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Colston JM, Francois R, Pisanic N, Peñataro Yori P, McCormick BJJ, Olortegui MP, Gazi MA, Svensen E, Ahmed MMM, Mduma E, Liu J, Houpt ER, Klapheke R, Schwarz JW, Atmar RL, Black RE, Kosek MN. Effects of Child and Maternal Histo-Blood Group Antigen Status on Symptomatic and Asymptomatic Enteric Infections in Early Childhood. J Infect Dis 2019; 220:151-162. [PMID: 30768135 PMCID: PMC6548901 DOI: 10.1093/infdis/jiz072] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Histo-blood group antigens (HBGAs) such as fucosyltransferase (FUT)2 and 3 may act as innate host factors that differentially influence susceptibility of individuals and their offspring to pediatric enteric infections. METHODS In 3 community-based birth cohorts, FUT2 and FUT3 statuses were ascertained for mother-child dyads. Quantitative polymerase chain reaction panels tested 3663 diarrheal and 18 148 asymptomatic stool samples for 29 enteropathogens. Cumulative diarrhea and infection incidence were compared by child (n = 520) and mothers' (n = 519) HBGA status and hazard ratios (HRs) derived for all-cause diarrhea and specific enteropathogens. RESULTS Children of secretor (FUT2 positive) mothers had a 38% increased adjusted risk of all-cause diarrhea (HR = 1.38; 95% confidence interval (CI), 1.15-1.66) and significantly reduced time to first diarrheal episode. Child FUT2 and FUT3 positivity reduced the risk for all-cause diarrhea by 29% (HR = 0.81; 95% CI, 0.71-0.93) and 27% (HR = 0.83; 95% CI, 0.74-0.92), respectively. Strong associations between HBGAs and pathogen-specific infection and diarrhea were observed, particularly for noroviruses, rotaviruses, enterotoxigenic Escherichia coli, and Campylobacter jejuni/coli. CONCLUSIONS Histo-blood group antigens affect incidence of all-cause diarrhea and enteric infections at magnitudes comparable to many common disease control interventions. Studies measuring impacts of interventions on childhood enteric disease should account for both child and mothers' HBGA status.
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Affiliation(s)
- Josh M Colston
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ruthly Francois
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Pablo Peñataro Yori
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | | | | | - Md Amran Gazi
- International Centre for Diarrhoeal Disease Research, Bangladesh
| | | | | | - Esto Mduma
- Haydom Global Health Institute, Haydom, Tanzania
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | | | | | | | - Robert E Black
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Margaret N Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
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302
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Media Access is Associated with Knowledge of Optimal Water, Sanitation and Hygiene Practices in Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111963. [PMID: 31163573 PMCID: PMC6604005 DOI: 10.3390/ijerph16111963] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 12/23/2022]
Abstract
The importance of water, sanitation and hygiene (WASH) behaviors in low- and middle-income countries in preventing childhood illness is well established. Tanzania is known to have high rates of chronic malnutrition and childhood stunting—both of which have been linked to poor WASH practices. Interviews were conducted with 5000 primary caregivers of children aged 0–23 months. Four composite WASH knowledge variables were created to assess the relationship between WASH knowledge and access to different forms of media, such as television, radio, and mobile phones. WASH knowledge variables measure knowledge of when to wash hands, the need for soap when washing hands, when to wash a baby’s hands, and how eating soil or chicken feces can affect a baby’s health. Logistic and linear regression analyses were conducted to measure the association between media access and WASH knowledge. Having watched television was positively associated with higher WASH knowledge indicators (all p < 0.05). Higher WASH knowledge was positively associated with more frequent handwashing after cleaning a baby’s bottom (all p < 0.0001). The quantity of media access also had a positive linear effect on handwashing; more media items owned was associated with increases in handwashing. Study findings indicate media access is associated with WASH knowledge among caregivers in resource-poor settings.
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Effects of single and integrated water, sanitation, handwashing, and nutrition interventions on child soil-transmitted helminth and Giardia infections: A cluster-randomized controlled trial in rural Kenya. PLoS Med 2019; 16:e1002841. [PMID: 31242190 PMCID: PMC6594579 DOI: 10.1371/journal.pmed.1002841] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/28/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Helminth and protozoan infections affect more than 1 billion children globally. Improving water quality, sanitation, handwashing, and nutrition could be more sustainable control strategies for parasite infections than mass drug administration, while providing other quality of life benefits. METHODS AND FINDINGS We enrolled geographic clusters of pregnant women in rural western Kenya into a cluster-randomized controlled trial (ClinicalTrials.gov NCT01704105) that tested 6 interventions: water treatment, improved sanitation, handwashing with soap, combined water treatment, sanitation, and handwashing (WSH), improved nutrition, and combined WSH and nutrition (WSHN). We assessed intervention effects on parasite infections by measuring Ascaris lumbricoides, Trichuris trichiura, hookworm, and Giardia duodenalis among children born to the enrolled pregnant women (index children) and their older siblings. After 2 years of intervention exposure, we collected stool specimens from 9,077 total children aged 2 to 15 years in 622 clusters, including 2,346 children in an active control group (received household visits but no interventions), 1,117 in the water treatment arm, 1,160 in the sanitation arm, 1,141 in the handwashing arm, 1,064 in the WSH arm, 1,072 in the nutrition arm, and 1,177 in the WSHN arm. In the control group, 23% of children were infected with A. lumbricoides, 1% with T. trichiura, 2% with hookworm, and 39% with G. duodenalis. The analysis included 4,928 index children (median age in years: 2) and 4,149 older siblings (median age in years: 5); study households had an average of 5 people, <10% had electricity access, and >90% had dirt floors. Compared to the control group, Ascaris infection prevalence was lower in the water treatment arm (prevalence ratio [PR]: 0.82 [95% CI 0.67, 1.00], p = 0.056), the WSH arm (PR: 0.78 [95% CI 0.63, 0.96], p = 0.021), and the WSHN arm (PR: 0.78 [95% CI 0.64, 0.96], p = 0.017). We did not observe differences in Ascaris infection prevalence between the control group and the arms with the individual interventions sanitation (PR: 0.89 [95% CI 0.73, 1.08], p = 0.228), handwashing (PR: 0.89 [95% CI 0.73, 1.09], p = 0.277), or nutrition (PR: 86 [95% CI 0.71, 1.05], p = 0.148). Integrating nutrition with WSH did not provide additional benefit. Trichuris and hookworm were rarely detected, resulting in imprecise effect estimates. No intervention reduced Giardia. Reanalysis of stool samples by quantitative polymerase chain reaction confirmed the reductions in Ascaris infections measured by microscopy in the WSH and WSHN groups. Trial limitations included imperfect uptake of targeted intervention behaviors, limited power to detect effects on rare parasite infections, and that it was not feasible to blind participants and sample collectors to treatment status. However, lab technicians and data analysts were blinded to treatment status. The trial was funded by the Bill & Melinda Gates Foundation and the United States Agency for International Development. CONCLUSIONS Integration of improved water quality, sanitation, and handwashing could contribute to sustainable control strategies for Ascaris infections, particularly in similar settings with recent or ongoing deworming programs. Combining nutrition with WSH did not provide further benefits, and water treatment alone was similarly effective to integrated WSH. Our findings provide new evidence that drinking water should be given increased attention as a transmission pathway for Ascaris. TRIAL REGISTRATION ClinicalTrials.gov NCT01704105.
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304
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Prüss-Ustün A, Wolf J, Bartram J, Clasen T, Cumming O, Freeman MC, Gordon B, Hunter PR, Medlicott K, Johnston R. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. Int J Hyg Environ Health 2019; 222:765-777. [PMID: 31088724 PMCID: PMC6593152 DOI: 10.1016/j.ijheh.2019.05.004] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND To develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and middle-income countries. METHODS For each of the analysed diseases, exposure levels with both sufficient global exposure data for 2016 and a matching exposure-response relationship were combined into population-attributable fractions. Attributable deaths and disability-adjusted life years (DALYs) were estimated for each disease and, for most of the diseases, by country, age and sex group separately for inadequate water, sanitation and hygiene behaviours and for the cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. FINDINGS An estimated 829,000 WASH-attributable deaths and 49.8 million DALYs occurred from diarrhoeal diseases in 2016, equivalent to 60% of all diarrhoeal deaths. In children under 5 years, 297,000 WASH-attributable diarrhoea deaths occurred, representing 5.3% of all deaths in this age group. If the global disease burden from different diseases and several counterfactual exposure distributions was combined it would amount to 1.6 million deaths, representing 2.8% of all deaths, and 104.6 million DALYs in 2016. CONCLUSIONS Despite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children. These estimates contribute to global monitoring such as for the Sustainable Development Goal indicator on mortality from inadequate WASH.
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Affiliation(s)
- Annette Prüss-Ustün
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland.
| | - Jennyfer Wolf
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland.
| | - Jamie Bartram
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Bruce Gordon
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland.
| | - Paul R Hunter
- The Norwich School of Medicine, University of East Anglia, Norwich, UK; Department of Environmental Health, Tshwane University of Technology, Pretoria, South Africa.
| | - Kate Medlicott
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland.
| | - Richard Johnston
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, Geneva, Switzerland.
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Kirby MA, Nagel CL, Rosa G, Zambrano LD, Musafiri S, Ngirabega JDD, Thomas EA, Clasen T. Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda. PLoS Med 2019; 16:e1002812. [PMID: 31158266 PMCID: PMC6546207 DOI: 10.1371/journal.pmed.1002812] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 04/23/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Unsafe drinking water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household water filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. METHODS AND FINDINGS In a large-scale program in Western Province, Rwanda, water filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking water (piped, borehole, protected spring/well, or rainwater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have water in their filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes. CONCLUSIONS Our findings indicate that the intervention improved household drinking water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI. TRIAL REGISTRATION Clinical Trials.gov NCT02239250.
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Affiliation(s)
- Miles A. Kirby
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Emory University Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Corey L. Nagel
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Ghislaine Rosa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura D. Zambrano
- Emory University Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Sanctus Musafiri
- University of Rwanda School of Medicine and Pharmacy, Butare, Rwanda
| | - Jean de Dieu Ngirabega
- Rwanda Biomedical Center, Kigali, Rwanda
- East African Health Research Commission, Arusha, United Republic of Tanzania
| | - Evan A. Thomas
- Mortenson Center in Global Engineering, University of Colorado Boulder, Boulder, Colorado, United States of America
| | - Thomas Clasen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Emory University Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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306
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Das JK, Salam RA, Hadi YB, Sadiq Sheikh S, Bhutta AZ, Weise Prinzo Z, Bhutta ZA. Preventive lipid-based nutrient supplements given with complementary foods to infants and young children 6 to 23 months of age for health, nutrition, and developmental outcomes. Cochrane Database Syst Rev 2019; 5:CD012611. [PMID: 31046132 PMCID: PMC6497129 DOI: 10.1002/14651858.cd012611.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND One nutritional intervention advocated to prevent malnutrition among children is lipid-based nutrient supplements (LNS). LNS provide a range of vitamins and minerals, but unlike most other micronutrient supplements, LNS also provide energy, protein and essential fatty acids. Alternative recipes and formulations to LNS include fortified blended foods (FBF), which are foods fortified with vitamins and minerals, and micronutrient powders (MNP), which are a combination of vitamins and minerals, OBJECTIVES: To assess the effects and safety of preventive LNS given with complementary foods on health, nutrition and developmental outcomes of non-hospitalised infants and children six to 23 months of age, and whether or not they are more effective than other foods (including FBF or MNP).This review did not assess the effects of LNS as supplementary foods or therapeutic foods in the management of moderate and severe acute malnutrition. SEARCH METHODS In October 2018, we searched CENTRAL, MEDLINE, Embase, 21 other databases and two trials registers for relevant studies. We also checked the reference lists of included studies and relevant reviews and contacted the authors of studies and other experts in the area for any ongoing and unpublished studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs that evaluated the impact of LNS plus complementary foods given at point-of-use (for any dose, frequency, duration) to non-hospitalised infants and young children aged six to 23 months in stable or emergency settings and compared to no intervention, other supplementary foods (i.e. FBF), nutrition counselling or multiple micronutrient supplements or powders for point-of-use fortification of complementary foods. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for relevance and, for those studies included in the review, extracted data, assessed risk of bias and rated the quality of the evidence using the GRADE approach. We carried out statistical analysis using Review Manager software. We used a random-effects meta-analysis for combining data as the interventions differed significantly. We set out the main findings of the review in 'Summary of findings' tables,. MAIN RESULTS Our search identified a total of 8124 records, from which we included 17 studies (54 papers) with 23,200 children in the review. The included studies reported on one or more of the pre-specified primary outcomes, and five studies included multiple comparison groups.Overall, the majority of trials were at low risk of bias for random sequence generation, allocation concealment, blinding of outcome assessment, incomplete outcome data, selective reporting and other sources of bias, but at high risk of bias for blinding of participants and personnel due to the nature of the intervention. Using the GRADE approach, we judged the quality of the evidence for most outcomes as low or moderate.LNS+complementary feeding compared with no intervention Thirteen studies compared LNS plus complementary feeding with no intervention. LNS plus complementary feeding reduced the prevalence of moderate stunting by 7% (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.88 to 0.98; nine studies, 13,372 participants; moderate-quality evidence), severe stunting by 15% (RR 0.85, 95% CI 0.74 to 0.98; five studies, 6151 participants; moderate-quality evidence), moderate wasting by 18% (RR 0.82, 95% CI 0.74 to 0.91; eight studies; 13,172 participants; moderate-quality evidence), moderate underweight by 15% (RR 0.85, 95% CI 0.80 to 0.91; eight studies, 13,073 participants; moderate-quality evidence), and anaemia by 21% (RR 0.79, 95% CI 0.69 to 0.90; five studies, 2332 participants; low-quality evidence). There was no impact of LNS plus complementary feeding on severe wasting (RR 1.27, 95% CI 0.66 to 2.46; three studies, 2329 participants) and severe underweight (RR 0.78, 95%CI 0.54 to 1.13; two studies, 1729 participants). Adverse effects did not differ between the groups (RR 0.86, 95% CI 0.74 to 1.01; three studies, 3382 participants).LNS+complementary feeding compared with FBF Five studies compared LNS plus complementary feeding with other FBF, including corn soy blend and UNIMIX. We pooled four of the five studies in meta-analyses and found that, when compared to other FBF, LNS plus complementary feeding significantly reduced the prevalence of moderate stunting (RR 0.89, 95% CI 0.82 to 0.97; three studies, 2828 participants; moderate-quality evidence), moderate wasting (RR 0.79, 95% CI 0.65 to 0.97; two studies, 2290 participants; moderate-quality evidence), and moderate underweight (RR 0.81, 95% CI 0.73 to 0.91; two studies, 2280 participants; moderate-quality evidence). We found no difference between LNS plus complementary feeding and FBF for severe stunting (RR 0.41, 95% CI 0.12 to 1.42; two studies, 729 participants; low-quality evidence), severe wasting (RR 0.64, 95% CI 0.19 to 2.81; two studies, 735 participants; moderate-quality evidence), and severe underweight (RR 1.23, 95% CI 0.67 to 2.25; one study, 173 participants; low-quality evidence).LNS+complementary feeding compared with MNP Four studies compared LNS plus complementary feeding with MNP. We pooled data from three of the four studies in meta-analyses and found that compared to MNP, LNS plus complementary feeding significantly reduced the prevalence of moderate underweight (RR 0.88, 95% CI 0.78 to 0.99; two studies, 2004 participants; moderate-quality evidence) and anaemia (RR 0.38, 95% CI 0.21 to 0.68; two studies, 557 participants; low-quality evidence). There was no difference between LNS plus complementary feeding and MNP for moderate stunting (RR 0.92, 95% CI 0.82 to 1.02; three studies, 2365 participants) and moderate wasting (RR 0.97, 95% CI 0.77 to 1.23; two studies, 2004 participants). AUTHORS' CONCLUSIONS The findings of this review suggest that LNS plus complementary feeding compared to no intervention is effective at improving growth outcomes and anaemia without adverse effects among children aged six to 23 months in low- and middle-income countries (LMIC) in Asia and Africa, and more effective if provided over a longer duration of time (over 12 months). Limited evidence also suggests that LNS plus complementary feeding is more effective than FBF and MNP at improving growth outcomes.
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Affiliation(s)
- Jai K Das
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Rehana A Salam
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Yousaf Bashir Hadi
- West Virginia UniversityDepartment of Internal Medicine1 Medical Center DriveMorgantownWest VirginiaUSA26506
| | - Sana Sadiq Sheikh
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Afsah Z Bhutta
- Dow University of Health SciencesKarachiSindhPakistan75500
| | - Zita Weise Prinzo
- World Health OrganizationDepartment of Nutrition for Health and DevelopmentAvenue Appia 20GenevaGESwitzerland1211
| | - Zulfiqar A Bhutta
- The Hospital for Sick ChildrenCentre for Global Child HealthTorontoCanada
- Aga Khan University HospitalCenter for Excellence in Women and Child HealthKarachiPakistan
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307
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Black RE, Walker CF. Do Water, Sanitation, and Hygiene Interventions Prevent Childhood Diarrhea? J Infect Dis 2019; 221:1241-1243. [DOI: 10.1093/infdis/jiz183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/26/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Robert E Black
- Institute for International Programs, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Christa Fischer Walker
- Institute for International Programs, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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308
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Brewster DR. External Generalizability of Clinical Trials to Developing Countries. J Pediatr Gastroenterol Nutr 2019; 68:609-610. [PMID: 30908384 DOI: 10.1097/mpg.0000000000002334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- David R Brewster
- Pediatric Department, National Hospital Guido Valadares, National University of Timor Lorosae, Dili, Timor-Leste
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309
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Isanaka S, Hitchings MDT, Berthé F, Briend A, Grais RF. Linear growth faltering and the role of weight attainment: Prospective analysis of young children recovering from severe wasting in Niger. MATERNAL AND CHILD NUTRITION 2019; 15:e12817. [PMID: 30903806 PMCID: PMC6849732 DOI: 10.1111/mcn.12817] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/11/2019] [Accepted: 03/15/2019] [Indexed: 12/17/2022]
Abstract
Efforts to reduce the impact of stunting have been largely independent of interventions to reduce the impact of wasting, despite the observation that the conditions can coexist in the same child and increase risk of death. To optimize the management of malnourished children—who can be wasted, stunted, or both—the relationship between stunting and wasting should be elaborated. We aimed to describe the relationship between concurrent weight and height gain during and after rehabilitation from severe wasting. We conducted a secondary analysis of a randomized trial for the outpatient treatment of severe wasting, including 1,542 children who recovered and were followed for 12 weeks. We described the overlap of stunting and severe wasting and the change in stunting over time. We showed the relationship between concurrent weight and height gain using adjusted generalized estimating equations and calculated the mean rate of change in weight‐for‐height z score (WHZ) and height‐for‐age z score (HAZ) during and after rehabilitation. At baseline, 79% (n = 1,223/1,542) and 49% (n = 757/1,542) of children were stunted and severely stunted, respectively. Prevalence increased over time among children <24 months. During rehabilitation when weight was not yet fully recovered, we found rapid WHZ gain but limited HAZ gain. Following successful rehabilitation, WHZ gain slowed. The rate of HAZ gain was negative after rehabilitation but increased relative to the period during treatment. The potential relationship between weight and height gain calls for increased coverage of wasting treatment to not only prevent child mortality but also reduce linear growth faltering.
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Affiliation(s)
- Sheila Isanaka
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States.,Department of Research, Epicentre, Paris, France
| | - Matt D T Hitchings
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States
| | | | - André Briend
- Center for Child Health Research, University of Tampere School of Medicine, Tampere, Finland.,Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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310
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Maleta KM, Manary MJ. WASH alone cannot prevent childhood linear growth faltering. LANCET GLOBAL HEALTH 2019; 7:e16-e17. [PMID: 30554752 DOI: 10.1016/s2214-109x(18)30420-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Kenneth M Maleta
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Private Bag 360 Blantyre 3, Malawi.
| | - Mark J Manary
- Department of Pediatrics, St Louis Children's Hospital, St Louis, MO, USA
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311
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Interventions to Improve Micronutrient Status of Women of Reproductive Age in Southeast Asia: A Narrative Review on What Works, What Might Work, and What Doesn't Work. Matern Child Health J 2019; 23:18-28. [PMID: 30357535 DOI: 10.1007/s10995-018-2637-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives To provide an overview of nutrition-specific and nutrition-sensitive interventions that could improve micronutrient status of women of reproductive age. Methods This narrative review has a special focus on Southeast Asia, as the work was undertaken within the framework of the SMILING (Sustainable Micronutrient Interventions to controL deficiencies and Improve Nutrition status and General health in Southeast Asia) project. Results In order for new interventions to become accepted, comprehension and interpretation of potential impact of different strategies by policymakers and non-nutritionists is needed. By presenting a wide overview of strategies, and discussing the context and current consensus on these strategies, the review aims to help with the formulation of new recommendations for national programs in Southeast Asia. Conclusions Current policies in Southeast Asia to improve micronutrient status of women of reproductive age are focused too much on single micronutrient supplementation for pregnant women (iron and folic acid supplements). A more holistic approach, including both nutrition-specific and nutrition-sensitive interventions, is needed.
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312
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Brown J, Albert J, Whittington D. Community-Led Total Sanitation Moves the Needle on Ending Open Defecation in Zambia. Am J Trop Med Hyg 2019; 100:767-769. [PMID: 30860017 PMCID: PMC6447111 DOI: 10.4269/ajtmh.19-0151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Dale Whittington
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of City and Regional Planning, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Global Research Institute, University of Manchester, Manchester, United Kingdom
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313
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Bauza V, Reese H, Routray P, Clasen T. Child Defecation and Feces Disposal Practices and Determinants among Households after a Combined Household-Level Piped Water and Sanitation Intervention in Rural Odisha, India. Am J Trop Med Hyg 2019; 100:1013-1021. [PMID: 30793682 PMCID: PMC6447099 DOI: 10.4269/ajtmh.18-0840] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/14/2018] [Indexed: 12/29/2022] Open
Abstract
Latrine access alone may be insufficient to encourage households to dispose of young children's feces safely in a latrine, and little is known about the determinants of improved child feces disposal. We used longitudinal data collected at up to three timepoints for children less than 5 years of age from households in Odisha, India, which received a combined household-level piped water supply and sanitation intervention, but did not specifically promote the safe disposal of child feces. Among the 85% of intervention households who reported access to improved sanitation, we characterized child defecation and feces disposal practices by age, across time, and season, and assessed determinants of improved disposal. Feces from children less than 3 years of age was commonly picked up by caregivers but disposed of unsafely with garbage into open areas (56.3% of households) or in a drain/ditch (6.2%). Although children 3 and 4 years were more likely to use a latrine than younger children, their feces was also more likely to be left in the open if they did not defecate in a latrine. For children less than 5 years of age, most (84.7%) children's feces that was safely disposed of in a latrine was because of the children defecating in the latrine directly. Significant predictors for disposing of child feces in an improved latrine were the primary female caregiver reporting using a latrine to defecate, the child's age, and water observed at place for handwashing. These findings suggest that child feces interventions should focus on encouraging children to begin using a toilet at a younger age and changing the common behavior of disposing of young child's feces into open areas.
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Affiliation(s)
- Valerie Bauza
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Heather Reese
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Parimita Routray
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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314
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Abstract
In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting. A result of chronic pathogen exposure, EED presents multiple causal pathways, and as such the scope and sensitivity of traditional water, sanitation, and hygiene (WASH) interventions have possibly been unsubstantial. Although the definite pathogenesis of EED and the mechanism by which stunting occurs are yet to be defined, this paper reviews the existing literature surrounding the proposed pathology and transmission of EED in infants and considerations for nutrition and WASH interventions to improve linear growth worldwide.
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Affiliation(s)
- Sophie Budge
- Cranfield Water Science Institute, Cranfield University, Bedfordshire, United Kingdom
| | - Alison H Parker
- Cranfield Water Science Institute, Cranfield University, Bedfordshire, United Kingdom
| | - Paul T Hutchings
- Cranfield Water Science Institute, Cranfield University, Bedfordshire, United Kingdom
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315
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Masuda K, Chitundu M. Multiple Micronutrient Supplementation Using Spirulina platensis during the First 1000 Days is Positively Associated with Development in Children under Five Years: A Follow up of A Randomized Trial in Zambia. Nutrients 2019; 11:E730. [PMID: 30934863 PMCID: PMC6520735 DOI: 10.3390/nu11040730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
Early childhood development relies on various micronutrients. We recently reported that home fortification of complementary foods using spirulina reduced the time to attain motor milestones in Zambian infants. The objective of this study is to estimate the long-term associations between spirulina supplementation during the first 1000 days and child gross motor development, fine motor development, language, and personal⁻social skills at preschool age. We used longitudinal data from a randomized trial conducted in Zambia. In 2015, 501 infants (age, 6⁻18 months) were provided daily supplements of maize-soy-based porridge with spirulina (SP) and without spirulina (CON). Supplementation period lasted for 16 months. In January 2018, children who participated in the initial trial were resurveyed (CON: 182 children; SP: 188 children; now aged 36⁻48 months). We assessed the infants' gross motor development, fine motor development, language, and personal⁻social skills using a modified version of Malawi Development Assessment Tool. The initial clinical trial registration number was NCT03523182. Children in the SP group had higher scores in gross and fine motor development, language, and social skills than those in the CON group. Home fortification of complementary foods using spirulina during the first 1000 days improved development among Zambian children at preschool age.
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Affiliation(s)
- Kazuya Masuda
- Institute of Economic Research, Hitotsubashi University, Tokyo 186-8603, Japan.
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316
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The landscape of enteric pathogen exposure of young children in public domains of low-income, urban Kenya: The influence of exposure pathway and spatial range of play on multi-pathogen exposure risks. PLoS Negl Trop Dis 2019; 13:e0007292. [PMID: 30917117 PMCID: PMC6453472 DOI: 10.1371/journal.pntd.0007292] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 04/08/2019] [Accepted: 03/12/2019] [Indexed: 11/19/2022] Open
Abstract
Young children are infected by a diverse variety of enteric pathogens in low-income, high-burden countries. Little is known about which conditions pose the greatest risk for enteric pathogen exposure and infection. Young children frequently play in residential public areas around their household, including areas contaminated by human and animal feces, suggesting these exposures are particularly hazardous. The objective of this study was to examine how the dose of six types of common enteric pathogens, and the probability of exposure to one or multiple enteric pathogens for young children playing at public play areas in Kisumu, Kenya is influenced by the type and frequency of child play behaviors that result in ingestion of soil or surface water. Additionally, we examine how pathogen doses and multi-pathogen exposure are modified by spatial variability in the number of public areas children are exposed to in their neighborhood. A Bayesian framework was employed to obtain the posterior distribution of pathogen doses for a certain number of contacts. First, a multivariate mixed effects tobit model was used to obtain the posterior distribution of pathogen concentrations, and their interdependencies, in soil and surface water, based upon empirical data of enteric pathogen contamination in three neighborhoods of Kisumu. Then, exposure doses were estimated using behavioral contact parameters from previous studies and contrasted under different exposure conditions. Pathogen presence and concentration in soil varied widely across local (< 25 meter radius area) and neighborhood-level scales, but pathogens were correlated among distinct surface water samples collected near to each other. Multi-pathogen exposure of children at public play areas was common. Pathogen doses and the probability of multi-pathogen ingestion increased with: higher frequency of environmental contact, especially for surface water; larger volume of soil or water ingested; and with play at multiple sites in the neighborhood versus single site play. Child contact with surface water and soil at public play areas in their neighborhood is an important cause of exposure to enteric pathogens in Kisumu, and behavioral, environmental, and spatial conditions are determinants of exposure.
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317
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Verbyla ME, Pitol AK, Navab-Daneshmand T, Marks SJ, Julian TR. Safely Managed Hygiene: A Risk-Based Assessment of Handwashing Water Quality. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2019; 53:2852-2861. [PMID: 30689351 DOI: 10.1021/acs.est.8b06156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sustainable Development Goal (SDG) Indicator 6.2.1 requires household handwashing facilities to have soap and water, but there are no guidelines for handwashing water quality. In contrast, drinking water quality guidelines are defined: water must be "free from contamination" to be defined as "safely managed" (SDG Indicator 6.1.1). We modeled the hypothesized mechanism of infection due to contaminated handwashing water to inform risk-based guidelines for microbial quality of handwashing water. We defined two scenarios that should not occur: (1) if handwashing caused fecal contamination, indicated using Escherichia coli, on a person's hands to increase rather than decrease and (2) if hand-to-mouth contacts following handwashing caused an infection risk greater than an acceptable threshold. We found water containing <1000 E. coli colony-forming units (CFU) per 100 mL removes E. coli from hands with>99.9% probability. However, for the annual probability of infection to be <1:1000, handwashing water must contain <2 × 10-6 focus-forming units of rotavirus, <1 × 10-4 CFU of Vibrio cholerae, and <9 × 10-6 Cryptosporidium oocysts per 100 mL. Our model suggests that handwashing with nonpotable water will generally reduce fecal contamination on hands but may be unable to lower the annual probability of infection risks from hand-to-mouth contacts below 1:1000.
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Affiliation(s)
- Matthew E Verbyla
- Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC) , École Polytechnique Fédérale de Lausanne (EPFL) , CH-1015 Lausanne , Switzerland
| | - Ana K Pitol
- Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC) , École Polytechnique Fédérale de Lausanne (EPFL) , CH-1015 Lausanne , Switzerland
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , CH-8600 Dübendorf , Switzerland
| | - Tala Navab-Daneshmand
- School of Chemical, Biological, and Environmental Engineering , Oregon State University , Corvallis , Oregon 97331 , United States
| | - Sara J Marks
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , CH-8600 Dübendorf , Switzerland
| | - Timothy R Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology , CH-8600 Dübendorf , Switzerland
- Swiss Tropical and Public Health Institute , P.O. Box, CH-4002 Basel , Switzerland
- University of Basel , P.O. Box, CH-4003 Basel , Switzerland
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318
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Wolf J, Johnston R, Hunter PR, Gordon B, Medlicott K, Prüss-Ustün A. A Faecal Contamination Index for interpreting heterogeneous diarrhoea impacts of water, sanitation and hygiene interventions and overall, regional and country estimates of community sanitation coverage with a focus on low- and middle-income countries. Int J Hyg Environ Health 2019; 222:270-282. [PMID: 30503228 PMCID: PMC6417992 DOI: 10.1016/j.ijheh.2018.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/26/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The impact on diarrhoea of sanitation interventions has been heterogeneous. We hypothesize that this is due to the level of prevailing faecal environmental contamination and propose a Faecal Contamination Index (FAECI) of selected WASH indicators (objective 1). Additionally, we provide estimates of the proportion of the population living in communities above certain sanitation coverage levels (objective 2). METHODS Objective 1: Faecal contamination post-intervention was estimated from WASH intervention reports. WASH indicators composing the FAECI included eight water, sanitation and hygiene practice indicators, which were selected for their relevance for health and data availability at study- and country-level. The association between the estimated level of faecal environmental contamination and diarrhoea was examined using meta-regression. Objective 2: A literature search was conducted to identify health-relevant community sanitation coverage thresholds. To estimate total community coverage with basic sanitation in low- and middle-income countries, at relevant thresholds, household surveys with data available at primary sampling unit (PSU)-level were analysed according to the identified thresholds, at country-, regional- and overall level. RESULTS Objective 1: We found a non-linear association between estimated environmental faecal contamination and sanitation interventions' impact on diarrhoeal disease. Diarrhoea reductions were highest at lower faecal contamination levels, and no diarrhoea reduction was found when contamination increased above a certain level. Objective 2: Around 45% of the population lives in communities with more than 75% of coverage with basic sanitation and 24% of the population lives in communities above 95% coverage, respectively. CONCLUSIONS High prevailing faecal contamination might explain interventions' poor effectiveness in reducing diarrhoea. The here proposed Faecal Contamination Index is a first attempt to estimate the level of faecal contamination in communities. Much of the world's population currently lives in faecally contaminated environments as indicated by low community sanitation coverage.
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Affiliation(s)
- Jennyfer Wolf
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
| | - Richard Johnston
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
| | - Paul R Hunter
- The Norwich School of Medicine, University of East Anglia, Norwich, UK; Department of Environmental Health, Tshwane University of Technology, Pretoria, South Africa.
| | - Bruce Gordon
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
| | - Kate Medlicott
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
| | - Annette Prüss-Ustün
- Department of Public Health, Environment and Social Determinants of Health, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
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319
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Lambrecht NJ, Wilson ML, Jones AD. Assessing the Impact of Animal Husbandry and Capture on Anemia among Women and Children in Low- and Middle-Income Countries: A Systematic Review. Adv Nutr 2019; 10:331-344. [PMID: 30854553 PMCID: PMC6416043 DOI: 10.1093/advances/nmy080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Animal husbandry and capture (AHC) may mitigate anemia among women and children by supplying a source of micronutrient-rich animal source foods (ASF), yet may concurrently increase exposure to anemia-inducing pathogens such as Plasmodium spp., helminths, and enteropathogens. We conducted a systematic literature review to assess the relation between AHC and anemia among women of reproductive age, school-aged children, and children aged <5 y in low- and middle-income countries (LMICs). We used a 2-stage screening process, in which 1 reviewer searched 4 databases (PubMed, Web of Science, EMBASE, and Global Health) with predetermined search terms for relevant articles. Two reviewers then independently screened studies using a priori exclusion criteria, yielding a total of 23 articles included in the final review. We evaluated evidence from observational studies assessing animal-dependent livelihoods and livestock ownership, and interventions that promoted livestock and fish production. We found little consistency in anemia outcomes across the several AHC exposures and population groups. Poultry production interventions had modest benefits on anemia among women and children, although whether these improvements were a result of increased ASF consumption, or a result of the combined treatment study design could not be determined. Observational studies identified chicken ownership, and no other livestock species, as a risk factor for anemia among young children. However, there was limited evidence to evaluate pathways underlying these associations. Studies tended to rely on self-reported fever and diarrhea to assess illness, and no study directly assessed linkages between AHC, pathogen burden, and anemia. Thus, there is insufficient evidence to conclude whether AHC improves or worsens anemia among women and children in LMICs. Given the current interest in promoting animal production among low-income households, future studies with robust measures of livestock ownership, ASF consumption, pathogen burden, and anemia status are needed to understand the nuances of this complex and potentially contradictory relation.
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Affiliation(s)
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Andrew D Jones
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI,Address correspondence to ADJ (e-mail: )
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320
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Espinal MA, Andrus JK, Jauregui B, Waterman SH, Morens DM, Santos JI, Horstick O, Francis LA, Olson D. Emerging and Reemerging Aedes-Transmitted Arbovirus Infections in the Region of the Americas: Implications for Health Policy. Am J Public Health 2019; 109:387-392. [PMID: 30676796 PMCID: PMC6366516 DOI: 10.2105/ajph.2018.304849] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2018] [Indexed: 12/26/2022]
Abstract
The increasing geographical spread and disease incidence of arboviral infections are among the greatest public health concerns in the Americas. The region has observed an increasing trend in dengue incidence in the last decades, evolving from low to hyperendemicity. Yellow fever incidence has also intensified in this period, expanding from sylvatic-restricted activity to urban outbreaks. Chikungunya started spreading pandemically in 2005 at an unprecedented pace, reaching the Americas in 2013. The following year, Zika also emerged in the region with an explosive outbreak, carrying devastating congenital abnormalities and neurologic disorders and becoming one of the greatest global health crises in years. The inadequate arbovirus surveillance in the region and the lack of serologic tests to differentiate among viruses poses substantial challenges. The evidence for vector control interventions remains weak. Clinical management remains the mainstay of arboviral disease control. Currently, only yellow fever and dengue vaccines are licensed in the Americas, with several candidate vaccines in clinical trials. The Global Arbovirus Group of Experts provides in this article an overview of progress, challenges, and recommendations on arboviral prevention and control for countries of the Americas.
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Affiliation(s)
- Marcos A Espinal
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Jon K Andrus
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Barbara Jauregui
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Stephen Hull Waterman
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - David Michael Morens
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Jose Ignacio Santos
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Olaf Horstick
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Lorraine Ayana Francis
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Daniel Olson
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
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Efficacy of Nutrition and WASH/Malaria Educational Community-Based Interventions in Reducing Anemia in Preschool Children from Bengo, Angola: Study Protocol of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030466. [PMID: 30764549 PMCID: PMC6388146 DOI: 10.3390/ijerph16030466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/26/2019] [Accepted: 02/02/2019] [Indexed: 01/26/2023]
Abstract
Angola reports one of the highest infant mortality rates in the world, and anemia represents one of its important causes. Recent studies, in under-five children from the Bengo province of Angola, described high prevalence’s, suggesting malaria, undernutrition and urogenital schistosomiasis as important contributors for the occurrence and spatial variations of anemia. Educational community-based interventions, either in Nutrition and Water, Sanitation, Hygiene and Malaria are recommended to correct anemia. Herein, we designed a cluster-randomized controlled trial to study the efficacy of two educational-plus-therapeutic interventions in the reduction of anemia: one in nutrition and the other in WASH/Malaria. Socioeconomic, nutritional, anthropometric, parasitological and biochemical data will be collected from all willing-to-participate children, aging under four and resident in the Health Research Center of Angola study area. Considering the multifactorial causes of this condition, determining the efficacy of both interventions might help documenting weaknesses and opportunities for planning integrated strategies to reduce anemia.
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Clasen T, Smith KR. Let the "A" in WASH Stand for Air: Integrating Research and Interventions to Improve Household Air Pollution (HAP) and Water, Sanitation and Hygiene (WaSH) in Low-Income Settings. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:25001. [PMID: 30801220 PMCID: PMC6752941 DOI: 10.1289/ehp4752] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Research often suffers from overspecialization, a practice nurtured in academia and reinforced by funders. Indeed, investigators in household air pollution (HAP) and water, sanitation and hygiene (WaSH), working in poor parts of the world, rarely interact despite having similar training and using similar methods to evaluate interventions in the same vulnerable populations. Disappointing results from recent trials of improved cookstoves and traditional approaches to WaSH suggest the need for alternative approaches. OBJECTIVES We argue that bringing these two areas together would improve the effectiveness and efficiency of interventions to reduce the massive disease burden associated with HAP and poor WaSH, including pneumonia and diarrhea, the leading killers of young children in low-income countries. RESULTS HAP and WaSH face similar challenges in designing, implementing, and securing the sustained and exclusive use of scalable interventions such as clean fuel and water. DISCUSSION Research can advance greater coordination of these areas by demonstrating their interactions and wider impacts on well-being as well as the potential for programmatic synergies. Integrated solutions to clean households and communities can benefit from the contribution in multiple disciplines, including economics and policy analysis; business and finance; engineering and technology; lab sciences, environmental health, and biomedical sciences; and behavioral and implementation sciences. CONCLUSION There are compelling reasons to overcome the artificial and unproductive segregation of HAP and WaSH. Researchers should encourage integration by expanding the scope of their collaborations and projects. Policy makers, funders, and implementers can help by supporting comprehensive solutions, encouraging innovation, and requiring rigorous evaluations of their effects. https://doi.org/10.1289/EHP4752.
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Affiliation(s)
- Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kirk R. Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
- Collaborative Clean Air Policy Centre, New Delhi, India
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323
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Allen SJ, Adepojou A, Akinyinka OO. Challenges and opportunities for paediatric gastroenterology in low- and middle-income countries: high time for action. Paediatr Int Child Health 2019; 39:4-6. [PMID: 30900525 DOI: 10.1080/20469047.2019.1568022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Stephen J Allen
- a Department of Clinical Sciences , Liverpool School of Tropical Medicine , Liverpool , UK.,b Department of Paediatric Gastroenterology , Alder Hey Children's NHS Foundation Trust , Liverpool , UK
| | - Akinlolu Adepojou
- b Department of Paediatric Gastroenterology , Alder Hey Children's NHS Foundation Trust , Liverpool , UK.,c Department of Paediatrics , University College Hospital; College Of Medicine, University of Ibadan , Ibadan , Nigeria
| | - Olusegun O Akinyinka
- d University of Ibadan , Ibadan , Nigeria.,e University College Hospital , Ibadan , Nigeria
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Prendergast AJ, Chasekwa B, Evans C, Mutasa K, Mbuya MNN, Stoltzfus RJ, Smith LE, Majo FD, Tavengwa NV, Mutasa B, Mangwadu GT, Chasokela CM, Chigumira A, Moulton LH, Ntozini R, Humphrey JH. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on stunting and anaemia among HIV-exposed children in rural Zimbabwe: a cluster-randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:77-90. [PMID: 30573417 PMCID: PMC6472652 DOI: 10.1016/s2352-4642(18)30340-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Children exposed to HIV have a high prevalence of stunting and anaemia. We aimed to test the effect of improved infant and young child feeding (IYCF) and improved water, sanitation, and hygiene (WASH) on child linear growth and haemoglobin concentrations. METHODS We did a cluster randomised 2 × 2 factorial trial in two districts in rural Zimbabwe. Women were eligible for inclusion if they permanently lived in the trial clusters (ie, the catchment area of between one and four village health workers employed by the Zimbabwean Ministry of Health and Child Care) and were confirmed pregnant. Clusters were randomly allocated to standard of care (52 clusters); IYCF (20 g small-quantity lipid-based nutrient supplement daily for infants from 6 months to 18 months, complementary feeding counselling with context-specific messages, longitudinal delivery, and reinforcement; 53 clusters); WASH (ventilated, improved pit latrine, two hand-washing stations, liquid soap, chlorine, play space, and hygiene counselling; 53 clusters); or IYCF plus WASH (53 clusters). Participants and fieldworkers were not masked. Our co-primary outcomes were length for age Z score and haemoglobin in infants at 18 months of age. Here, we report these outcomes in the HIV-exposed children, analysed by intention to treat. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes with an important statistical interaction between the interventions. The trial is registered at ClinicalTrials.gov (NCT01824940) and is now complete. FINDINGS Between Nov 22, 2012, and March 27, 2015, 726 HIV-positive pregnant women were included in the trial. 668 children were evaluated at 18 months (147 from 46 standard of care clusters; 147 from 48 IYCF clusters; 184 from 44 WASH clusters; 190 from 47 IYCF plus WASH clusters). Of the 668 children, 22 (3%) were HIV-positive, 594 (89%) HIV-exposed uninfected, and 52 (8%) HIV-unknown. The IYCF intervention increased mean length for age Z score by 0·26 (95% CI 0·09-0·43; p=0·003) and haemoglobin concentration by 2·9 g/L (95% CI 0·90-4·90; p=0·005). 165 (50%) of 329 children in the non-IYCF groups were stunted, compared with 136 (40%) of 336 in the IYCF groups (absolute difference 10%, 95% CI 2-17); and the prevalence of anaemia was also lower in the IYCF groups (45 [14%] of 319) than in the non-IYCF groups (24 [7%] of 329; absolute difference 7%, 95% CI 2-12). The WASH intervention had no effect on length or haemoglobin concentration. There were no trial-related adverse or serious adverse events. INTERPRETATION Since HIV-exposed children are particularly vulnerable to undernutrition and responded well to improved complementary feeding, IYCF interventions could have considerable benefits in areas of high antenatal HIV prevalence. However, elementary WASH interventions did not lead to improvements in growth. FUNDING Bill & Melinda Gates Foundation, UK Aid, Wellcome Trust, Swiss Development Cooperation, US National Institutes of Health, and UNICEF.
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Affiliation(s)
- Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA.
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Ceri Evans
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Global Alliance for Improved Nutrition, Washington DC, USA
| | | | - Laura E Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Florence D Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | | | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
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325
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Wren-Atilola HM, Solomons NW, Scott ME, Koski KG. Infant growth faltering linked to subclinical mastitis, maternal faecal-oral contamination, and breastfeeding. MATERNAL AND CHILD NUTRITION 2019; 15:e12756. [PMID: 30472802 DOI: 10.1111/mcn.12756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 12/26/2022]
Abstract
Infant growth faltering occurs in breastfed infants <6 months of age. The possibility that maternal health status contributes to this growth faltering is underexplored. We investigated whether (a) subclinical mastitis (SCM), an asymptomatic inflammation of the breast, (b) maternal intestinal nematode and protozoan infections, indicators of faecal-oral contamination, or (c) poor breastfeeding practices increased the odds of stunting (length-for-age z-score < -2SD), underweight (weight-for-age z-score < -2SD), or low head circumference (head circumference-for-age z-score < -2SD) in breastfed infants in rural indigenous communities in Guatemala. Mother-infant dyads (n = 105) were subdivided into those with and without SCM (milk Na:K ratio > 0.6). Maternal and infant anthropometry were measured at the time of breast milk collection. Maternal stool samples were examined for the presence of intestinal nematodes and protozoa. Questionnaires were used to characterize breastfeeding practices (exclusivity and frequency) and support, hygiene (latrine use and household faucet), and infant diarrhoea. SCM occurred in 14% of women and was associated with increased odds of infant stunting (odds ratio [OR] = 4.3; confidence interval [CI] [1.1, 15.8]), underweight (OR = 9.2; CI [1.8, 48.0]), and low head circumference (OR = 15.9; CI [2.6, 96.9]). Maternal pathogenic protozoa and nematodes were uncommon (<4%), but nonpathogenic protozoa were common (e.g., Entamoeba coli [39%]). Entamoeba coli increased the likelihood (OR = 3.3; CI [1.02, 10.6]) of low head circumference, whereas higher breastfeeding frequency lowered its odds (OR = 0.74, CI [0.56, 0.97]). Prevention of SCM may improve early infant growth, but public health measures that increase breastfeeding frequency and reduce faecal-oral contamination may be required to minimize low head circumference.
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Affiliation(s)
| | - Noel W Solomons
- Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
| | - Marilyn E Scott
- Institute of Parasitology, McGill University, Montreal, Quebec, Canada
| | - Kristine G Koski
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
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Johri M, Sylvestre MP, Koné GK, Chandra D, Subramanian SV. Effects of improved drinking water quality on early childhood growth in rural Uttar Pradesh, India: A propensity-score analysis. PLoS One 2019; 14:e0209054. [PMID: 30620737 PMCID: PMC6324831 DOI: 10.1371/journal.pone.0209054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/27/2018] [Indexed: 12/17/2022] Open
Abstract
Context Recent randomised controlled trials in Bangladesh and Kenya concluded that household water treatment, alone or in combination with upgraded sanitation and handwashing, did not reduce linear growth faltering or improve other child growth outcomes. Whether these results are applicable in areas with distinct constellations of water, sanitation and hygiene (WaSH) risks is unknown. Analysis of observational data offers an efficient means to assess the external validity of trial findings. We studied whether a water quality intervention could improve child growth in a rural Indian setting with higher levels of circulating pathogens than the original trial sites. Methods We analysed a cross-sectional dataset including a microbiological measure of household water quality. All households accessed water from an improved source. We applied propensity score methods to emulate a randomised trial investigating the hypothesis that receipt of drinking water meeting Sustainable Development Goal (SDG) 6.1 quality standards for absence of faecal contamination leads to improved growth. Growth outcomes (stunting, underweight, wasting, and their corresponding Z-scores) were assessed in children 12–23 months of age. For each outcome, we estimated the mean and 95% confidence interval of the absolute risk difference between treatment groups. Findings Of 1088 households, 442 (40.62%) received drinking water meeting SDG 6.1 standards. The adjusted risk of child underweight was 7.4% (1.3% to 13.4%) lower among those drinking water satisfying SDG 6.1 norms than among controls. Evidence concerning the relationship of drinking water meeting SDG 6.1 norms to length-for-age and weight-for-age was inconclusive, and there was no apparent relationship with stunting or wasting. Conclusions In contexts characterised by high pathogen transmission, water quality improvements have the potential to reduce the proportion of underweight children, but are unlikely to impact stunting or wasting. Further research is required to assess how these modelled benefits can best be achieved in real world settings.
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Affiliation(s)
- Mira Johri
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
- Département d’administration de la santé, École de santé publique, Université de Montréal, Montreal, Canada
- * E-mail:
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
- Département de médicine sociale et préventive, École de santé publique, Université de Montréal, Montreal, Canada
| | - Georges Karna Koné
- Abt associates, Health finance and governance (FHG) Project, Port-au-Prince, Haiti
| | - Dinesh Chandra
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Québec, Canada
- Independent consultant, New Delhi, India
| | - S. V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge MA, United States of America
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327
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Gimaiyo G, McManus J, Yarri M, Singh S, Trevett A, Moloney G, Robins A, Lehmann L. Can child-focused sanitation and nutrition programming improve health practices and outcomes? Evidence from a randomised controlled trial in Kitui County, Kenya. BMJ Glob Health 2019; 4:e000973. [PMID: 30687525 PMCID: PMC6326299 DOI: 10.1136/bmjgh-2018-000973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/11/2018] [Accepted: 10/14/2018] [Indexed: 01/13/2023] Open
Abstract
Introduction In Kenya’s Kitui County, 46% of children under 5 years are stunted. Sanitation and nutrition programmes have sought to reduce child undernutrition, though they are typically implemented separately. We evaluate the effectiveness of an integrated sanitation and nutrition (SanNut) intervention in improving caregiver sanitation and nutrition knowledge and behaviours. Methods We conducted a cluster-randomised controlled trial to evaluate the impact of the SanNut intervention on caregiver knowledge, sanitary and hygiene practices, sanitation outcomes and nutrition outcomes. The evaluation included caregivers of children under 5 years across 604 villages in Kitui County. 309 treatment villages were randomly assigned to receive both the SanNut intervention and the standard Community-Led Total Sanitation (CLTS) intervention, while 295 control villages only received the CLTS intervention. 8 households with children under 5 years were randomly selected from each evaluation village to participate in the endline survey, for a total of 4322 households. Results SanNut led to modest improvements in sanitary knowledge and practices emphasised by the programme. Caregivers in treatment villages were 3.3 pp (+32%) more likely to mention lack of handwashing after handling child faeces as a potential cause of diarrhoea, and 4.9 pp (+7.8%) more likely to report safe disposal of child faeces than caregivers in control villages. Treatment households were 1.9 pp (+79%) more likely to have a stocked handwashing station and 2.9 pp (−16%) less likely to report incidences of child diarrhoea. However, SanNut appears to have had no impact on nutritional practices, such as breastfeeding, vitamin A supplementation or deworming. Non-child outcomes traditionally associated with CLTS, including latrine use and homestead sanitary conditions, were similar in treatment and control groups. Conclusion Child-focused messaging can potentially be integrated into CLTS programming, though this integration was more successful for topics closer to CLTS objectives (sanitation practices, including limiting faecal contamination and handwashing) than for more disparate topics (nutritional practices). Trial registration Pan-African Clinical Trials Registry (PACTR201803003159346) and American Economic Association registry for randomised controlled trials (AEARCTR-0002019).
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Affiliation(s)
| | | | - Matt Yarri
- Data Analytics Department, Lyft, San Francisco, USA
| | | | | | - Grainne Moloney
- Regional Office for Eastern and Southern Africa (ESARO) - Nutrition Department, UNICEF, Nairobi, Kenya
| | - Ann Robins
- Nutrition Department, UNICEF, Nairobi, Kenya
| | - Lilian Lehmann
- Southeast Asia Department, IDinsight, Manila, Philippines
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328
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Humphrey JH, Mbuya MNN, Ntozini R, Moulton LH, Stoltzfus RJ, Tavengwa NV, Mutasa K, Majo F, Mutasa B, Mangwadu G, Chasokela CM, Chigumira A, Chasekwa B, Smith LE, Tielsch JM, Jones AD, Manges AR, Maluccio JA, Prendergast AJ. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial. Lancet Glob Health 2019; 7:e132-e147. [PMID: 30554749 PMCID: PMC6293965 DOI: 10.1016/s2214-109x(18)30374-7] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/03/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.
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Affiliation(s)
- Jean H Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
| | - Mduduzi N N Mbuya
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA; Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | | | - Naume V Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence Majo
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Batsirai Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | | | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Laura E Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Andrew D Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Amee R Manges
- University of British Columbia, Vancouver, BC, Canada
| | | | - Andrew J Prendergast
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK
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Smuts CM, Matsungo TM, Malan L, Kruger HS, Rothman M, Kvalsvig JD, Covic N, Joosten K, Osendarp SJM, Bruins MJ, Frenken LGJ, Lombard CJ, Faber M. Effect of small-quantity lipid-based nutrient supplements on growth, psychomotor development, iron status, and morbidity among 6- to 12-mo-old infants in South Africa: a randomized controlled trial. Am J Clin Nutr 2019; 109:55-68. [PMID: 30649163 PMCID: PMC6358035 DOI: 10.1093/ajcn/nqy282] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/18/2018] [Indexed: 01/14/2023] Open
Abstract
Background Evidence on the effect of small-quantity lipid-based nutrient supplements (SQ-LNSs) on early child growth and development is mixed. Objective This study assessed the effect of daily consumption of 2 different SQ-LNS formulations on linear growth (primary outcome), psychomotor development, iron status (secondary outcomes), and morbidity in infants from age 6 to 12 mo within the context of a maize-based complementary diet. Methods Infants (n = 750) were randomly assigned to receive SQ-LNS, SQ-LNS-plus, or no supplement. Both SQ-LNS products contained micronutrients and essential fatty acids. SQ-LNS-plus contained, in addition, docosahexaenoic acid, arachidonic acid (important for brain and eye development), lysine (limiting amino acid in maize), phytase (enhances iron absorption), and other nutrients. Infants' weight and length were measured bimonthly. At age 6 and 12 mo, psychomotor development using the Kilifi Developmental Inventory and South African Parent Rating Scale and hemoglobin, plasma ferritin, C-reactive protein, and α1-acid glycoprotein were assessed. WHO Motor Milestone outcomes, adherence, and morbidity were monitored weekly through home visits. Primary analysis was by intention-to-treat, comparing each SQ-LNS group with the control. Results SQ-LNS-plus had a positive effect on length-for-age zscore at age 8 mo (mean difference: 0.11; 95% CI: 0.01, 0.22; P = 0.032) and 10 mo (0.16; 95% CI: 0.04, 0.27; P = 0.008) but not at 12 mo (0.09; 95% CI: -0.02, 0.21; P = 0.115), locomotor development score (2.05; 95% CI: 0.72, 3.38; P = 0.003), and Parent Rating Score (1.10; 95% CI: 0.14, 2.07; P = 0.025), but no effect for weight-for-age zscore. Both SQ-LNS (P = 0.027) and SQ-LNS-plus (P = 0.005) improved hemoglobin concentration and reduced the risk of anemia, iron deficiency, and iron-deficiency anemia. Both SQ-LNS products reduced longitudinal prevalence of fever, coughing, and wheezing but increased incidence and longitudinal prevalence of diarrhea, vomiting, and rash/sores. Conclusions Point-of-use fortification with SQ-LNS-plus showed an early transient effect on linear growth and improved locomotor development. Both SQ-LNS products had positive impacts on anemia and iron status. This trial was registered at clinicaltrials.gov as NCT01845610.
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Affiliation(s)
- Cornelius M Smuts
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa,Address correspondence to CMS (e-mail: )
| | - Tonderayi M Matsungo
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Linda Malan
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Herculina S Kruger
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Marinel Rothman
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Jane D Kvalsvig
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Namukolo Covic
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Karen Joosten
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | | | | | | | - Carl J Lombard
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa,Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Mieke Faber
- Center of Excellence for Nutrition, North-West University, Potchefstroom, South Africa,Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa
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330
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Stewart CP, Dewey KG, Lin A, Pickering AJ, Byrd KA, Jannat K, Ali S, Rao G, Dentz HN, Kiprotich M, Arnold CD, Arnold BF, Allen LH, Shahab-Ferdows S, Ercumen A, Grembi JA, Naser AM, Rahman M, Unicomb L, Colford JM, Luby SP, Null C. Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh. Am J Clin Nutr 2019; 109:148-164. [PMID: 30624600 PMCID: PMC6358037 DOI: 10.1093/ajcn/nqy239] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/14/2018] [Indexed: 12/24/2022] Open
Abstract
Background Anemia in young children is a global health problem. Risk factors include poor nutrient intake and poor water quality, sanitation, or hygiene. Objective We evaluated the effects of water quality, sanitation, handwashing, and nutrition interventions on micronutrient status and anemia among children in rural Kenya and Bangladesh. Design We nested substudies within 2 cluster-randomized controlled trials enrolling pregnant women and following their children for 2 y. These substudies included 4 groups: water, sanitation, and handwashing (WSH); nutrition (N), including lipid-based nutrient supplements (LNSs; ages 6-24 mo) and infant and young child feeding (IYCF) counseling; WSH+N; and control. Hemoglobin and micronutrient biomarkers were measured after 2 y of intervention and compared between groups using generalized linear models with robust SEs. Results In Kenya, 699 children were assessed at a mean ± SD age of 22.1 ± 1.8 mo, and in Bangladesh 1470 participants were measured at a mean ± SD age of 28.0 ± 1.9 mo. The control group anemia prevalences were 48.8% in Kenya and 17.4% in Bangladesh. There was a lower prevalence of anemia in the 2 N intervention groups in both Kenya [N: 36.2%; prevalence ratio (PR): 0.74; 95% CI: 0.58, 0.94; WSH+N: 27.3%; PR: 0.56; 95% CI: 0.42, 0.75] and Bangladesh (N: 8.7%; PR: 0.50; 95% CI: 0.32, 0.78; WSH+N: 7.9%, PR: 0.46; 95% CI: 0.29, 0.73). In both trials, the 2 N groups also had significantly lower prevalences of iron deficiency, iron deficiency anemia, and low vitamin B-12 and, in Kenya, a lower prevalence of folate and vitamin A deficiencies. In Bangladesh, the WSH group had a lower prevalence of anemia (12.8%; PR: 0.74; 95% CI: 0.54, 1.00) than the control group, whereas in Kenya, the WSH+N group had a lower prevalence of anemia than did the N group (PR: 0.75; 95% CI: 0.53, 1.07), but this was not significant (P = 0.102). Conclusions IYCF counseling with LNSs reduced the risks of anemia, iron deficiency, and low vitamin B-12. Effects on folate and vitamin A varied between studies. Improvements in WSH also reduced the risk of anemia in Bangladesh but did not provide added benefit over the nutrition-specific intervention. These trials were registered at clinicaltrials.gov as NCT01590095 (Bangladesh) and NCT01704105 (Kenya).
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Affiliation(s)
- Christine P Stewart
- Department of Nutrition, University of California, Davis, Davis, CA,Address correspondence to CPS (e-mail: )
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Audrie Lin
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering,Present address for AJP: Department of Civil and Environmental Engineering, Tufts University, 200 College Avenue, Medford, MA 02155
| | - Kendra A Byrd
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Kaniz Jannat
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shahjahan Ali
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Gouthami Rao
- Innovations for Poverty Action, Nairobi, Kenya,Present address for GR: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, CDC, 1600 Clifton Road, Atlanta, GA 30329
| | - Holly N Dentz
- Department of Nutrition, University of California, Davis, Davis, CA,Innovations for Poverty Action, Nairobi, Kenya
| | - Marion Kiprotich
- Innovations for Poverty Action, Nairobi, Kenya,Present address for MK: One Acre Fund, Nairobi, Kenya
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Benjamin F Arnold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA
| | - Lindsay H Allen
- USDA, Agricultural Research Service, Western Human Nutrition Research Center, Davis, CA
| | | | - Ayse Ercumen
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA
| | | | - Abu Mohd Naser
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Leanne Unicomb
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, CA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA
| | - Clair Null
- Innovations for Poverty Action, Nairobi, Kenya,Present address for CN: Mathmatica Policy Research, 1100 First Street, NE, 12th Floor, Washington, DC 20002
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331
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Montealegre MC, Roy S, Böni F, Hossain MI, Navab-Daneshmand T, Caduff L, Faruque ASG, Islam MA, Julian TR. Risk Factors for Detection, Survival, and Growth of Antibiotic-Resistant and Pathogenic Escherichia coli in Household Soils in Rural Bangladesh. Appl Environ Microbiol 2018; 84:e01978-18. [PMID: 30315075 PMCID: PMC6275341 DOI: 10.1128/aem.01978-18] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022] Open
Abstract
Soils in household environments in low- and middle-income countries may play an important role in the persistence, proliferation, and transmission of Escherichia coli Our goal was to investigate the risk factors for detection, survival, and growth of E. coli in soils collected from household plots. E. coli was enumerated in soil and fecal samples from humans, chickens, and cattle from 52 households in rural Bangladesh. Associations between E. coli concentrations in soil, household-level risk factors, and soil physicochemical characteristics were investigated. Susceptibility to 16 antibiotics and the presence of intestinal pathotypes were evaluated for 175 E. coli isolates. The growth and survival of E. coli in microcosms using soil collected from the households were also assessed. E. coli was isolated from 44.2% of the soil samples, with an average of 1.95 log10 CFU/g dry soil. Soil moisture and clay content were associated with E. coli concentrations in soil, whereas no household-level risk factor was significantly correlated. Antibiotic resistance and pathogenicity were common among E. coli isolates, with 42.3% resistant to at least one antibiotic, 12.6% multidrug resistant (≥3 classes), and 10% potentially pathogenic. Soil microcosms demonstrate growth and/or survival of E. coli, including an enteropathogenic extended-spectrum beta-lactamase (ESBL)-producing isolate, in some, but not all, of the household soils tested. In rural Bangladesh, defined soil physicochemical characteristics appear more influential for E. coli detection in soils than household-level risk factors. Soils may act as reservoirs in the transmission of antibiotic-resistant and potentially pathogenic E. coli and therefore may impact the effectiveness of water, sanitation, and hygiene interventions.IMPORTANCE Soil may represent a direct source or act as an intermediary for the transmission of antibiotic-resistant and pathogenic Escherichia coli strains, particularly in low-income and rural settings. Thus, determining risk factors associated with detection, growth, and long-term survival of E. coli in soil environments is important for public health. Here, we demonstrate that household soils in rural Bangladesh are reservoirs for antibiotic-resistant and potentially pathogenic E. coli strains and can support E. coli growth and survival, and defined soil physicochemical characteristics are drivers of E. coli survival in this environment. In contrast, we found no evidence that household-level factors, including water, sanitation, and hygiene indicators, were associated with E. coli contamination of household soils.
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Affiliation(s)
| | - Subarna Roy
- Enteric and Food Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Franziska Böni
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Muhammed Iqbal Hossain
- Enteric and Food Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tala Navab-Daneshmand
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Lea Caduff
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - A S G Faruque
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Aminul Islam
- Enteric and Food Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Timothy R Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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332
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Abraham D, Kaliappan SP, Walson JL, Rao Ajjampur SS. Intervention strategies to reduce the burden of soil-transmitted helminths in India. Indian J Med Res 2018; 147:533-544. [PMID: 30168484 PMCID: PMC6118140 DOI: 10.4103/ijmr.ijmr_881_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Soil-transmitted helminth (STH) infections continue to be a major global cause of morbidity, with a large proportion of the burden of STH infections occurring in India. In addition to direct health impacts of these infections, including anaemia and nutritional deficiencies in children, these infections also significantly impact economic development, as a result of delays in early childhood cognitive development and future income earning potential. The current World Health Organization strategy for STH is focused on morbidity control through the application of mass drug administration to all pre-school-aged and school-aged children. In India, the control of STH-related morbidity requires mobilization of significant human and financial resources, placing additional burdens on limited public resources. Infected adults and untreated children in the community act as a reservoir of infection by which treated children get rapidly reinfected. As a result, deworming programmes will need to be sustained indefinitely in the absence of other strategies to reduce reinfection, including water, hygiene and sanitation interventions (WASH). However, WASH interventions require sustained effort by the government or other agencies to build infrastructure and to promote healthy behavioural modifications, and their effectiveness is often limited by deeply entrenched cultural norms and behaviours. Novel strategies must be explored to provide a lasting solution to the problem of STH infections in India other than the indefinite provision of deworming for morbidity control.
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Affiliation(s)
- Dilip Abraham
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Judd L Walson
- Department of Global Health, Medicine (Infectious Disease), Paediatrics & Epidemiology, University of Washington, Seattle, USA; DeWorm3, Division of Life Sciences, Natural History Museum, London, UK
| | - Sitara Swarna Rao Ajjampur
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
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333
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Arndt MB, Walson JL. Enteric infection and dysfunction-A new target for PLOS Neglected Tropical Diseases. PLoS Negl Trop Dis 2018; 12:e0006906. [PMID: 30592716 PMCID: PMC6310236 DOI: 10.1371/journal.pntd.0006906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Michael B. Arndt
- PATH, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
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334
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Byrd KA, Williams TN, Lin A, Pickering AJ, Arnold BF, Arnold CD, Kiprotich M, Dentz HN, Njenga SM, Rao G, Colford JM, Null C, Stewart CP. Sickle Cell and α+-Thalassemia Traits Influence the Association between Ferritin and Hepcidin in Rural Kenyan Children Aged 14-26 Months. J Nutr 2018; 148:1903-1910. [PMID: 30517728 PMCID: PMC6669948 DOI: 10.1093/jn/nxy229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/23/2018] [Accepted: 08/16/2018] [Indexed: 01/01/2023] Open
Abstract
Background The relation between subclinical hemoglobinopathies and concentrations of the iron-regulatory hormone hepcidin is not well characterized. Objective We investigated the relation of hepcidin concentration with hemoglobinopathies among young children in Kenya. Methods We quantified serum hepcidin and ferritin in 435 Kenyan children aged 14-20 mo in a subsample of the Water, Sanitation, and Handwashing (WASH) Benefits Trial. Blood samples were genotyped for α+-thalassemia and for sickle cell disorder. Hepcidin was compared across sickle cell and α+-thalassemia genotypes separately by using generalized linear models, and children who were normozygous for both conditions were also compared with those who had either of these conditions. In the association between hepcidin and ferritin, we assessed effect modification by genotype. Results In this population, we found that 16.2% had sickle cell trait and 0.2% had sickle cell disorder, whereas 40.0% were heterozygous for α+-thalassemia and 8.2% were homozygous. Hepcidin concentration did not differ by genotype, but effect modification was found by genotype in the association between hepcidin and ferritin (P < 0.1). Among normozygous sickle cell children (HbAA), there was an association between hepcidin and ferritin (β = 0.92; 95% CI: 0.72, 1.10). However, among those with sickle cell trait (HbAS), the association was no longer significant (β = 0.31; 95% CI: -0.04, 0.66). Similarly, among children who were normozygous (αα/αα) or heterozygous (-α/αα) for α+-thalassemia, hepcidin and ferritin were significantly associated [β = 0.94 (95% CI: 0.68, 1.20) and β = 0.77 (95% CI: 0.51, 1.03), respectively]; however, in children who were homozygous for α+-thalassemia (-α/-α), there was no longer a significant association (β = 0.45; 95% CI: -0.10, 1.00). Conclusion Hepcidin was not associated with hemoglobin genotype, but there may be a difference in the way hepcidin responds to iron status among those with either sickle cell trait or homozygous α+-thalassemia in young Kenyan children. This trial was registered at clinicaltrials.gov as NCT01704105.
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Affiliation(s)
- Kendra A Byrd
- Department of Nutrition, University of California, Davis, Davis, CA
| | - Thomas N Williams
- Imperial College, St. Mary's Hospital, London, United Kingdom
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Program, Kilifi, Kenya
| | - Audrie Lin
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA
| | - Benjamin F Arnold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, Davis, CA
| | | | - Holly N Dentz
- Department of Nutrition, University of California, Davis, Davis, CA
- Innovations for Poverty Action, Nairobi, Kenya
| | | | | | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Clair Null
- Mathematica Policy Research, Washington, DC
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Wirth JP, Kitilya B, Petry N, PrayGod G, Veryser S, Mngara J, Zwahlen C, Wieringa F, Berger J, de Onis M, Rohner F, Becquey E. Growth Status, Inflammation, and Enteropathy in Young Children in Northern Tanzania. Am J Trop Med Hyg 2018; 100:192-201. [PMID: 30398137 DOI: 10.4269/ajtmh.17-0720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Recent evidence suggests that enteropathy of the gut due to environmental conditions (i.e., environmental enteropathy [EE]) in young children is negatively associated with linear growth. Using a case-control study design, we examined the potential determinants of stunting in stunted and non-stunted children 22-28 months of age. Potential determinants included inflammation biomarkers C-reactive protein, alpha-1-acid glycoprotein (AGP), and endotoxin-core antibody (EndoCAb) measured in serum samples; enteropathy markers alpha-1-antitrypsin, neopterin, myeloperoxidase (MPO) measured in stools samples; and demographic, health, feeding, and household characteristics. We also explored the determinants of EE by testing associations of composite EE scores and individual biomarkers with potential risk factors. Fifty-two percent of children (n = 310) were found to be stunted, and mean height-for-age Z scores (HAZ) were -1.22 (standard deviation [SD] ± 0.56) among non-stunted (control) children and -2.82 (SD ± 0.61) among stunted (case) children. Child HAZ was significantly (P < 0.05) and inversely associated with AGP, and child stunting was significantly positively associated (P < 0.05) with low dietary diversity, severe household hunger, and absence of soap in the household. Alpha-1-acid glycoprotein and EndoCAb concentrations were also significantly higher (P < 0.05) among children in households with no soap. Our study documented a seemingly localized cultural practice of young children (25%) being fed their dirty bathwater, which was associated with significantly higher concentrations of MPO (P < 0.05). Alpha-1-acid glycoprotein showed the most consistent associations with child growth and hygiene practices, but fecal EE biomarkers were not associated with child growth. The lack of retrospective data in our study may explain the null findings related to fecal EE biomarkers and child growth.
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Affiliation(s)
- James P Wirth
- GroundWork, Fläsch, Switzerland.,Unité Mixte de Recherche (UMR)-204, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
| | - Brenda Kitilya
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | - George PrayGod
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | - Julius Mngara
- National Institute for Medical Research (NIMR), Mwanza, Tanzania
| | | | - Frank Wieringa
- Unité Mixte de Recherche (UMR)-204, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
| | - Jacques Berger
- Unité Mixte de Recherche (UMR)-204, Institut de Recherche pour le Développement (IRD), IRD/Université de Montpellier/SupAgro, Montpellier, France
| | | | | | - Elodie Becquey
- International Food Policy Research Institute (IFPRI), Dakar, Senegal
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336
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Husseini M, Darboe MK, Moore SE, Nabwera HM, Prentice AM. Thresholds of socio-economic and environmental conditions necessary to escape from childhood malnutrition: a natural experiment in rural Gambia. BMC Med 2018; 16:199. [PMID: 30382849 PMCID: PMC6211595 DOI: 10.1186/s12916-018-1179-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/21/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Childhood malnutrition remains highly prevalent in low-income countries, and a 40% reduction in under-5 year stunting is WHO's top Global Target 2025. Disappointingly, meta-analyses of intensive nutrition interventions reveal that they generally have low efficacy at improving growth. Unhygienic environments also contribute to growth failure, but large WASH Benefits and SHINE trials of improved water, sanitation and hygiene (WASH) recently reported no benefits to child growth. METHODS To explore the thresholds of socio-economic status (SES) and living standards associated with malnutrition, we exploited a natural experiment in which the location of our research centre within a remote rural village created a wide diversity of wealth, education and housing conditions within the same ecological setting and with free health services to all. A composite SES score was generated by grading occupation, education, income, water and sanitation, and housing and families were allocated to 5 groups (SES1 = highest). SES ranged from very poor subsistence-farming villagers to post graduate staff with overseas training. Nutritional status at 24 m was obtained from clinic records for 230 children and expressed relative to WHO Growth Standards. RESULTS Height-for-age (HAZ) and weight-for-age (WAZ) Z-scores were strongly predicted by SES group. HAZ varied from - 0.67 to - 2.23 (P < 0.001) and WAZ varied from - 0.90 to - 1.64 (P < 0.001), from SES1 to SES5, respectively. Weight-for-height (WHZ) showed no gradient. Children in SES1 showed greater dispersion so were further divided in a post hoc analysis. Children resident in Western housing on the research compound (SES1A) had HAZ = + 0.68 and WAZ = + 0.36. The residual gradient between those in SES1B and SES5 spanned only 0.65 Z-score for HAZ (- 1.58 to - 2.23) and was not significant for WAZ or WHZ. CONCLUSIONS The large difference in growth between children in SES1A living in Western-type housing and SES1B children living in the village, and the very shallow gradient between SES1B and SES5, implies a very high SES threshold before stunting and underweight will be eliminated. This may help to explain the lack of efficacy of the recent WASH interventions and points to the need for what is termed 'Transformative WASH'. Good quality housing, with piped water into the home, may be key to eliminating malnutrition.
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Affiliation(s)
- Mayya Husseini
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
- Regional Activity Centre for Sustainable Consumption and Production (SCP/RAC), Sant Pau Art Nouveau Site, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Momodou K Darboe
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
| | - Sophie E Moore
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Helen M Nabwera
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia.
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Caron Y, Hong R, Gauthier L, Laillou A, Wieringa FT, Berger J, Poirot E. Stunting, Beyond Acute Diarrhoea: Giardia Duodenalis, in Cambodia. Nutrients 2018; 10:E1420. [PMID: 30282952 PMCID: PMC6213534 DOI: 10.3390/nu10101420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The adverse outcomes of malnutrition on the development of a child are well acknowledged as are the broad variety of contextual factors that may impact child nutritional status. Adequate nutrient intake and the adoption of appropriate water, sanitation and hygiene measures are largely documented for their positive influence on health. Improved sanitation and protection from human feces can significantly lower the incidence of diarrhea and environmental enteropathy. However, the impact of excessive exposure to animal feces on child health is less well documented. OBJECTIVES This study tests the hypothesis that there is a positive association between exposure to animal feces, morbidity and anthropometric outcomes in children under 5 years of age, in Cambodia. It aims to improve insights that can contribute to discerning high-impact policies that promote children can develop to their full potential. METHODS Data for this study was drawn from the third follow-up round of the MyHealth project cohort study that is conducted in six districts of three Cambodian provinces (Phnom Penh, Kratie and Ratanak Kiri). The analysis included a sample of 639 children under 5 years of age. RESULTS The presence of livestock and more particularly, pigs near the main household dwelling was found a risk factor associated with Giardia duodenalis infection (23%). Giardia duodenalis infection was found to be a protective factor for acute diarrhea, yet, associated with stunting in the univariate model. CONCLUSIONS Preventive measures that protect from extensive exposure to animal feces may be most effective to prevent infection with Giardia duodenalis and consequent stunting, thereby improving the potential for a healthy development in young Cambodian children. The results support the need for cross-sector policy measures that reinforce comprehensive early childhood interventions towards improving nutritional status as part of a wider set of child welfare and development measures.
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Affiliation(s)
- Yannick Caron
- Institut Pasteur du Cambodge, Laboratory of Medical Biology, 5 Boulevard Monivong, P.O. Box 983, Phnom Penh 12100, Cambodia.
| | - Rathmony Hong
- United Nations Children's Fund (UNICEF), Integrated Early Childhood Development, Exchange Square, 5th Floor, No. 19&20, Street 106, Sangkat Wat Phnom, Khan Daun Penh, Phnom Penh 12100, Cambodia.
| | | | - Arnaud Laillou
- United Nations Children's Fund (UNICEF), Integrated Early Childhood Development, Exchange Square, 5th Floor, No. 19&20, Street 106, Sangkat Wat Phnom, Khan Daun Penh, Phnom Penh 12100, Cambodia.
| | - Frank T Wieringa
- Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, 3400 Montpellier, France.
| | - Jacques Berger
- Institute of Research for Development (IRD), UMR Nutripass IRD-UM2-UM1, 3400 Montpellier, France.
| | - Etienne Poirot
- United Nations Children's Fund (UNICEF), Integrated Early Childhood Development, Exchange Square, 5th Floor, No. 19&20, Street 106, Sangkat Wat Phnom, Khan Daun Penh, Phnom Penh 12100, Cambodia.
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Rogawski ET, Liu J, Platts-Mills JA, Kabir F, Lertsethtakarn P, Siguas M, Khan SS, Praharaj I, Murei A, Nshama R, Mujaga B, Havt A, Maciel IA, Operario DJ, Taniuchi M, Gratz J, Stroup SE, Roberts JH, Kalam A, Aziz F, Qureshi S, Islam MO, Sakpaisal P, Silapong S, Yori PP, Rajendiran R, Benny B, McGrath M, Seidman JC, Lang D, Gottlieb M, Guerrant RL, Lima AAM, Leite JP, Samie A, Bessong PO, Page N, Bodhidatta L, Mason C, Shrestha S, Kiwelu I, Mduma ER, Iqbal NT, Bhutta ZA, Ahmed T, Haque R, Kang G, Kosek MN, Houpt ER. Use of quantitative molecular diagnostic methods to investigate the effect of enteropathogen infections on linear growth in children in low-resource settings: longitudinal analysis of results from the MAL-ED cohort study. LANCET GLOBAL HEALTH 2018; 6:e1319-e1328. [PMID: 30287125 PMCID: PMC6227248 DOI: 10.1016/s2214-109x(18)30351-6] [Citation(s) in RCA: 232] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/28/2018] [Accepted: 07/11/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Enteropathogen infections in early childhood not only cause diarrhoea but contribute to poor growth. We used molecular diagnostics to assess whether particular enteropathogens were associated with linear growth across seven low-resource settings. METHODS We used quantitative PCR to detect 29 enteropathogens in diarrhoeal and non-diarrhoeal stools collected from children in the first 2 years of life obtained during the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) multisite cohort study. Length was measured monthly. We estimated associations between aetiology-specific diarrhoea and subclinical enteropathogen infection and quantity and attained length in 3 month intervals, at age 2 and 5 years, and used a longitudinal model to account for temporality and time-dependent confounding. FINDINGS Among 1469 children who completed 2 year follow-up, 35 622 stool samples were tested and yielded valid results. Diarrhoeal episodes attributed to bacteria and parasites, but not viruses, were associated with small decreases in length after 3 months and at age 2 years. Substantial decrements in length at 2 years were associated with subclinical, non-diarrhoeal, infection with Shigella (length-for-age Z score [LAZ] reduction -0·14, 95% CI -0·27 to -0·01), enteroaggregative Escherichia coli (-0·21, -0·37 to -0·05), Campylobacter (-0·17, -0·32 to -0·01), and Giardia (-0·17, -0·30 to -0·05). Norovirus, Cryptosporidium, typical enteropathogenic E coli, and Enterocytozoon bieneusi were also associated with small decrements in LAZ. Shigella and E bieneusi were associated with the largest decreases in LAZ per log increase in quantity per g of stool (-0·13 LAZ, 95% CI -0·22 to -0·03 for Shigella; -0·14, -0·26 to -0·02 for E bieneusi). Based on these models, interventions that successfully decrease exposure to Shigella, enteroaggregative E coli, Campylobacter, and Giardia could increase mean length of children by 0·12-0·37 LAZ (0·4-1·2 cm) at the MAL-ED sites. INTERPRETATION Subclinical infection and quantity of pathogens, particularly Shigella, enteroaggregative E coli, Campylobacter, and Giardia, had a substantial negative association with linear growth, which was sustained during the first 2 years of life, and in some cases, to 5 years. Successfully reducing exposure to certain pathogens might reduce global stunting. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Elizabeth T Rogawski
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - Shaila S Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Buliga Mujaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | - Darwin J Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Mami Taniuchi
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Jean Gratz
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Suzanne E Stroup
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James H Roberts
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - M Ohedul Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pimmada Sakpaisal
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sasikorn Silapong
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Pablo P Yori
- Asociación Benéfica PRISMA, Iquitos, Peru; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Monica McGrath
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Jessica C Seidman
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Dennis Lang
- Foundation for the National Institutes of Health, Bethesda, MD, USA
| | - Michael Gottlieb
- Foundation for the National Institutes of Health, Bethesda, MD, USA
| | - Richard L Guerrant
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ladaporn Bodhidatta
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Carl Mason
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sanjaya Shrestha
- Walter Reed/AFRIMS Research Unit, Nepal, Kathmandu, Nepal; University of Bergen, Bergen, Norway
| | - Ireen Kiwelu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Margaret N Kosek
- Asociación Benéfica PRISMA, Iquitos, Peru; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
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Delea MG, Sclar GD, Woreta M, Haardörfer R, Nagel CL, Caruso BA, Dreibelbis R, Gobezayehu AG, Clasen TF, Freeman MC. Collective Efficacy: Development and Validation of a Measurement Scale for Use in Public Health and Development Programmes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2139. [PMID: 30274212 PMCID: PMC6211028 DOI: 10.3390/ijerph15102139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 02/04/2023]
Abstract
Impact evaluations of water, sanitation, and hygiene interventions have demonstrated lower than expected health gains, in some cases due to low uptake and sustained adoption of interventions at a community level. These findings represent common challenges for public health and development programmes relying on collective action. One possible explanation may be low collective efficacy (CE)-perceptions regarding a group's ability to execute actions related to a common goal. The purpose of this study was to develop and validate a metric to assess factors related to CE. We conducted this research within a cluster-randomised sanitation and hygiene trial in Amhara, Ethiopia. Exploratory and confirmatory factor analyses were carried out to examine underlying structures of CE for men and women in rural Ethiopia. We produced three CE scales: one each for men and women that allow for examinations of gender-specific mechanisms through which CE operates, and one 26-item CE scale that can be used across genders. All scales demonstrated high construct validity. CE factor scores were significantly higher for men than women, even among household-level male-female dyads. These CE scales will allow implementers to better design and target community-level interventions, and examine the role of CE in the effectiveness of community-based programming.
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Affiliation(s)
- Maryann G Delea
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Gloria D Sclar
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Mulat Woreta
- Emory Ethiopia, Bahir Dar, Addis Ababa, Ethiopia.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Corey L Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Bethany A Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Robert Dreibelbis
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | | | - Thomas F Clasen
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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340
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Baker KK, Senesac R, Sewell D, Gupta AS, Cumming O, Mumma J. Fecal Fingerprints of Enteric Pathogen Contamination in Public Environments of Kisumu, Kenya, Associated with Human Sanitation Conditions and Domestic Animals. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:10263-10274. [PMID: 30106283 PMCID: PMC6557411 DOI: 10.1021/acs.est.8b01528] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Young children are infected by a diverse range of enteric pathogens in high disease burden settings, suggesting pathogen contamination of the environment is equally diverse. This study aimed to characterize across- and within-neighborhood diversity in enteric pathogen contamination of public domains in urban informal settlements of Kisumu, Kenya, and to assess the relationship between pathogen detection patterns and human and domestic animal sanitation conditions. Microbial contamination of soil and surface water from 166 public sites in three Kisumu neighborhoods was measured by enterococcal assays and quantitative reverse transcription polymerase chain reaction (qRT-PCR) for 19 enteric pathogens. Regression was used to assess the association between observed sanitary indicators of contamination with enterococci and pathogen presence and concentration, and pathogen diversity. Seventeen types of pathogens were detected in Kisumu public domains. Enteric pathogens were codetected in 33% of soil and 65% of surface water samples. Greater pathogen diversity was associated with the presence of domestic animal feces but not with human open defecation, deteriorating latrines, flies, or disposal of human feces. Sanitary conditions were not associated with enterococcal bacteria, specific pathogen concentrations, or "any pathogen". Young children played at 40% of observed sites. Managing domestic animal feces may be required to reduce enteric pathogen environmental contamination in high-burden settings.
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Affiliation(s)
- Kelly K. Baker
- Department of Occupational and Environmental Health
- Corresponding Author Phone: (001) 319-384-4008;.
| | - Reid Senesac
- Department of Occupational and Environmental Health
| | | | - Ananya Sen Gupta
- Department of Electrical Engineering, University of Iowa, Iowa City, Iowa 52242, United States
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Jane Mumma
- Department of Community Nutrition, Great Lakes University of Kisumu, 40100 Kisumu, Kenya
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Wodnik BK, Freeman MC, Ellis AS, Awino Ogutu E, Webb Girard A, Caruso BA. Development and Application of Novel Caregiver Hygiene Behavior Measures Relating to Food Preparation, Handwashing, and Play Environments in Rural Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1994. [PMID: 30217011 PMCID: PMC6163645 DOI: 10.3390/ijerph15091994] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 12/21/2022]
Abstract
Exposure to fecal pathogens results in both acute and chronic sequalae in young children. Diarrhea causes nearly 20% of all under-five mortality, while even sub-clinical enteric infections may lead to growth shortfalls. Stunting affects nearly 165 million children globally and results in lifelong and intergenerational effects for the world's poorest populations. Caregiver hygiene behaviors, such as those surrounding handwashing and food preparation, play a critical role in exposure to fecal pathogens; standard metrics to assess these behaviors are warranted to provide a means of quantifying the impact these behaviors have on enteric infections and to evaluate the success or failure of interventions and programs. This paper documents the development of three novel caregiver hygiene behavior measures: hygienic food preparation and storage, handwashing at key times, and provision of a safe play environment for children under two years. We developed these measures using formative qualitative work, survey creation and deployment theoretically underpinned by the COM-B model of behavior change, and exploratory and confirmatory factor analysis. The final measure for hygienic food preparation and storage includes 10 items across two factors; the final measure for handwashing at key times includes 15 items across three factors; and the final measure for safe play environment contains 13 items across three factors. Future researchers may employ these measures to assess caregiver behaviors in other populations, identify specific behavioral dimensions that should be the focus of interventions, and evaluate interventions and programs.
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Affiliation(s)
- Breanna K Wodnik
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Anna S Ellis
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Emily Awino Ogutu
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Amy Webb Girard
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Bethany A Caruso
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Byrd K, Dentz HN, Williams A, Kiprotich M, Pickering AJ, Omondi R, Kwena O, Rao G, Arnold CD, Arnold BF, Dewey KG, Colford JM, Null C, Stewart CP. A behaviour change intervention with lipid-based nutrient supplements had little impact on young child feeding indicators in rural Kenya. MATERNAL AND CHILD NUTRITION 2018; 15:e12660. [PMID: 30207423 DOI: 10.1111/mcn.12660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/14/2018] [Accepted: 07/12/2018] [Indexed: 11/28/2022]
Abstract
Poor infant and young child feeding (IYCF) practices are associated with linear growth faltering. Our objective was to evaluate the impact of a nutrition and water and sanitation for health intervention on three IYCF indicators-minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) in Kenyan children. Households were randomized into one of eight groups: (a) active control; (b) passive control; (c) water quality (W); (d) sanitation (S); (e) handwashing (H); (f) combined Water, Sanitation, and Handwashing; (g) nutrition (N); and (h) combined WSH + N. In the N and WSH + N arms, community-based promoters counselled households on optimal IYCF practices, and small-quantity lipid-based nutrient supplements (SQ-LNS) were provided to children 6-24 months of age. Twelve months (Year 1) and 24 months (Year 2) after interventions began, enumerators surveyed mothers to ascertain IYCF practices. We made pairwise comparisons of each intervention arm versus the active control arm using log binomial models. In total, 3,652 caretakers were surveyed at Year 1 and 4,987 caretakers at Year 2. Compared with the active control, there were no differences in any of the arms in MDD, MMF, or MAD, aside from an increase in MDD at Year 1 in the nutrition only arm but not in the combined WSH + N arm (N: 68%; WSH + N: 61%; C: 61%; N arm prevalence ratio: 1.13 95% CI [1.01, 1.25]). In this setting, a nutrition behaviour change communication intervention had little impact on IYCF indicators. The provision of SQ-LNS was not detrimental to current IYCF indicators in the community.
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Affiliation(s)
- Kendra Byrd
- Department of Nutrition, University of California Davis, Davis, California
| | - Holly N Dentz
- Department of Nutrition, University of California Davis, Davis, California
| | - Anne Williams
- Department of Global Health, Emory University, Atlanta, Georgia
| | | | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts
| | - Ronald Omondi
- Center for International Policy Research, Mathematica Policy Research, Washington, District of Columbia
| | - Osborne Kwena
- Center for International Policy Research, Mathematica Policy Research, Washington, District of Columbia
| | | | - Charles D Arnold
- Department of Nutrition, University of California Davis, Davis, California
| | - Benjamin F Arnold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California
| | - Kathryn G Dewey
- Department of Nutrition, University of California Davis, Davis, California
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, California
| | - Clair Null
- Innovations for Poverty Action, Kakamega, Kenya.,Center for International Policy Research, Mathematica Policy Research, Washington, District of Columbia
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Chatterjee P, Kanungo S, Dutta S. Challenges for programmatic implementation of killed whole cell oral cholera vaccines for prevention and control of cholera: a meta-opinion. Expert Opin Biol Ther 2018; 18:983-988. [PMID: 30107757 DOI: 10.1080/14712598.2018.1512578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Cholera remains a public health threat. The development of safe, effective, easy-to-administer, heat-stable, and cheap killed whole cell oral cholera vaccines (OCVs) has provided an additional tool to counter cholera. In this meta-opinion, we review the challenges of delivering OCVs through the existing public health infrastructure in vulnerable areas. AREAS COVERED We provide an overview of the available vaccines against cholera, the existing evidence about the effectiveness of a two-dose as well as a single-dose OCV strategy. We also highlight the experience from the public health campaigns for OCV deployment. EXPERT OPINION Several public health experiences have shown the feasibility of incorporating OCVs into the public health response against cholera. Combined with a comprehensive water, sanitation, and hygiene (WaSH) improvement plan, OCVs need to be deployed in identified vulnerable areas, targeting the highest risk groups first. Vaccination programs should not be deployed in lieu of investments in WaSH services, but as a complimentary service in a comprehensive, cholera control intervention package. It has been a challenge to have high two-dose coverage across all eligible recipients, necessitating the adoption of innovative strategies to boost coverage. Longer intervals between doses may help to overcome resource and logistical limitations enabling higher coverage.
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Affiliation(s)
- Pranab Chatterjee
- a National Institute of Cholera and Enteric Disease - Division of Epidemiology , Indian Council of Medical Research , Kolkata , India
| | - Suman Kanungo
- a National Institute of Cholera and Enteric Disease - Division of Epidemiology , Indian Council of Medical Research , Kolkata , India
| | - Shanta Dutta
- b National Institute of Cholera and Enteric Diseases , Indian Council of Medical Research , Kolkata , India
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Where Children Play: Young Child Exposure to Environmental Hazards during Play in Public Areas in a Transitioning Internally Displaced Persons Community in Haiti. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081646. [PMID: 30081490 PMCID: PMC6122025 DOI: 10.3390/ijerph15081646] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 12/17/2022]
Abstract
Globally, gastrointestinal (GI) infections by enteric pathogens are the second-leading cause of morbidity and mortality in children under five years of age (≤5 years). While GI pathogen exposure in households has been rigorously examined, there is little data about young children's exposure in public domains. Moreover, public areas in low-income settings are often used for other waste disposal practices in addition to human feces, such as trash dumping in areas near households. If young children play in public domains, they might be exposed to interrelated and highly concentrated microbial, chemical, and physical hazards. This study performed structured observations at 36 public areas in an internally displaced persons community that has transitioned into a formal settlement in Haiti. We documented how often young children played in public areas and quantified behaviors that might lead to illness and injury. Children ≤5 years played at all public sites, which included infants who played at 47% of sites. Children touched and mouthed plastic, metal and glass trash, food and other objects from the ground, ate soil (geophagia) and drank surface water. They also touched latrines, animals, animal feces and open drainage canals. Hand-to-mouth contact was one of the most common behaviors observed and the rate of contact significantly differed among developmental stages (infants: 18/h, toddlers: 11/h and young children: 9/h), providing evidence that children could ingest trace amounts of animal/human feces on hands that may contain GI pathogens. These findings demonstrate that water, sanitation and hygiene interventions could be more effective if they consider exposure risks to feces in public domains. Furthermore, this research highlights the need for waste-related interventions to address the broader set of civil conditions that create unsafe, toxic and contaminated public environments where young children play.
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345
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Just MR, Carden SW, Li S, Baker KK, Gambhir M, Fung ICH. The impact of shared sanitation facilities on diarrheal diseases with and without an environmental reservoir: a modeling study. Pathog Glob Health 2018; 112:195-202. [PMID: 29874978 DOI: 10.1080/20477724.2018.1478927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Epidemiological studies have identified an increased risk of diarrheal diseases associated with using shared sanitation facilities. We hypothesized that this might be related to differences in transmission routes of pathogens. We proposed a mathematical model of two fictitious pathogens, one transmitted with an environmental reservoir and one without. We assumed that individuals susceptible to one pathogen are not susceptible to the other, and therefore, decoupled the two models. We initialized the model with 99% individuals being susceptible. We sampled the parameter space using Latin Hypercube Sampling. We simulated 10,000 parameter sets. We varied the effective shared sanitation coverage (the product of latrine coverage and users' compliance). Our results show that, in our hypothetical scenario, across all levels of effective coverage of shared sanitation, the median final cumulative incidence of diarrheal disease was higher than that of zero coverage. Our simulation findings suggest that increasing effective coverage of shared sanitation may have limited benefits against diarrhea-causing pathogens with an environmental reservoir and may lack benefit against diarrhea-causing pathogens without an environmental reservoir given increased human contacts if latrines are poorly maintained.
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Affiliation(s)
- Matthew R Just
- a Department of Mathematical Sciences , Georgia Southern University , Statesboro , GA , USA
| | - Stephen W Carden
- a Department of Mathematical Sciences , Georgia Southern University , Statesboro , GA , USA
| | - Sheng Li
- b CUNY School of Public Health, City University of New York , New York City , NY , USA
| | - Kelly K Baker
- c Department of Occupational and Environmental Health , College of Public Health, The University of Iowa , Iowa City , IA , USA
| | - Manoj Gambhir
- d Epidemiological Modelling Unit, Faculty of Medicine, Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia
| | - Isaac Chun-Hai Fung
- e Department of Epidemiology and Environmental Health Sciences , Jiann-Ping Hsu College of Public Health, Georgia Southern University , Statesboro , GA , USA
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346
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Cumming O, Curtis V. Implications of WASH Benefits trials for water and sanitation. LANCET GLOBAL HEALTH 2018; 6:e613-e614. [DOI: 10.1016/s2214-109x(18)30192-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 11/27/2022]
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Delahoy MJ, Wodnik B, McAliley L, Penakalapati G, Swarthout J, Freeman MC, Levy K. Pathogens transmitted in animal feces in low- and middle-income countries. Int J Hyg Environ Health 2018; 221:661-676. [PMID: 29729998 PMCID: PMC6013280 DOI: 10.1016/j.ijheh.2018.03.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/20/2018] [Accepted: 03/14/2018] [Indexed: 02/04/2023]
Abstract
Animals found in close proximity to humans in low-and middle-income countries (LMICs) harbor many pathogens capable of infecting humans, transmissible via their feces. Contact with animal feces poses a currently unquantified-though likely substantial-risk to human health. In LMIC settings, human exposure to animal feces may explain some of the limited success of recent water, sanitation, and hygiene interventions that have focused on limiting exposure to human excreta, with less attention to containing animal feces. We conducted a review to identify pathogens that may substantially contribute to the global burden of disease in humans through their spread in animal feces in the domestic environment in LMICs. Of the 65 potentially pathogenic organisms considered, 15 were deemed relevant, based on burden of disease and potential for zoonotic transmission. Of these, five were considered of highest concern based on a substantial burden of disease for which transmission in animal feces is potentially important: Campylobacter, non-typhoidal Salmonella (NTS), Lassa virus, Cryptosporidium, and Toxoplasma gondii. Most of these have a wide range of animal hosts, except Lassa virus, which is spread through the feces of rats indigenous to sub-Saharan Africa. Combined, these five pathogens cause close to one million deaths annually. More than half of these deaths are attributed to invasive NTS. We do not estimate an overall burden of disease from improperly managed animal feces in LMICs, because it is unknown what proportion of illnesses caused by these pathogens can be attributed to contact with animal feces. Typical water quantity, water quality, and handwashing interventions promoted in public health and development address transmission routes for both human and animal feces; however, sanitation interventions typically focus on containing human waste, often neglecting the residual burden of disease from pathogens transmitted via animal feces. This review compiles evidence on which pathogens may contribute to the burden of disease through transmission in animal feces; these data will help prioritize intervention types and regions that could most benefit from interventions aimed at reducing human contact with animal feces.
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Affiliation(s)
- Miranda J Delahoy
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Breanna Wodnik
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Lydia McAliley
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Gauthami Penakalapati
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Jenna Swarthout
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Matthew C Freeman
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Karen Levy
- Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Arnold BF, Null C, Luby SP, Colford JM. Implications of WASH Benefits trials for water and sanitation - Authors' reply. LANCET GLOBAL HEALTH 2018; 6:e616-e617. [PMID: 29706562 DOI: 10.1016/s2214-109x(18)30229-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Benjamin F Arnold
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, CA 94720, USA.
| | - Clair Null
- Center for International Policy Research and Evaluation, Mathematica Policy Research, Washington, DC, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - John M Colford
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, CA 94720, USA
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Coffey D, Spears D. Implications of WASH Benefits trials for water and sanitation. LANCET GLOBAL HEALTH 2018; 6:e615. [PMID: 29706564 DOI: 10.1016/s2214-109x(18)30225-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/09/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Diane Coffey
- Department of Sociology and Population Research Center, University of Texas at Austin, Austin, TX 78712, USA
| | - Dean Spears
- Department of Economics and Population Research Center, University of Texas at Austin, Austin, TX 78712, USA.
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350
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Tofail F, Fernald LC, Das KK, Rahman M, Ahmed T, Jannat KK, Unicomb L, Arnold BF, Ashraf S, Winch PJ, Kariger P, Stewart CP, Colford JM, Luby SP. Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:255-268. [PMID: 29616235 PMCID: PMC5859216 DOI: 10.1016/s2352-4642(18)30031-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Poor nutrition and hygiene make children vulnerable to delays in growth and development. We aimed to assess the effects of water quality, sanitation, handwashing, and nutritional interventions individually or in combination on the cognitive, motor, and language development of children in rural Bangladesh. Methods In this cluster-randomised controlled trial, we enrolled pregnant women in their first or second trimester from rural villages of Gazipur, Kishoreganj, Mymensingh, and Tangail districts of central Bangladesh, with an average of eight women per cluster. Groups of eight geographically adjacent clusters were block-randomised, using a random number generator, into six intervention groups (all of which received weekly visits from a community health promoter for the first 6 months and every 2 weeks for the next 18 months) and a double-sized control group (no intervention or health promoter visit). The six intervention groups were: chlorinated drinking water; improved sanitation; handwashing with soap; combined water, sanitation, and handwashing; improved nutrition through counselling and provision of lipid-based nutrient supplements; and combined water, sanitation, handwashing, and nutrition. Here, we report on the prespecified secondary child development outcomes: gross motor milestone achievement assessed with the WHO module at age 1 year, and communication, gross motor, personal social, and combined scores measured by the Extended Ages and Stages Questionnaire (EASQ) at age 2 years. Masking of participants was not possible. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01590095. Findings Between May 31, 2012, and July 7, 2013, 5551 pregnant women residing in 720 clusters were enrolled. Index children of 928 (17%) enrolled women were lost to follow-up in year 1 and an additional 201 (3%) in year 2. 4757 children were assessed at 1 year and 4403 at 2 years. At year 1, compared with the control group, the combined water, sanitation, handwashing, and nutrition group had a higher rate of attaining the standing alone milestone (hazard ratio 1·19, 95% CI 1·01–1 ·40), and the nutrition group had a higher rate of attaining the walking alone milestone (1·32, 95% CI 1·07–1·62). The combined water, sanitation, handwashing, and nutrition group had a higher rate of attaining the walking alone milestone than those in the water, sanitation, and handwashing group (1·29, 1·01–1·65). At 2 years, we noted beneficial effects in the combined EASQ score in all intervention groups, with effect sizes smallest in the water treatment group (difference 0·15, 95% CI 0·04 to 0·26 vs control) and largest in the combined water, sanitation, handwashing, and nutrition treatment group (0·37, 0·27–0·46). Interpretation Improvements in water quality, handwashing, sanitation, or nutrition supported by intensive interpersonal communication, when delivered either individually or in combination, contributed to improvements in child development. A crucial next step is to establish whether similar effects can be achieved with reduced intensity of promoter contacts that could be supported in large-scale interventions. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Lia Ch Fernald
- School of Public Health, University of California Berkeley, Berkeley, CA USA
| | - Kishor K Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kaniz K Jannat
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Benjamin F Arnold
- School of Public Health, University of California Berkeley, Berkeley, CA USA
| | - Sania Ashraf
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia Kariger
- School of Public Health, University of California Berkeley, Berkeley, CA USA
| | | | - John M Colford
- School of Public Health, University of California Berkeley, Berkeley, CA USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University Stanford, CA USA
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