176) of flies, including enteropathogenic E. coli (37/176), adenovirus (25/176), Giardia spp. (13/176), and Trichuris trichiura (12/176). We detected ≥1 pathogen gene from half the flies caught in control (54%, 30/56) and intervention compounds (50%, 17/34) at baseline, which decreased 12 months post-intervention to 43% (23/53) at control compounds and 27% (9/33) for intervention compounds. These data indicate flies as a potentially important mechanical vector for enteric pathogen transmission in this setting. The intervention may have reduced the risk of fly-mediated enteric infection for some pathogens, but infrequent detection resulted in wide confidence intervals; we observed no apparent difference in infection risk between groups in a pooled estimate of all pathogens assessed (aRR = 0.84, [0.61, 1.2]). The infection risks posed by flies suggest that the design of sanitation systems and service delivery should include fly control measures to prevent enteric pathogen transmission.
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Affiliation(s)
- Drew Capone
- Department
of Environmental and Occupational Health, School of Public Health, Indiana University, 2719 E 10th St, Bloomington, Indiana47401, United States
| | - Zaida Adriano
- WE
Consult ltd, 177 Rua
Tomas Ribeiro, Maputo1102, Mozambique
| | - Oliver Cumming
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, LondonWC1E 7HT, United
Kingdom
| | - Seth R. Irish
- Epidemiology
and Public Health Department, Swiss Tropical
and Public Health Institute, Kreuzstrasse 2, Allschwil4123, Switzerland
| | - Jackie Knee
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, LondonWC1E 7HT, United
Kingdom
| | - Rassul Nala
- Ministério
da Saúde, Instituto Nacional de Saúde
Maputo, Maputo1102, Mozambique
| | - Joe Brown
- Department
of Environmental Sciences and Engineering, Gillings School of Public
Health, University of North Carolina at
Chapel Hill, Chapel
Hill, North Carolina27599, United States
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Crider YS, Tsuchiya M, Mukundwa M, Ray I, Pickering AJ. Adoption of Point-of-Use Chlorination for Household Drinking Water Treatment: A Systematic Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:16001. [PMID: 36715546 PMCID: PMC9885856 DOI: 10.1289/ehp10839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Centralized chlorination of urban piped water supplies has historically contributed to major reductions in waterborne illness. In locations without effective centralized water treatment, point-of-use (POU) chlorination for households is widely promoted to improve drinking water quality and health. Realizing these health benefits requires correct, consistent, and sustained product use, but real-world evaluations have often observed low levels of use. To our knowledge, no prior reviews exist on adoption of chlorine POU products. OBJECTIVES Our objectives were to identify which indicators of adoption are most often used in chlorine POU studies, summarize levels of adoption observed, understand how adoption changes over time, and determine how adoption is affected by frequency of contact between participants and study staff. METHODS We conducted a systematic review of household POU chlorination interventions or programs from 1990 through 2021 that reported a quantitative measure of adoption, were conducted in low- and middle-income countries, included data collection at households, and reported the intervention start date. RESULTS We identified 36 studies of household drinking water chlorination products that met prespecified eligibility criteria and extracted data from 46 chlorine intervention groups with a variety of chlorine POU products and locations. There was no consensus definition of adoption of household water treatment; the most common indicator was the proportion of household stored water samples with free chlorine residual > 0.1 or 0.2 mg / L . Among studies that reported either free or total chlorine-confirmed adoption of chlorine POU products, use was highly variable (across all chlorine intervention groups at the last time point measured in each study; range: 1.5%-100%; sample size-weighted median = 47 % ; unweighted median = 58 % ). The median follow-up duration among intervention groups was 3 months. On average, adoption declined over time and was positively associated with frequency of contact between respondents and study staff. DISCUSSION Although prior research has shown that POU chlorine products improve health when correctly and consistently used, a reliance on individual adoption for effective treatment is unlikely to lead to the widespread public health benefits historically associated with pressurized, centralized treatment of piped water supplies. https://doi.org/10.1289/EHP10839.
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Affiliation(s)
- Yoshika S. Crider
- Energy and Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
- Division of Epidemiology and Biostatistics, UC Berkeley, Berkeley, California, USA
- King Center on Global Development, Stanford University, Stanford, California, USA
| | - Miki Tsuchiya
- Master of Development Practice Program, UC Berkeley, Berkeley, California, USA
| | - Magnifique Mukundwa
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, UC Berkeley, Berkeley, California, USA
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Tong H, Piwoz E, Ruel MT, Brown KH, Black RE, Walker N. Maternal and child nutrition in the Lives Saved Tool: Results of a recent update. J Glob Health 2022; 12:08005. [PMID: 36583418 PMCID: PMC9801341 DOI: 10.7189/jogh.12.08005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The Lives Saved Tool (LiST) is a mathematical modelling tool for estimating the survival, health, and nutritional impacts of scaling intervention coverage in low- and middle-income countries (LMICs). Various nutrition interventions are included in LiST and are regularly (and independently) reviewed and updated as new data emerge. This manuscript describes our latest in-depth review of nutrition evidence, focusing on intervention efficacy, appropriate population-affected fractions, and new interventions for potential inclusion in the LiST model. Methods An external advisory group (EAG) was assembled to review evidence from systematic reviews on intervention-outcome (I-O) pairs for women and children under five years of age. GRADE quality was assigned to each pair based on a LiST-specific checklist to facilitate consistent decisions during the consideration. For existing interventions with new information, the EAG was asked to recommend whether to update the default efficacy values and population-affected fractions. For the new interventions, the EAG decided whether there was sufficient evidence of benefit, and in affirmative cases, information on the efficacy and affected fraction values that could be used. Decisions were based on expert group consensus. Results Overall, the group reviewed 53 nutrition-related I-O pairs, including 25 existing and 28 new ones. Efficacy and population-affected fractions were updated for seven I-O pairs; three pairs were updated for efficacy estimates only, three were updated for population-affected fractions only; and nine new I-O pairs were added to the model, bringing the total of nutrition-related I-O pairs to 34. Included in the new I-O pairs were two new nutrition interventions added to LIST: zinc fortification and neonatal vitamin A supplementation. Conclusions For modelling tools like LiST to be useful, it is crucial to update interventions, efficacy and population-affected fractions as new evidence becomes available. The present updates will enable LiST users to better estimate the potential health, nutrition, and survival benefits of investing in nutrition.
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Affiliation(s)
- Hannah Tong
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ellen Piwoz
- Independent Consultant, Annapolis, Maryland, USA
| | - Marie T Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, California, USA
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Neff Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Benkerroum N, Ismail A. Human Breast Milk Contamination with Aflatoxins, Impact on Children's Health, and Possible Control Means: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16792. [PMID: 36554670 PMCID: PMC9779431 DOI: 10.3390/ijerph192416792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Aflatoxins are natural toxicants produced mainly by species of the Aspergillus genus, which contaminate virtually all feeds and foods. Apart from their deleterious health effects on humans and animals, they can be secreted unmodified or carried over into the milk of lactating females, thereby posing health risks to suckling babies. Aflatoxin M1 (AFM1) is the major and most toxic aflatoxin type after aflatoxin B1 (AFB1). It contaminates human breast milk upon direct ingestion from dairy products or by carry-over from the parent molecule (AFB1), which is hydroxylated in the liver and possibly in the mammary glands by cytochrome oxidase enzymes and then excreted into breast milk as AFM1 during lactation via the mammary alveolar epithelial cells. This puts suckling infants and children fed on this milk at a high risk, especially that their detoxifying activities are still weak at this age essentially due to immature liver as the main organ responsible for the detoxification of xenobiotics. The occurrence of AFM1 at toxic levels in human breast milk and associated health conditions in nursing children is well documented, with developing countries being the most affected. Different studies have demonstrated that contamination of human breast milk with AFM1 represents a real public health issue, which should be promptly and properly addressed to reduce its incidence. To this end, different actions have been suggested, including a wider and proper implementation of regulatory measures, not only for breast milk but also for foods and feeds as the upstream sources for breast milk contamination with AFM1. The promotion of awareness of lactating mothers through the organization of training sessions and mass media disclosures before and after parturition is of a paramount importance for the success of any action. This is especially relevant that there are no possible control measures to ensure compliance of lactating mothers to specific regulatory measures, which can yet be appropriate for the expansion of breast milk banks in industrialized countries and emergence of breast milk sellers. This review attempted to revisit the public health issues raised by mother milk contamination with AFM1, which remains undermined despite the numerous relevant publications highlighting the needs to tackle its incidence as a protective measure for the children physical and mental health.
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Affiliation(s)
- Noreddine Benkerroum
- Expertise Aliments Santé, Food Health Consultancy, 7450 Dollier Str., Montréal, QC H1S 2J6, Canada
| | - Amir Ismail
- Institute of Food Science and Nutrition, Bahauddin Zakariya University, Multan 60000, Pakistan
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Brouwer AF, Eisenberg MC, Bakker KM, Boerger SN, Zahid MH, Freeman MC, Eisenberg JNS. Leveraging infectious disease models to interpret randomized controlled trials: Controlling enteric pathogen transmission through water, sanitation, and hygiene interventions. PLoS Comput Biol 2022; 18:e1010748. [DOI: 10.1371/journal.pcbi.1010748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 12/15/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Randomized controlled trials (RCTs) evaluate hypotheses in specific contexts and are often considered the gold standard of evidence for infectious disease interventions, but their results cannot immediately generalize to other contexts (e.g., different populations, interventions, or disease burdens). Mechanistic models are one approach to generalizing findings between contexts, but infectious disease transmission models (IDTMs) are not immediately suited for analyzing RCTs, since they often rely on time-series surveillance data. We developed an IDTM framework to explain relative risk outcomes of an infectious disease RCT and applied it to a water, sanitation, and hygiene (WASH) RCT. This model can generalize the RCT results to other contexts and conditions. We developed this compartmental IDTM framework to account for key WASH RCT factors: i) transmission across multiple environmental pathways, ii) multiple interventions applied individually and in combination, iii) adherence to interventions or preexisting conditions, and iv) the impact of individuals not enrolled in the study. We employed a hybrid sampling and estimation framework to obtain posterior estimates of mechanistic parameter sets consistent with empirical outcomes. We illustrated our model using WASH Benefits Bangladesh RCT data (n = 17,187). Our model reproduced reported diarrheal prevalence in this RCT. The baseline estimate of the basic reproduction number R 0 for the control arm (1.10, 95% CrI: 1.07, 1.16) corresponded to an endemic prevalence of 9.5% (95% CrI: 7.4, 13.7%) in the absence of interventions or preexisting WASH conditions. No single pathway was likely able to sustain transmission: pathway-specific R 0 s for water, fomites, and all other pathways were 0.42 (95% CrI: 0.03, 0.97), 0.20 (95% CrI: 0.02, 0.59), and 0.48 (95% CrI: 0.02, 0.94), respectively. An IDTM approach to evaluating RCTs can complement RCT analysis by providing a rigorous framework for generating data-driven hypotheses that explain trial findings, particularly unexpected null results, opening up existing data to deeper epidemiological understanding.
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77
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Koyratty N, Ntozini R, Mbuya MNN, Jones AD, Schuster RC, Kordas K, Li CS, Tavengwa NV, Majo FD, Humphrey J, Smith LE. Growth and growth trajectory among infants in early life: contributions of food insecurity and water insecurity in rural Zimbabwe. BMJ Nutr Prev Health 2022; 5:332-343. [PMID: 36619329 PMCID: PMC9813639 DOI: 10.1136/bmjnph-2022-000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Stunting or linear growth faltering, measured by length-for-age Z-score (LAZ), remains a significant public health challenge, particularly in rural low-income and middle-income countries. It is a marker of inadequate environments in which infants are born and raised. However, the contributions of household resource insecurities, such as food and water, to growth and growth trajectory are understudied. Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1-M18). Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=-0.09; 95% -0.19 to -0.13). From M6 to M18, poor food access was associated with lower LAZ (β=-0.11; 95% -0.20 to -0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time. Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.
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Affiliation(s)
- Nadia Koyratty
- Department of Poverty, Health and Nutrition, International Food Policy Research Institute, Washington DC, Washington DC, USA
| | - Robert Ntozini
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mduduzi NN Mbuya
- Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Roseanne C Schuster
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - Chin-Shang Li
- School of Nursing, University at Buffalo, Buffalo, NY, USA
| | - Naume V Tavengwa
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D Majo
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura E Smith
- Statistics, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
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Capone D, Barker T, Cumming O, Flemister A, Geason R, Kim E, Knee J, Linden Y, Manga M, Meldrum M, Nala R, Smith S, Brown J. Persistent Ascaris Transmission Is Possible in Urban Areas Even Where Sanitation Coverage Is High. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:15969-15980. [PMID: 36288473 PMCID: PMC9671051 DOI: 10.1021/acs.est.2c04667] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
In low-income, urban, informal communities lacking sewerage and solid waste services, onsite sanitation (sludges, aqueous effluent) and child feces are potential sources of human fecal contamination in living environments. Working in informal communities of urban Maputo, Mozambique, we developed a quantitative, stochastic, mass-balance approach to evaluate plausible scenarios of localized contamination that could explain why the soil-transmitted helminth Ascaris remains endemic despite nearly universal coverage of latrines that sequester most fecal wastes. We used microscopy to enumerate presumptively viable Ascaris ova in feces, fecal sludges, and soils from compounds (i.e., household clusters) and then constructed a steady-state mass-balance model to evaluate possible contamination scenarios capable of explaining observed ova counts in soils. Observed Ascaris counts (mean = -0.01 log10 ova per wet gram of soil, sd = 0.71 log10) could be explained by deposits of 1.9 grams per day (10th percentile 0.04 grams, 90th percentile 84 grams) of child feces on average, rare fecal sludge contamination events that transport 17 kg every three years (10th percentile 1.0 kg, 90th percentile 260 kg), or a daily discharge of 2.7 kg aqueous effluent from an onsite system (10th percentile 0.09 kg, 90th percentile 82 kg). Results suggest that even limited intermittent flows of fecal wastes in this setting can result in a steady-state density of Ascaris ova in soils capable of sustaining transmission, given the high prevalence of Ascaris shedding by children (prevalence = 25%; mean = 3.7 log10 per wet gram, sd = 1.1 log10), the high Ascaris ova counts in fecal sludges (prevalence = 88%; mean = 1.8 log10 per wet gram, sd = 0.95 log10), and the extended persistence and viability of Ascaris ova in soils. Even near-universal coverage of onsite sanitation may allow for sustained transmission of Ascaris under these conditions.
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Affiliation(s)
- Drew Capone
- Department
of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, Indiana47401, United States
| | - Troy Barker
- Department
of Environmental Sciences and Engineering, Gillings School of Public
Health, University of North Carolina at
Chapel Hill, Chapel
Hill, North Carolina27599, United States
| | - Oliver Cumming
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, LondonWC1E 7HT, U.K.
| | - Abeoseh Flemister
- Department
of Biology, University of North Carolina
at Chapel Hill, Chapel
Hill, North Carolina27599, United States
| | - Riley Geason
- Department
of Biology, University of North Carolina
at Chapel Hill, Chapel
Hill, North Carolina27599, United States
| | - Elizabeth Kim
- Department
of Biology, University of North Carolina
at Chapel Hill, Chapel
Hill, North Carolina27599, United States
| | - Jackie Knee
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, LondonWC1E 7HT, U.K.
| | - Yarrow Linden
- Department
of Environmental Sciences and Engineering, Gillings School of Public
Health, University of North Carolina at
Chapel Hill, Chapel
Hill, North Carolina27599, United States
| | - Musa Manga
- Department
of Environmental Sciences and Engineering, Gillings School of Public
Health, University of North Carolina at
Chapel Hill, Chapel
Hill, North Carolina27599, United States
| | - Mackenzie Meldrum
- Department
of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia30332, United States
| | - Rassul Nala
- Ministério
da Saúde, Instituto Nacional de Saúde
Maputo, Maputo1102, Mozambique
| | - Simrill Smith
- Department
of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia30332, United States
| | - Joe Brown
- Department
of Environmental Sciences and Engineering, Gillings School of Public
Health, University of North Carolina at
Chapel Hill, Chapel
Hill, North Carolina27599, United States
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Workman CL, Stoler J, Harris A, Ercumen A, Kearns J, Mapunda KM. Food, water, and sanitation insecurities: Complex linkages and implications for achieving WASH security. Glob Public Health 2022; 17:3060-3075. [PMID: 34506263 DOI: 10.1080/17441692.2021.1971735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Food, water and sanitation insecurities are complex, multi-dimensional phenomena that entail more than availability and access; food, water, and sanitation resources must be safe and culturally appropriate. Researchers and implementers concerned with these insecurities have demonstrated that there are notable interactions between them resulting in significant psychological and biological outcomes. Recent randomised controlled trials (RCTs) in Bangladesh, Kenya (WASH Benefits) and Zimbabwe (SHINE) demonstrated no effect from water, sanitation and hygiene (WASH) interventions on linear growth, and mixed evidence on enteropathogen burden and risk of diarrhoea in young children. These data suggest a need for a more comprehensive understanding of WASH security. The risks posed by multiple resource insecurities shift depending on the individual, their movement throughout their day, their economically and socially prescribed roles, and ecological features such as seasonality and precipitation. By more fully integrating food, water and sanitation security in interventions and subsequent impact evaluations, we can achieve WASH security-one that addresses myriad transmission pathways and co-occurring diseases-that ultimately would improve health outcomes throughout the world. In this critical review, we outline the complexity of combined resource insecurities as a step towards transformative WASH.
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Affiliation(s)
| | | | - Angela Harris
- North Carolina State University, Raleigh, North Carolina
| | - Ayse Ercumen
- North Carolina State University, Raleigh, North Carolina
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Mkupete MJ, Von Fintel D, Burger R. Decomposing inequality of opportunity in child health in Tanzania: The role of access to water and sanitation. HEALTH ECONOMICS 2022; 31:2465-2480. [PMID: 35997640 PMCID: PMC9805148 DOI: 10.1002/hec.4591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Poor child nutrition is a major public health challenge in Tanzania. Large between and within regional nutritional inequalities exist in rural and urban areas. We looked at how locational circumstances hinder children from having an equal opportunity for good nutrition. We used the 2008/09 Living Standards Measurement Study data for Tanzania to identify the part played by water and sanitation in rural and urban inequality of opportunity in child nutrition. We used the dissimilarity index and the Shapley decomposition technique to quantify and decompose inequality of opportunity in nutrition. We find that 16% of the circumstance-driven inequality of opportunity needs to be redistributed for equality of opportunity to prevail. We find that in rural areas, about 42% of the inequality of opportunity in nutrition is due to water and sanitation problems and 22% to child age. In urban areas, we find that the inequality of opportunity is related mainly to the child's sex, price fluctuations and intergenerational factors. The findings suggest that policies to improve water and sanitation coverage could help equalize opportunities for children in rural areas. In urban areas, policies that could help equalize opportunities require incentives to change social norms and behavior around feeding practices and vaccination.
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Affiliation(s)
- Mkupete Jaah Mkupete
- University of Dar es SalaamDar es SalaamTanzania
- Stellenbosch UniversityStellenboschSouth Africa
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Baker KK, Mumma JAO, Simiyu S, Sewell D, Tsai K, Anderson JD, MacDougall A, Dreibelbis R, Cumming O. Environmental and behavioural exposure pathways associated with diarrhoea and enteric pathogen detection in 5-month-old, periurban Kenyan infants: a cross-sectional study. BMJ Open 2022; 12:e059878. [PMID: 36316067 PMCID: PMC9628658 DOI: 10.1136/bmjopen-2021-059878] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to test whether household environmental hygiene and behavioural conditions moderated associations between diarrhoea and enteric pathogen detection in infants 5 months of age in Kenya and pathogen sources, including latrine access, domestic animal co-habitation and public food sources. DESIGN Cross-sectional study utilising enrolment survey data of households participating in the Safe Start cluster-randomised controlled trial . SETTING Kisumu, Kenya. PARTICIPANTS A total of 898 caregivers with 5-month (22 week ± 1 week) aged infants were enrolled in the study and completed the enrolment survey. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes were (1) caregiver-reported 7-day diarrhoea prevalence and (2) count of types of enteric viruses, bacteria and parasites in infant stool. Exposures and effect modifiers included water access and treatment, cohabitation with domestic animals, sanitation access, handwashing practices, supplemental feeding, access to refrigeration and flooring. RESULTS Reported handwashing after handling animals (adjusted odds ratio (aOR)=0.20; 95% CI=0.06 to 0.50) and before eating (aOR=0.44; 95% CI=0.26 to 0.73) were strongly associated with lower risk of caregiver-reported diarrhoea, while cohabitation with animals (aOR=1.54; 95% CI=1.01 to 2.34) living in a household with vinyl-covered dirt floors (aOR=0.60; 95% CI=0.45 to 0.87) were strongly associated with pathogen codetection in infants. Caregiver handwashing after child (p=0.02) or self-defecation (p=0.03) moderated the relationship between shared sanitation access and infant exposure to pathogens, specifically private latrine access was protective against pathogen exposure of infants in households, where caregivers washed hands after defecation. In the absence of handwashing, access to private sanitation posed no benefits over shared latrines for protecting infants from exposure. CONCLUSION Our evidence highlights eliminating animal cohabitation and improving flooring, postdefecation and food-related handwashing, and safety and use of cow milk sources as interventions to prevent enteric pathogen exposure of young infants in Kenya. TRIAL REGISTRATION NUMBER NCT03468114.
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Affiliation(s)
- Kelly K Baker
- Department of Occupational and Environmental Health, The University of Iowa, Iowa City, Iowa, USA
| | | | - Sheillah Simiyu
- African Population and Health Research Center, Nairobi, Kenya
| | - Daniel Sewell
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | - Kevin Tsai
- Department of Occupational and Environmental Health, The University of Iowa, Iowa City, Iowa, USA
| | | | - Amy MacDougall
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Sahiledengle B, Petrucka P, Kumie A, Mwanri L, Beressa G, Atlaw D, Tekalegn Y, Zenbaba D, Desta F, Agho KE. Association between water, sanitation and hygiene (WASH) and child undernutrition in Ethiopia: a hierarchical approach. BMC Public Health 2022; 22:1943. [PMID: 36261797 PMCID: PMC9583486 DOI: 10.1186/s12889-022-14309-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Undernutrition is a significant public health challenge and one of the leading causes of child mortality in a wide range of developing countries, including Ethiopia. Poor access to water, sanitation, and hygiene (WASH) facilities commonly contributes to child growth failure. There is a paucity of information on the interrelationship between WASH and child undernutrition (stunting and wasting). This study aimed to assess the association between WASH and undernutrition among under-five-year-old children in Ethiopia. METHODS A secondary data analysis was undertaken based on the Ethiopian Demographic and Health Surveys (EDHS) conducted from 2000 to 2016. A total of 33,763 recent live births extracted from the EDHS reports were included in the current analysis. Multilevel logistic regression models were used to investigate the association between WASH and child undernutrition. Relevant factors from EDHS data were identified after extensive literature review. RESULTS The overall prevalences of stunting and wasting were 47.29% [95% CI: (46.75, 47.82%)] and 10.98% [95% CI: (10.65, 11.32%)], respectively. Children from households having unimproved toilet facilities [AOR: 1.20, 95% CI: (1.05,1.39)], practicing open defecation [AOR: 1.29, 95% CI: (1.11,1.51)], and living in households with dirt floors [AOR: 1.32, 95% CI: (1.12,1.57)] were associated with higher odds of being stunted. Children from households having unimproved drinking water sources were significantly less likely to be wasted [AOR: 0.85, 95% CI: (0.76,0.95)] and stunted [AOR: 0.91, 95% CI: (0.83, 0.99)]. We found no statistical differences between improved sanitation, safe disposal of a child's stool, or improved household flooring and child wasting. CONCLUSION The present study confirms that the quality of access to sanitation and housing conditions affects child linear growth indicators. Besides, household sources of drinking water did not predict the occurrence of either wasting or stunting. Further longitudinal and interventional studies are needed to determine whether individual and joint access to WASH facilities was strongly associated with child stunting and wasting.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia.
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Abera Kumie
- School of Public Health, College of Health Science, Addis Ababa University, Ababa, Ethiopia
| | - Lillian Mwanri
- Torrens University Australia, Adelaide Campus, 5000, Adelaide, SA, Australia
| | - Girma Beressa
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Fikreab Desta
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, 2751, Penrith, NSW, Australia
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83
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Aluri KZ, Halder AK, Islam M, Benjamin‐Chung J, Alam M, Shoab AK, Rahman M, Unicomb L, Luby SP. The effect of a large-scale water, sanitation and hygiene intervention in Bangladesh on knowledge, behaviour and health: Findings from an endline programme evaluation. Trop Med Int Health 2022; 27:913-924. [PMID: 36096154 PMCID: PMC9826406 DOI: 10.1111/tmi.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The Sanitation, Hygiene Education and Water Supply in Bangladesh Programme (SHEWA-B) was a 5-year intervention aiming to improve water, sanitation and hygiene (WASH) practices among 20 million rural residents through community hygiene promoters. This analysis evaluates the impact of SHEWA-B on knowledge, behaviour and childhood diarrhoea outcomes. METHODS The evaluation included repeated cross-sectional surveys and health surveillance in matched cohorts in intervention and control clusters. Cross-sectional surveys and structured observations at baseline, midline, and endline assessed the availability of WASH technology, caregiver knowledge and behaviour. Fieldworkers collected monthly health data in a subset of control and intervention households to determine the prevalence of diarrhoea. RESULTS Of 5091 households surveyed, participants residing in intervention clusters showed minimal improvements in knowledge, reported behaviour, or use of WASH technology compared to the control clusters. During structured observations, intervention households increased more than control households at handwashing before preparing food and after cleaning a baby's anus when comparing endline to baseline, but these changes were not seen when comparing endline to the midline. The prevalence of childhood diarrhoea remained similar in both groups before (10.2% in intervention, 10.0% in control) and after (8.8% in intervention, 11.7% in control) midline changes were made to improve the intervention. Intervention clusters showed no improvement in diarrhoea over time compared to control clusters. CONCLUSIONS SHEWA-B's community-based WASH promotion did not yield the intended impact on knowledge, behaviour or health. Greater priority should be given to approaches that have demonstrated effectiveness. Including rigorous evaluations would broaden the evidence base to support and improve large-scale programmes.
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Affiliation(s)
- Kelly Zhang Aluri
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Amal K. Halder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Mahfuza Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Jade Benjamin‐Chung
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Monirul Alam
- United Nations Children's Fund BangladeshDhakaBangladesh
| | - Abul Kasham Shoab
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)DhakaBangladesh
| | - Stephen P. Luby
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA,Department of Medicine, Infectious DiseaseStanford University School of MedicineStanfordCaliforniaUSA
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84
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Komakech JJ, Walters CN, Rakotomanana H, Hildebrand DA, Stoecker BJ. The associations between women's empowerment measures, child growth and dietary diversity: Findings from an analysis of demographic and health surveys of seven countries in Eastern Africa. MATERNAL & CHILD NUTRITION 2022; 18:e13421. [PMID: 35999703 PMCID: PMC9480916 DOI: 10.1111/mcn.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/14/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022]
Abstract
Evidence on the efficacy of women's empowerment to improve child growth and minimum dietary diversity (MDD) in the Eastern Africa (EA) region is limited. This cross‐sectional study used recent Demographic and Health Survey data of mother–child dyads from seven countries in EA to examine the associations between women's empowerment measures, child growth and MDD. Length‐for‐age z‐scores, weight‐for‐length z‐scores and weight‐for‐age z‐scores were used to categorize growth indicators of 6–23 months old children. Multivariable logistic regression was used to identify significant associations. Among all countries, 32%–59% of children experienced growth failure. Children meeting MDD were 18%–45%. Women having self‐esteem were associated with lower odds of stunting (adjusted odds ratio [AOR] = 0.62 in Rwanda), wasting (AOR = 0.38 in Uganda), underweight (AORs = 0.60 and 0.57 in Tanzania and Uganda, respectively) and growth failure (AOR = 0.64 in Rwanda). Having health decision control in Burundi was associated with lower odds of stunting (AOR = 0.49) and child growth failure (AOR = 0.52) and higher odds of meeting MDD (AOR = 2.50). Having Legal empowerment among women increased the odds of stunting (AOR = 1.79 in Burundi), underweight (AOR = 1.77 in Uganda) and growth failure (AOR = 1.87 in Burundi). Economic empowerment showed mixed associations with child growth and MDD among some countries. Women's self‐esteem and health decision control were associated with better child growth and MDD for some countries in EA. Nutrition‐sensitive interventions aimed at improving child growth and MDD should consider local contexts when addressing women's empowerment. Understanding the associations between women's empowerment, child growth and child dietary diversity is important for most nutrition‐sensitive interventions seeking to improve child feeding practices and growth by targeting mothers. In this study, for women to have self‐esteem and health decision control was consistently beneficial for child growth and minimum dietary diversity (MDD). Mixed associations existed among other women's empowerment measures, child growth and MDD across the seven East African countries investigated. For improved child growth and better child dietary diversity, targeting specific women's empowerment measures based on local context may be beneficial in the East African region.
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Affiliation(s)
- Joel J. Komakech
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
| | - Christine N. Walters
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
| | - Hasina Rakotomanana
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
| | - Deana A. Hildebrand
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
| | - Barbara J. Stoecker
- Department of Nutritional Sciences, College of Education and Human Sciences Oklahoma State University Stillwater Oklahoma USA
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85
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Guruge GND, Rathnayake N, Abhayasinghe K. Description of a telephone and Internet-based intervention to improve community responses to COVID-19 spread. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:44. [PMID: 36163079 PMCID: PMC9511449 DOI: 10.1186/s41043-022-00325-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This paper describes the process and results of a health promotion intervention to engage lay communities using telephone and online communication, to improve their current responses to the spread of COVID-19.
Methods
An intervention was conducted from March to July 2020 in three districts of Sri Lanka. Seven ‘trigger’ stories were shared through telephone or online communication to stimulate brainstorming and to engage selected community members. Determinants were identified and prioritised through discussions, and potentially beneficial actions were implemented as agreed by participants. The process was monitored, outcomes were evaluated monthly, and activities were modified according to ongoing observations.
Results
A total of 638 families (both adults and children) involved actively in implementing useful actions and reported an increased sense of personal control. Potential risk groups, best feasible community safety precautions and preparation to face challenges in the event of infection reaching their community were identified during brainstorming sessions with community mobilisers. A majority reported that they felt more confident, united and less anxious about handling potential risks and problems. Other beneficial outcomes include lifestyle changes leading to healthier behaviours and a sense of greater control over the conditions that govern their lives.
Conclusion
Use of telephone and online communication was effective in generating desirable community changes.
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86
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Dewey KG, Arnold CD, Wessells KR, Prado EL, Abbeddou S, Adu-Afarwuah S, Ali H, Arnold BF, Ashorn P, Ashorn U, Ashraf S, Becquey E, Brown KH, Christian P, Colford JM, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Humphrey JH, Huybregts L, Iannottie LL, Jannat K, Lartey A, Port AL, Leroy JL, Luby SP, Maleta K, Matias SL, Mbuya MNN, Mridha MK, Nkhoma M, Null C, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Prendergast AJ, Ruel M, Shaikh S, Weber AM, Wolff P, Zongrone A, Stewart CP. Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2022; 116:1314-1333. [PMID: 36045000 DOI: 10.1093/ajcn/nqac232] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. OBJECTIVE We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3). METHODS We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models. We used random effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. RESULTS SQ-LNS provision led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation. CONCLUSIONS Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. Registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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Affiliation(s)
- Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, 9000Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Gaibandha-5700, Bangladesh
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sania Ashraf
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.,Helen Keller International, New York, NY, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jean H Humphrey
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | | | - Kaniz Jannat
- School of Health Sciences, Western Sydney University, NSW, Australia
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Agnes Le Port
- Montpellier Interdisciplinary center on Sustainable Agri-food systems (MoISA), French National Research Institute for Sustainable Development (IRD), Montpellier, France
| | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Kenneth Maleta
- Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh.,Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh
| | - Minyanga Nkhoma
- Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh
| | - Harriet Okronipa
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Jean-Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, CA, USA
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Gaibandha-5700, Bangladesh
| | - Ann M Weber
- School of Public Health, Division of Epidemiology, University of Nevada, Reno, USA
| | | | | | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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Agaro A, Hareru HE, Muche T, Sisay W/tsadik D, Ashuro Z, Negassa B, Legesse MT, Kaso AW, Alemu W, Alemayehu Gube A, Aregu MB, Soboksa NE. Predictors of Hand-Washing Practices at Critical Times Among Mothers of Under-5 Years Old Children in Rural Setting of Gedeo Zone, Southern Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221120784. [PMID: 36051946 PMCID: PMC9425877 DOI: 10.1177/11786302221120784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Various communicable and infectious diseases could be contained by proper hand washing leading to a reduction in mortality and morbidity of children. OBJECTIVE To assess predictors of hand-washing practices at critical times among mothers of under 5 years old children in rural setting of Gedeo zone, Southern Ethiopia. METHOD An institutional-based cross-sectional survey was conducted among 422 women with children under the age of 5 attended the Dilla Zuria health facility and were chosen using a systematic sampling method. Data was gathered using pre-tested interview-administered structured questionnaires. Data was entered into EPI info version 17 and analyzed using SPSS version 25. Binary logistic regression was employed to identify the association between dependent and independent variables. Finally, for variables with a P < .05 in multivariable analysis, adjusted odds ratio (AOR) with a 95% confidence interval (CI) was determined and interpreted. RESULTS The hand washing practice of mothers at critical times was 44.9% [95% CI: 40.1, 49.7%]. The pertinent predictors were favorable attitude [AOR = 7.77, 95% CI: 4.56, 10.37], availability of water source near the household [AOR = 5.31, 95% CI: 3.56, 10.37], and constant availability of soaps at household [AOR = 2.32, 95% CI: 1.33, 6.70]. CONCLUSION In our study, hand-washing practices at critical times was low. The pertinent predictors were attitude, the presence of a water source near the household, and the presence of soap. Therefore, it is advised to encourage domestic hygiene education to improve mothers' attitudes and to increase the availability of water and soap close to the household to promote handwashing with soap and water at critical times.
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Affiliation(s)
- Ashenafi Agaro
- School of Public Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Habtamu Endashaw Hareru
- School of Public Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Temesgen Muche
- Department of Human Nutrition, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Daniel Sisay W/tsadik
- School of Public Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Zemachu Ashuro
- Department of Environmental Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Belay Negassa
- Department of Environmental Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Mehret Tesfu Legesse
- School of Public Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Abdene Weya Kaso
- School of Public Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Wagaye Alemu
- School of Public Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Addisu Alemayehu Gube
- School of Public Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Mekonnen Birhanie Aregu
- Department of Environmental Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
| | - Negasa Eshete Soboksa
- Department of Environmental Health, Medicine and Health Science College, Dilla University, Dilla, Ethiopia
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88
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Lowe J, Ercumen A, Prottas C, Harris AR. Exploring the determinants and indicators of poultry feces management behaviors in rural Western Uganda. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 834:155202. [PMID: 35421491 DOI: 10.1016/j.scitotenv.2022.155202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
Animal ownership has reported financial and nutritional benefits but has also been associated with enteric and respiratory infections, and inadequate sanitation and hygiene can lead to children touching and ingesting animal fecal matter. We identified key indicators for poultry feces management and investigated their social determinants using data from a baseline survey of a randomized-controlled trial of a poultry management training program in rural Western Uganda. The baseline survey was conducted in the Masindi and Kiryandongo districts of Uganda in September 2019, and data collected from 609 households were used. We evaluated indicators for poultry feces management behaviors using scale development methods, including descriptive statistics, bivariate correlation analyses, and Factor Analysis of Mixed Data. We also investigated social determinants of key poultry feces management behaviors using logistic and multinomial logistic regression models. A significant increase in odds of having free-roaming poultry was found for each additional poultry owned (OR = 1.18, P < 0.001). The odds of a household having an observed enclosure for poultry increased by 5% with each incremental poultry owned (OR = 1.05, P < 0.001), and by 4% with increasing wealth with each additional point on the poverty probability index score (OR = 1.04, P < 0.001). Our results also suggest enclosures are intermittently used and constructing them without further intervention likely will not be sufficient for effectively managing animal fecal contamination. We recommend that future studies on animal feces management measure indicators for corralling and feces disposal practices and evaluate their relationship to enteric pathogen exposure and health outcomes. Insights from this work can inform the development of robust indicators of poultry feces management behaviors that can be used for monitoring and evaluation purposes.
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Affiliation(s)
- Jeremy Lowe
- Department of Civil, Construction, and Environmental Engineering, NC State University, Raleigh, NC, United States.
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, NC State University, Raleigh, NC, United States.
| | | | - Angela R Harris
- Department of Civil, Construction, and Environmental Engineering, NC State University, Raleigh, NC, United States.
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89
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Contreras JD, Islam M, Mertens A, Pickering AJ, Kwong LH, Arnold BF, Benjamin-Chung J, Hubbard AE, Alam M, Sen D, Islam S, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Influence of community-level sanitation coverage and population density on environmental fecal contamination and child health in a longitudinal cohort in rural Bangladesh. Int J Hyg Environ Health 2022; 245:114031. [PMID: 36058111 PMCID: PMC9489923 DOI: 10.1016/j.ijheh.2022.114031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/15/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Household-level sanitation interventions have had limited effects on child health or environmental contamination, potentially due to low community coverage. Higher community-level coverage with safely managed sanitation can reduce opportunities for disease transmission. METHODS We estimated associations between community sanitation coverage, environmental fecal contamination, and child health among 360 compounds in the control arm of the WASH Benefits trial in rural Bangladesh (NCT01590095). In each compound, we enumerated E. coli in environmental samples and recorded the 7-day prevalence of caregiver-reported diarrheal disease and acute respiratory infections (ARI) in children under five. We observed indicators of latrine access and quality among all neighboring compounds within 100 m of study compounds. We defined community coverage as the proportion of neighboring compounds with (1) at least one latrine, and (2) exclusively hygienic latrines (improved facility observed to safely contain feces), within both 50 m and 100 m of study compounds. We assessed effect modification by population density and season. RESULTS Adjusted for confounders, study compounds surrounded by 100% coverage of at least one latrine per compound within 50 m had slightly lower log10E. coli counts in stored water (Δlog = -0.13, 95% CI -0.26, -0.01), child hand rinses (Δlog = -0.13, 95% CI -0.24, -0.02), and caregiver hand rinses (Δlog = -0.16, 95% CI -0.29, -0.03) and marginally lower prevalence of diarrheal disease (prevalence ratio [PR] = 0.82, 95% CI 0.64, 1.04) and ARI (PR = 0.84, 95% CI 0.69, 1.03) compared to compounds surrounded by <100% coverage. Effects were similar but less pronounced at 100 m. At higher population densities, community latrine coverage was associated with larger reductions in E. coli on child and caregiver hands and prevalence of diarrheal disease. Coverage with exclusively hygienic latrines was not associated with any outcome. CONCLUSION Higher community sanitation coverage was associated with reduced fecal contamination and improved child health, with stronger effects at highly local scales (50m) and at high population densities. Our findings indicate that the relationship between community sanitation coverage, environmental contamination, and child health varies by definition of coverage, distance, and population density. This work highlights significant uncertainty around how to best measure sanitation coverage and the expected health effects of increasing sanitation coverage using a specific metric. Better understanding of community-level sanitation access is needed to inform policy for implementing sanitation systems that effectively protect community health.
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Affiliation(s)
- Jesse D Contreras
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, 27695, United States
| | - Mahfuza Islam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Laura H Kwong
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, 94158, United States
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, 94304, United States
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Mahfuja Alam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Debashis Sen
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Sharmin Islam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, 94305, United States
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, 27695, United States.
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90
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Contreras JD, Islam M, Mertens A, Pickering AJ, Arnold BF, Benjamin-Chung J, Hubbard AE, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh. PLoS Med 2022; 19:e1004041. [PMID: 35939520 PMCID: PMC9394830 DOI: 10.1371/journal.pmed.1004041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/22/2022] [Accepted: 06/02/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diarrhea and acute respiratory infection (ARI) are leading causes of death in children. The WASH Benefits Bangladesh trial implemented a multicomponent sanitation intervention that led to a 39% reduction in the prevalence of diarrhea among children and a 25% reduction for ARI, measured 1 to 2 years after intervention implementation. We measured longer-term intervention effects on these outcomes between 1 to 3.5 years after intervention implementation, including periods with differing intensity of behavioral promotion. METHODS AND FINDINGS WASH Benefits Bangladesh was a cluster-randomized controlled trial of water, sanitation, hygiene, and nutrition interventions (NCT01590095). The sanitation intervention included provision of or upgrades to improved latrines, sani-scoops for feces removal, children's potties, and in-person behavioral promotion. Promotion was intensive up to 2 years after intervention initiation, decreased in intensity between years 2 to 3, and stopped after 3 years. Access to and reported use of latrines was high in both arms, and latrine quality was significantly improved by the intervention, while use of child feces management tools was low. We enrolled a random subset of households from the sanitation and control arms into a longitudinal substudy, which measured child health with quarterly visits between 1 to 3.5 years after intervention implementation. The study period therefore included approximately 1 year of high-intensity promotion, 1 year of low-intensity promotion, and 6 months with no promotion. We assessed intervention effects on diarrhea and ARI prevalence among children <5 years through intention-to-treat analysis using generalized linear models with robust standard errors. Masking was not possible during data collection, but data analysis was masked. We enrolled 720 households (360 per arm) from the parent trial and made 9,800 child observations between June 2014 and December 2016. Over the entire study period, diarrheal prevalence was lower among children in the sanitation arm (11.9%) compared to the control arm (14.5%) (prevalence ratio [PR] = 0.81, 95% CI 0.66, 1.00, p = 0.05; prevalence difference [PD] = -0.027, 95% CI -0.053, 0, p = 0.05). ARI prevalence did not differ between sanitation (21.3%) and control (22.7%) arms (PR = 0.93, 95% CI 0.82, 1.05, p = 0.23; PD = -0.016, 95% CI -0.043, 0.010, p = 0.23). There were no significant differences in intervention effects between periods with high-intensity versus low-intensity/no promotion. Study limitations include use of caregiver-reported symptoms to define health outcomes and limited data collected after promotion ceased. CONCLUSIONS The observed effect of the WASH Benefits Bangladesh sanitation intervention on diarrhea in children appeared to be sustained for at least 3.5 years after implementation, including 1.5 years after heavy promotion ceased. Existing latrine access was high in the study setting, suggesting that improving on-site latrine quality can deliver health benefits when latrine use practices are in place. Further work is needed to understand how latrine adoption can be achieved and sustained in settings with low existing access and how sanitation programs can adopt transformative approaches of excreta management, including safe disposal of child and animal feces, to generate a hygienic home environment. TRIAL REGISTRATION ClinicalTrials.gov; NCT01590095; https://clinicaltrials.gov/ct2/show/NCT01590095.
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Affiliation(s)
- Jesse D. Contreras
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Mahfuza Islam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, California, United States of America
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, United States of America
| | - Alan E. Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Stephen P. Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, United States of America
| | - John M. Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, United States of America
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91
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Gaffan N, Kpozèhouen A, Dégbey C, Glèlè Ahanhanzo Y, Glèlè Kakaï R, Salamon R. Household access to basic drinking water, sanitation and hygiene facilities: secondary analysis of data from the demographic and health survey V, 2017-2018. BMC Public Health 2022; 22:1345. [PMID: 35836162 PMCID: PMC9284778 DOI: 10.1186/s12889-022-13665-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Benin, access to water, sanitation and hygiene (WASH) remains an issue. This study aims to provide an overview of household access to basic WASH services based on nationally representative data. METHOD Secondary analyses were run using the 'HOUSEHOLD' dataset of the fifth Demographic and Health Survey 2017-2018. The dependent variables were household access to individual and combined basic WASH services. The characteristics of the household head and those related to the composition, wealth and environment of the household were independent variables. After a descriptive analysis of all study variables, multivariate logistic regression was performed to identify predictors of outcome variables. RESULTS The study included 14,156 households. Of these, 63.98% (95% CI = 61.63-66.26), 13.28% (95% CI = 12.10-14.57) and 10.11% (95% CI = 9.19-11.11) had access to individual basic water, sanitation and hygiene facilities, respectively. Also, 3% (95% CI = 2.53-3.56) of households had access to combined basic WASH services. Overall, the richest households and few, and those headed by people aged 30 and over, female and with higher levels of education, were the most likely to have access to individual and combined basic WASH services. In addition, disparities based on the department of residence were observed. CONCLUSION The authors suggest a multifactorial approach that addresses the identified determinants.
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Affiliation(s)
- Nicolas Gaffan
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin.
| | - Alphonse Kpozèhouen
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | - Cyriaque Dégbey
- Department of Environmental Health, Regional Institute of Public Health, University of Abomey Calavi, Ouidah, Benin.,University Hospital Hygiene Clinic, National Hospital and University Centre Hubert Koutoukou Maga, Cotonou, Benin
| | - Yolaine Glèlè Ahanhanzo
- Department of Epidemiology and Biostatistics, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | - Romain Glèlè Kakaï
- Laboratory of Biomathematics and Forest Estimations, University of Abomey-Calavi, Cotonou, Benin
| | - Roger Salamon
- Institute of Public Health, Epidemiology and Development, Victor Segalen University, Bordeaux, France
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92
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Differential Overlap in Human and Animal Fecal Microbiomes and Resistomes in Rural versus Urban Bangladesh. Appl Environ Microbiol 2022; 88:e0075922. [DOI: 10.1128/aem.00759-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
While the development of antibiotic resistance in animal gut microbiomes and subsequent transmission to humans has been demonstrated in intensive farming environments and high-income countries, evidence of zoonotic exchange of antibiotic resistance in LMIC communities is lacking. This research provides genomic evidence of overlap of antibiotic resistance genes between humans and animals, especially in urban communities, and highlights chickens as important reservoirs of antibiotic resistance.
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93
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Wolf J, Hubbard S, Brauer M, Ambelu A, Arnold BF, Bain R, Bauza V, Brown J, Caruso BA, Clasen T, Colford JM, Freeman MC, Gordon B, Johnston RB, Mertens A, Prüss-Ustün A, Ross I, Stanaway J, Zhao JT, Cumming O, Boisson S. Effectiveness of interventions to improve drinking water, sanitation, and handwashing with soap on risk of diarrhoeal disease in children in low-income and middle-income settings: a systematic review and meta-analysis. Lancet 2022; 400:48-59. [PMID: 35780792 PMCID: PMC9251635 DOI: 10.1016/s0140-6736(22)00937-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/26/2022] [Accepted: 05/17/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Estimates of the effectiveness of water, sanitation, and hygiene (WASH) interventions that provide high levels of service on childhood diarrhoea are scarce. We aimed to provide up-to-date estimates on the burden of disease attributable to WASH and on the effects of different types of WASH interventions on childhood diarrhoea in low-income and middle-income countries (LMICs). METHODS In this systematic review and meta-analysis, we updated previous reviews following their search strategy by searching MEDLINE, Embase, Scopus, Cochrane Library, and BIOSIS Citation Index for studies of basic WASH interventions and of WASH interventions providing a high level of service, published between Jan 1, 2016, and May 25, 2021. We included randomised and non-randomised controlled trials conducted at household or community level that matched exposure categories of the so-called service ladder approach of the Sustainable Development Goal (SDG) for WASH. Two reviewers independently extracted study-level data and assessed risk of bias using a modified Newcastle-Ottawa Scale and certainty of evidence using a modified Grading of Recommendations, Assessment, Development, and Evaluation approach. We analysed extracted relative risks (RRs) and 95% CIs using random-effects meta-analyses and meta-regression models. This study is registered with PROSPERO, CRD42016043164. FINDINGS 19 837 records were identified from the search, of which 124 studies were included, providing 83 water (62 616 children), 20 sanitation (40 799 children), and 41 hygiene (98 416 children) comparisons. Compared with untreated water from an unimproved source, risk of diarrhoea was reduced by up to 50% with water treated at point of use (POU): filtration (n=23 studies; RR 0·50 [95% CI 0·41-0·60]), solar treatment (n=13; 0·63 [0·50-0·80]), and chlorination (n=25; 0·66 [0·56-0·77]). Compared with an unimproved source, provision of an improved drinking water supply on premises with higher water quality reduced diarrhoea risk by 52% (n=2; 0·48 [0·26-0·87]). Overall, sanitation interventions reduced diarrhoea risk by 24% (0·76 [0·61-0·94]). Compared with unimproved sanitation, providing sewer connection reduced diarrhoea risk by 47% (n=5; 0·53 [0·30-0·93]). Promotion of handwashing with soap reduced diarrhoea risk by 30% (0·70 [0·64-0·76]). INTERPRETATION WASH interventions reduced risk of diarrhoea in children in LMICs. Interventions supplying either water filtered at POU, higher water quality from an improved source on premises, or basic sanitation services with sewer connection were associated with increased reductions. Our results support higher service levels called for under SDG 6. Notably, no studies evaluated interventions that delivered access to safely managed WASH services, the level of service to which universal coverage by 2030 is committed under the SDG. FUNDING WHO, Foreign, Commonwealth & Development Office, and National Institute of Environmental Health Sciences.
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Affiliation(s)
- Jennyfer Wolf
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland.
| | - Sydney Hubbard
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Argaw Ambelu
- Department of Environmental Health Sciences and Technology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Benjamin F Arnold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Robert Bain
- UNICEF Middle East and North Africa, Amman, Jordan
| | - Valerie Bauza
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Bethany A Caruso
- The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Bruce Gordon
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland
| | - Richard B Johnston
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Annette Prüss-Ustün
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland
| | - Ian Ross
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeffrey Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jeff T Zhao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Sophie Boisson
- Department of Environmental, Climate Change and Health, WHO, Geneva, Switzerland
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Liu Z, Ashorn U, Chingwanda C, Maleta K, Hallamaa L, Matchado A, Kortekangas E, Dewey KG, Ashorn P, Fan Y. Provision of small‐quantity lipid‐based nutrient supplements does not improve intestinal health among rural Malawian children. MATERNAL & CHILD NUTRITION 2022; 18:e13331. [PMID: 35128820 PMCID: PMC9218311 DOI: 10.1111/mcn.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Zhifei Liu
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | | | - Kenneth Maleta
- Department of Public Health University of Malawi Zomba Malawi
| | - Lotta Hallamaa
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Andrew Matchado
- Department of Public Health University of Malawi Zomba Malawi
| | - Emma Kortekangas
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Kathryn G Dewey
- Department of Nutrition University of California Davis CA USA
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Department of Paediatrics Tampere University Hospital Tampere Finland
| | - Yue‐Mei Fan
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology Tampere University Tampere Finland
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95
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Nipa NJ, Aktar N, Hira HM, Akter F, Jahan D, Islam S, Etando A, Abdullah A, Chowdhury K, Ahmad R, Haq A, Haque M. Intestinal Parasitic Infections Among Pediatric Patients in a Metropolitan City of Bangladesh With Emphasis on Cryptosporidiosis. Cureus 2022; 14:e26927. [PMID: 35865179 PMCID: PMC9293268 DOI: 10.7759/cureus.26927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Gastrointestinal parasitic infections are one of the global health concerns in developing countries like Bangladesh. Among them, Cryptosporidium spp. plays an essential role in causing diarrhea, malnutrition, and poor cognitive function, especially in children. This study was conducted to identify the frequency of Cryptosporidium cases and other parasitic agents. Methods A cross-sectional observational study was conducted among 219 hospitalized children with diarrhea. The conventional microscopic technique was applied for parasitic detection. Particular staining (modified Ziehl-Neelsen) procedure was performed to identify oocysts of Cryptosporidium spp. A polymerase chain reaction (PCR) was performed to determine the SSU rRNA and gp60 gene of Cryptosporidium. Results Cysts of Giardia duodenalis (2.3%), ova of Ascaris lumbricoides (1.4%,), Trichuris trichiura (0.5%), and both A. lumbricoides and T. trichiura (0.9%) were identified in samples through wet mount preparation. The distribution of Cryptosporidium spp. as detected by the staining method and nested PCR was 1.4% and 4.1%, respectively. Conclusion Factors independently associated with Cryptosporidium infection are unsafe water, lack of regular hand washing, and insufficiency of exclusive breastfeeding. This study reports, presumably for the first time, the detection of Cryptosporidium oocysts in Chattogram metropolitan city of Bangladesh.
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Affiliation(s)
| | - Nasima Aktar
- Microbiology, Chittagong Medical College, Chattogram, BGD
| | - Hasina M Hira
- Community Medicine, Chittagong Medical College, Chattogram, BGD
| | - Farhana Akter
- Endocrinology and Diabetes, Chittagong Medical College, Chattogram, BGD
| | | | | | - Ayukafangha Etando
- Medical Laboratory Sciences, Faculty of Health Sciences, Eswatini Medical Christian University, Mbabane, SWZ
| | - Adnan Abdullah
- Occupational Medicine, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
| | - Kona Chowdhury
- Pediatrics, Gonoshasthaya Samaj Vittik Medical College, Savar, BGD
| | - Rahnuma Ahmad
- Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | - Ahsanul Haq
- Statistics, Gonoshasthaya - RNA Biotech Limited, Savar, BGD
| | - Mainul Haque
- Pharmacology and Therapeutics, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
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96
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Win H, Shafique S, Probst-Hensch N, Fink G. Change in nutritional status of urban slum children before and after the first COVID-19 wave in Bangladesh: A repeated cross-sectional assessment. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000456. [PMID: 36962389 PMCID: PMC10021417 DOI: 10.1371/journal.pgph.0000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
The onset of COVID-19 severely disrupted economies and increased acute household food insecurity in developing countries. Consequently, a global rise in childhood undernutrition was predicted, especially among vulnerable populations, but primary evidence on actual changes in nutritional status remained scarce. In this paper, we assessed shifts in nutritional status of urban slum children in Bangladesh pre- and post- the country's first wave of COVID-19 and nationwide lockdown. We used two rounds of cross-sectional data collected before and after the pandemic's first year in two large slum settlements (Korail and Tongi) of Dhaka and Gazipur, Bangladesh (n = 1119). Regression models estimated pre-post changes in: 1) predictors of childhood undernutrition (household income, jobs, food security, dietary diversity, healthcare utilization, and hand hygiene); and 2) under-five children's nutritional status (average height-for-age z-score (HAZ) and weight-for-height z-score (WHZ), stunting, and wasting). Subgroup analysis was done by household migration status and slum area. Over the sample period, average monthly household income dropped 23% from BDT 20,740 to BDT 15,960 (β = -4.77; 95% CI:-6.40, -3.15), and currently employed fathers slightly declined from 99% to 95% (β = -0.04; 95% CI:-0.05, -0.02). Average HAZ among the slum children improved 0.13 SD (95% CI: 0.003, 0.26). Among non-migrant children in Tongi, the odds of stunting increased (OR = 2.01, 95% CI: 1.16, 3.48) and average WHZ reduced -0.40 SD (95% CI: -0.74, -0.06). Despite great economic hardship, and differential patterns of representativeness by household geography and migration status, slum children in Bangladesh generally demonstrated resilience to nutritional decline over the first year of the pandemic. While underlying threats to nutritional deterioration persisted, considerable job and income recovery in the post-lockdown period appeared to have cushioned the overall decline. However, as the pandemic continues, monitoring and appropriate actions are needed to avert lasting setbacks to Bangladesh nutritional progress.
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Affiliation(s)
- Hayman Win
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sohana Shafique
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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97
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Food Safety Practices and Stunting among School-Age Children—An Observational Study Finding from an Urban Slum of Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138044. [PMID: 35805701 PMCID: PMC9265275 DOI: 10.3390/ijerph19138044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
Background: Food safety incorporates the handling, preparation, and storage of food materials in ways that prevent foodborne illness. We aimed to investigate the typical food safety practices in a Bangladeshi slum context and to explore if stunting among school-age children was associated with various components of food safety. Method: We analysed the MAL-ED birth cohort data from the Bangladesh site. A total of 265 healthy children were enrolled in the study; we could follow up and collect food safety-related data from 187 participants. Results: The average age of the children was 6.5 years (standard deviation or SD 0.04) and 49% of them were female. About 26% of the children were stunted. In our bivariate analysis, caregivers’ handwashing practice after using the toilet, treatment of drinking water, presence of insects/pests in the cooking area, and child’s eating ready-made/street food more than three times per day were significantly associated with stunting. After adjusting for pertinent factors, treatment of drinking water (adjusted odds ratio or AOR = 2.50, 95% confidence interval or CI: 1.03, 6.05), and child’s eating ready-made/street food more than three times/day (AOR = 2.34, 95%CI: 1.06, 5.15) remained significantly associated with stunting. Conclusions: Diverse aspects of food safety practices have a substantial association with stunting among school-age children living in an unhygienic slum environment in Dhaka, Bangladesh.
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Nasim N, El-Zein A, Thomas J. A review of rural and peri-urban sanitation infrastructure in South-East Asia and the Western Pacific: Highlighting regional inequalities and limited data. Int J Hyg Environ Health 2022; 244:113992. [PMID: 35752101 DOI: 10.1016/j.ijheh.2022.113992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/22/2022] [Accepted: 06/03/2022] [Indexed: 12/16/2022]
Abstract
Rural and peri-urban communities in developing countries rely on sanitation systems which are often unsafely managed. One of the major barriers to assess safely managed sanitation is a lack of data about the existing sanitation infrastructure and levels of containment safety. The aim was to review rural and peri-urban on-site sanitation studies in order to understand different infrastructure types, associated management practices and any impacts on human health. The scope was limited to South-East Asia and Western Pacific regions in order to better identify regional inequalities. Among the 155 reviewed articles, 73 studies (47%) linked sanitation infrastructure to poor human health. Nearly all articles reported latrine ownership (n = 149, 96%) while sanitation infrastructure types were covered less frequently (n = 104, 67%). In particular, there was a lack of published literature describing back-end characteristics (dimension and materials) (n = 12, 8%) and/or management practices (n = 4, 3%). This stems from a limited application of research methodologies that characterise sanitation infrastructure and faecal sludge management (containment, emptying and on-site treatment). Inequality between regions was prevalent with three quarters of the studies on latrine back-end infrastructure from Bangladesh and India in South-East Asia. A strategic research approach is needed to address the current knowledge gaps regarding sanitation infrastructure and safe faecal sludge management.
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Affiliation(s)
- Nabeela Nasim
- School of Civil Engineering, The University of Sydney, Australia.
| | - Abbas El-Zein
- School of Civil Engineering, The University of Sydney, Australia.
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Mshamu S, Mmbando A, Meta J, Bradley J, Bøjstrup TC, Day NPJ, Mukaka M, Okumu F, Olotu A, Pell C, Deen J, Knudsen J, Lindsay SW, von Seidlein L. Assessing the impact of a novel house design on the incidence of malaria in children in rural Africa: study protocol for a household-cluster randomized controlled superiority trial. Trials 2022; 23:519. [PMID: 35725486 PMCID: PMC9207857 DOI: 10.1186/s13063-022-06461-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Traditional rural housing in hot, humid regions of sub-Saharan Africa usually consists of single-level, poorly ventilated dwellings. Houses are mostly poorly screened against malaria mosquitoes and limited airflow discourages the use of bednets resulting in high indoor transmission. This study aims to determine whether living in a novel design house with elevated bedrooms and permeable screened walls reduces malaria, respiratory tract infections, and diarrhoea among children in rural Tanzania. Methods/study design This is a household-randomized, controlled study in 60 villages in Mtwara, Tanzania. A total of 550 households are randomly selected, 110 of which are allocated a novel design house and 440 households continue to reside in traditional houses. A dynamic cohort of about 1650 children under 13 years will be enrolled and followed for 3 years, approximately 330 living in novel design houses and 1320 in traditional rural houses. The primary endpoint is the incidence of malaria; secondary endpoints are incidences of acute respiratory tract infections and diarrhoea diseases detected by passive and active surveillance. Exposure to malaria vectors will be assessed using light traps in all study houses. Structural, economic, and social science studies will assess the durability, cost-effectiveness, and acceptability of the new houses compared with traditional housing. Environmental data will be collected indoors and outdoors in study homes to assess the differences between house typologies. Discussion This is the first randomized controlled trial to assess the protective efficacy of a new house design targeting malaria in sub-Saharan Africa. The findings of this study could influence the future construction of homes in hot and humid zones of Africa. Trial registration ClinicalTrials.govNCT04529434. Registered on August 27, 2020
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Affiliation(s)
- Salum Mshamu
- CSK Research Solutions, Mtwara, Tanzania.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Arnold Mmbando
- Ifakara Health Institute, Ifakara, Tanzania.,Department of Biosciences, Durham University, Durham, UK
| | - Judith Meta
- University of Amsterdam, Amsterdam, Netherlands
| | - John Bradley
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Nicholas P J Day
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | - Mavuto Mukaka
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | | | - Ally Olotu
- Ifakara Health Institute, Ifakara, Tanzania
| | | | | | - Jakob Knudsen
- The Royal Danish Academy of Fine Arts, Copenhagen, Denmark
| | | | - Lorenz von Seidlein
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. .,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.
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Head JR, Chanthavilay P, Catton H, Vongsitthi A, Khamphouxay K, Simphaly N. Changes in household food security, access to health services and income in northern Lao PDR during the COVID-19 pandemic: a cross-sectional survey. BMJ Open 2022; 12:e055935. [PMID: 35654468 PMCID: PMC9163008 DOI: 10.1136/bmjopen-2021-055935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 05/08/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We assessed the relative difficulty in meeting food needs during the COVID-19 pandemic compared with before; determined the relationship between pandemic-associated difficulties in food access and household, maternal and child food security; and identified resiliency-promoting strategies. DESIGN A cross-sectional survey of households undertaken in November 2020. SETTING Rural districts of Luang Prabang Province, Lao People's Democratic Republic. PARTICIPANTS Households (N=1122) with children under 5 years. PRIMARY AND SECONDARY OUTCOMES MEASURED Survey respondents reported the relative ease of access of food and healthcare as well as changes in income and expenditures compared with before March 2020. We determined indicators of food security and source of foods consumed for households, women and children, as well as prevalence of malnutrition in children under 5. RESULTS Nearly four-fifths (78.5%) found it harder to meet household food needs during the pandemic. The most common reasons were increased food prices (51.2%), loss of income (45.3%) and decreased food availability (36.6%). Adjusting for demographics, households with increased difficulty meeting food needs had lower food consumption scores and child dietary diversity. Over 85% of households lost income during the pandemic. Decreased expenditures was associated with reliance on more extreme coping strategies to meet food needs. The households who experienced no change in meeting food needs produced a greater percentage of their food from homegrown methods (4.22% more, 95% CI 1.28 to 7.15), than households who found it more difficult. CONCLUSIONS Pandemic-associated shocks may have large effects on food insecurity. Action is needed to mitigate consequences of the pandemic on nutrition. Local food production and safety net programmes that offset income losses may help.
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Affiliation(s)
- Jennifer R Head
- Division of Epidemiology, University of California Berkeley, Berkeley, California, USA
| | - Phetsavanh Chanthavilay
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Helen Catton
- Save the Children International, Luang Prabang, Lao People's Democratic Republic
| | - Ammaline Vongsitthi
- Save the Children International, Luang Prabang, Lao People's Democratic Republic
| | - Kelley Khamphouxay
- Save the Children International, Luang Prabang, Lao People's Democratic Republic
| | - Niphone Simphaly
- Provincial Health Department, Luang Prabang, Lao People's Democratic Republic
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