1
|
MacLeod C, Ngabirano L, N'Diaye DS, Braun L, Cumming O. Household-level water, sanitation and hygiene factors and interventions and the prevention of relapse after severe acute malnutrition recovery: A systematic review. MATERNAL & CHILD NUTRITION 2024; 20:e13634. [PMID: 38372439 PMCID: PMC11168358 DOI: 10.1111/mcn.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
Severe acute malnutrition (SAM) is the most serious form of acute malnutrition and is associated with high mortality risk among children under 5. While the Community-based Management of Acute Malnutrition (CMAM) approach, recommended for treating cases of uncomplicated SAM, has increased treatment coverage and recovery outcomes, high relapse rates have been reported. Several risk factors for SAM relapse, such as insufficient food intake and high infectious disease burden in the community, have been identified. However, the role of household water, sanitation and hygiene (WASH) conditions remains unclear. This systematic review: (1) assesses the effectiveness of WASH interventions on preventing SAM relapse and (2) identifies WASH-related conditions associated with relapse to SAM among children aged 6-59 months discharged as recovered following SAM CMAM treatment. We performed electronic searches of six databases to identify relevant studies published between 1 January 2000 and 6 November 2023 and assessed their quality. After deduplication, 10,294 documents were screened by title and abstract, with 13 retrieved for full-text screening. We included three studies ranging from low- to medium-quality. One intervention study found that providing a WASH kit during SAM outpatient treatment did not reduce the risk of relapse to SAM. Two observational studies found inconsistent associations between household WASH conditions-unimproved sanitation and unsafe drinking water-and SAM relapse. Despite the paucity of evidence, the hypothesised causal pathways between WASH conditions and the risk of relapse remain plausible. Further evidence is needed to identify interventions for an integrated postdischarge approach to prevent relapse.
Collapse
Affiliation(s)
- Clara MacLeod
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | | | | | - Laura Braun
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Oliver Cumming
- Department of Disease ControlLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| |
Collapse
|
2
|
Kerr M, Cardinale V, De Vito C, Khanolkar AR. Lifestraw Family water filters in low- and middle-income countries: a systematic review and meta-analysis to define longer-term public health impact against childhood diarrhoea and inform scale-up. J Glob Health 2024; 14:04018. [PMID: 38939952 PMCID: PMC11215800 DOI: 10.7189/jogh.14.04018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background Diarrhoeal disease disproportionately affects children <5 years in low- and middle-income countries (LMICs). The pathogens responsible for diarrhoea are commonly transmitted through faecally-contaminated drinking water. Lifestraw Family point-of-use water filters have been the subject of intervention studies for over a decade and were the first filters evaluated by the World Health Organization in its water treatment evaluation scheme to provide comprehensive protection against many diarrhoea-causing pathogens. This systematic review aimed to: 1) report on aspects related to physical environment and implementation and 2) conduct an updated meta-analysis on Lifestraw Family filter effectiveness against childhood diarrhoea based on studies with ≥12 months of follow-up. Methods We conducted a literature search in November 2022 using MEDLINE, Embase, Cochrane, and CINAHL databases. Inclusion criteria were: 1) RCTs, cluster-RCTs, quasi-experimental, or matched cohort studies on 2) Lifestraw Family 1.0 or 2.0 filters 3) conducted in LMICs 4) that evaluated filter effectiveness against diarrhoea in children <5 and 5) analysed ≥12 months of follow-up data on clinical effectiveness against diarrhoea and were 6) published from 2010 with 7) full-text availability in English. A modified Newcastle-Ottawa Scale was used to assess risk of bias. Relative risk (RR) and 95% confidence intervals (CIs) were extracted and analysed using a random-effects meta-analysis. Results We included 6 studies in LMICs involving 4740 children <5. Of the four clinically-effective interventions, common characteristics were access to improved water sources (75%), the 2.0 version of the filter or the 1.0 version with additional water storage (100%), use of behaviour change theory, community engagement, and health messaging (75%), local filter repair-and-replace mechanisms (75%), and specially-trained local interventionists (100%). The meta-analysis showed a 30% reduction in diarrhoea risk in the intervention group (RR = 0.69; 95% CI = 0.52-0.91, P = 0.01). Conclusions Lifestraw Family water filters can be effective interventions to reduce diarrhoea in vulnerable paediatric populations for at least one year, though certain aspects related to physical environment and implementation may increase their public health impact. The findings of this study suggest considerations for scale-up that can be applied in settings in need of longer-term interim solutions until universal access to safe drinking water is achieved.
Collapse
Affiliation(s)
- Melissa Kerr
- Department of Population Health Sciences, King’s College London, Guy’s Campus, London, England, UK
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Amal R Khanolkar
- Department of Population Health Sciences, King’s College London, Guy’s Campus, London, England, UK
| |
Collapse
|
3
|
Liu Q, Deng J, Yan W, Qin C, Du M, Wang Y, Zhang S, Liu M, Liu J. Burden and trends of infectious disease mortality attributed to air pollution, unsafe water, sanitation, and hygiene, and non-optimal temperature globally and in different socio-demographic index regions. Glob Health Res Policy 2024; 9:23. [PMID: 38937833 PMCID: PMC11212388 DOI: 10.1186/s41256-024-00366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Environmental factors greatly impact infectious disease-related mortality, yet there's a lack of comprehensive global studies on the contemporary burden and trends. This study aims to evaluate the global burden and trends of infectious disease mortality caused by air pollution, unsafe water, poor sanitation, and non-optimal temperature across Socio-Demographic Index (SDI) regions from 1990 to 2019. METHODS This observational study utilized data from the Global Burden of Diseases Study to examine mortality rates from infectious diseases attributed to environmental risk factors between 1990 and 2019, including air pollution, unsafe water, sanitation, handwashing facilities (UWSH), and non-optimal temperatures. Age-standardized mortality rates (ASMRs) and estimated annual percentage change (EAPC) were utilized to present infectious disease mortality, and its trajectory influenced by environmental risk factors over the years. Nonlinear regression was conducted to explore the association between the SDI and ASMRs across regions from 1990 to 2019. RESULTS In 2019, global infectious disease deaths linked to air pollution, UWSH, and non-optimal temperature reached a startling 2,556,992. Disease mortality varied widely across SDI regions, with the highest number of deaths due to air pollution and UWSH in Low SDI regions, and deaths from non-optimal temperature primarily in High SDI regions. Age disparities emerged, with children under five and the elderly most affected. However, an increasing mortality trend was observed among seniors (65-69, 75-79, and over 80) in High SDI regions due to enteric infections linked to UWSH. Globally, a consistent decrease in ASMR was seen from 1990 to 2019 for all diseases connected to these factors, except for respiratory infections linked to non-optimal temperature. CONCLUSIONS Our study underscores the significant impact of air pollution, UWSH, and non-optimal temperatures on global infectious disease mortality, particularly among vulnerable groups such as children and the elderly. It's important to tackle these challenges with targeted interventions aiming to enhance environmental quality, improve water and sanitation systems, and control extreme temperatures. In addition, international cooperation is essential for bridging regional disparities and driving global public health initiatives forward, thereby helping achieve Sustainable Development Goals more effectively.
Collapse
Affiliation(s)
- Qiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jie Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Wenxin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Chenyuan Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yaping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Shimo Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University, Haidian District, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China.
- Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University, Haidian District, Beijing, China.
- Institute for Global Health and Development, Peking University, Haidian District, Beijing, China.
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China.
- Institute of Environmental Medicine, Peking University, Beijing, China.
| |
Collapse
|
4
|
Sahiledengle B, Atlaw D, Mwanri L, Petrucka P, Kumie A, Tekalegn Y, Desta F, Zenbaba D, Mesfin T, Gomora D, Agho KE. Burden of Childhood Diarrhea and Its Associated Factors in Ethiopia: A Review of Observational Studies. Int J Public Health 2024; 69:1606399. [PMID: 38903206 PMCID: PMC11188320 DOI: 10.3389/ijph.2024.1606399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Objectives: This systematic review and meta-analysis aimed to: i) determine the pooled prevalence of acute diarrhea; and ii) synthesize and summarize current evidence on factors of acute diarrheal illnesses among under-five children in Ethiopia. Methods: A comprehensive systematic search was conducted in PubMed, SCOPUS, HINARI, Science Direct, Google Scholar, Global Index Medicus, Directory of Open Access Journals (DOAJ), and the Cochrane Library. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The methodological quality of each included article was assessed using the Joanna Briggs Institute (JBI) quality assessment tool for cross-sectional and case-control studies. A random-effect meta-analysis model was used to estimate the pooled prevalence of diarrheal illnesses. Heterogeneity and publication bias were assessed using I2 test statistics and Egger's test, respectively. The statistical analysis was done using STATA™ software version 14. Results: Fifty-three studies covering over 27,458 under-five children who met the inclusion criteria were included. The pooled prevalence of diarrhea among under-five children in Ethiopia was found to be 20.8% (95% CI: 18.69-22.84, n = 44, I2 = 94.9%, p < 0.001). Our analysis revealed a higher prevalence of childhood diarrhea in age groups of 12-23 months 25.42% (95%CI: 21.50-29.35, I2 = 89.4%, p < 0.001). In general, the evidence suggests that diarrheal risk factors could include: i) child level determinants (child's age 0-23 months, not being vaccinated against rotavirus, lack of exclusive breastfeeding, and being an under-nourished child); ii) parental level determinants {mothers poor handwashing practices [pooled odds ratio (OR) = 3.05; 95% CI:2.08-4.54] and a history of maternal recent diarrhea (pooled OR = 3.19, 95%CI: 1.94-5.25)}; and iii) Water, Sanitation and Hygiene (WASH) determinants [lack of toilet facility (pooled OR = 1.56, 95%CI: 1.05-2.33)], lack handwashing facility (pooled OR = 4.16, 95%CI: 2.49-6.95) and not treating drinking water (pooled OR = 2.28, 95% CI: 1.50-3.46). Conclusion: In Ethiopia, the prevalence of diarrhea among children under the age of five remains high and is still a public health problem. The contributing factors to acute diarrheal illnesses were child, parental, and WASH factors. A continued focus on improving access to WASH facilities, along with enhancing maternal hygiene behavior will accelerate reductions in diarrheal disease burden in Ethiopia.
Collapse
Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide Campus, Adelaide, SA, Australia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Abera Kumie
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Fikreab Desta
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Telila Mesfin
- School of Medicine, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia
| | | |
Collapse
|
5
|
Swarthout J, Mureithi M, Mboya J, Arnold BF, Wolfe MK, Dentz HN, Lin A, Arnold CD, Rao G, Stewart CP, Clasen T, Colford JM, Null C, Pickering AJ. Addressing Fecal Contamination in Rural Kenyan Households: The Roles of Environmental Interventions and Animal Ownership. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:9500-9514. [PMID: 38760010 PMCID: PMC11155254 DOI: 10.1021/acs.est.3c09419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024]
Abstract
Combined water, sanitation, and handwashing (WSH) interventions could reduce fecal contamination along more transmission pathways than single interventions alone. We measured Escherichia coli levels in 3909 drinking water samples, 2691 child hand rinses, and 2422 toy ball rinses collected from households enrolled in a 2-year cluster-randomized controlled trial evaluating single and combined WSH interventions. Water treatment with chlorine reduced E. coli in drinking water. A combined WSH intervention improved water quality by the same magnitude but did not affect E. coli levels on hands or toys. One potential explanation for the limited impact of the sanitation intervention (upgraded latrines) is failure to address dog and livestock fecal contamination. Small ruminant (goat or sheep) ownership was associated with increased E. coli levels in stored water and on child hands. Cattle and poultry ownership was protective against child stunting, and domesticated animal ownership was not associated with child diarrhea. Our findings do not support restricting household animal ownership to prevent child diarrheal disease or stunting but do support calls for WSH infrastructure that can more effectively reduce household fecal contamination.
Collapse
Affiliation(s)
- Jenna
M. Swarthout
- Department
of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | | | - John Mboya
- Innovations
for Poverty Action, Nairobi 00200, Kenya
- Department
of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California 94720, United States
| | - Benjamin F. Arnold
- Francis
I. Proctor Foundation, Department of Ophthalmology and Institute for
Global Health Sciences, University of California,
San Francisco, San Francisco, California 94158, United States
| | - Marlene K. Wolfe
- Gangarosa
Department of Environmental Health, Emory
University, Atlanta, Georgia 30322, United States
| | - Holly N. Dentz
- Institute
for Global Nutrition, University of California,
Davis, Davis, California 95616, United States
| | - Audrie Lin
- Department
of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, California 95064, United States
| | - Charles D. Arnold
- Institute
for Global Nutrition, University of California,
Davis, Davis, California 95616, United States
| | - Gouthami Rao
- Department
of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Christine P. Stewart
- Institute
for Global Nutrition, University of California,
Davis, Davis, California 95616, United States
| | - Thomas Clasen
- Gangarosa
Department of Environmental Health, Emory
University, Atlanta, Georgia 30322, United States
| | - John M. Colford
- School
of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California 94720, United States
| | - Clair Null
- Mathematica, Washington, District of
Columbia 20002, United States
| | - Amy J. Pickering
- Department
of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
- Department
of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California 94720, United States
- Chan
Zuckerberg Biohub San Francisco, San Francisco, California 94158, United States
| |
Collapse
|
6
|
Fejfar D, Tracy W, Kelly E, Moffa M, Bain R, Bartram J, Anderson D, Cronk R. Identifying predictors of E. coli in rural household water in sub-Saharan Africa using elimination regression. ENVIRONMENTAL SCIENCE : WATER RESEARCH & TECHNOLOGY 2024; 10:1147-1159. [PMID: 38798903 PMCID: PMC11115386 DOI: 10.1039/d3ew00915g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Exposure to fecally contaminated drinking water contributes to the global disease burden, especially in sub-Saharan Africa (SSA). We used cross-sectional data and elimination regression analysis to examine factors influencing E. coli contamination in household drinking water samples from 4,499 rural households in nine countries in SSA (Malawi, Mozambique, and Zambia in Southern Africa; Ghana, Mali, and Niger in Western Africa; and Kenya, Rwanda, and Tanzania in Eastern Africa). The proportion of household water samples containing E. coli was 71%, ranging from 45% (Malawi) to 89% (Tanzania). Pooled and multi-country predictive logistic regression models showed that using an unimproved-type water source, the absence of a community water committee, and domestic animal ownership were significantly associated with household drinking water contamination. Household water treatment and storage practices, sanitation and hygiene practices, and payment for drinking water were not significantly associated with E. coli contamination in any model. The season was a significant predictor of E. coli in the pooled model; samples collected in the rainy season were 2.3 [2.0, 2.7] times as likely to be contaminated with E. coli. Practitioners and policymakers should prioritize implementing piped on-plot water services, establishing effective local water source management structures, and incorporating animal husbandry practices into water, sanitation, and hygiene interventions.
Collapse
Affiliation(s)
- Donald Fejfar
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, North Carolina 27599, United States
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 3101 McGavran-Greenberg Hall, Chapel Hill, North Carolina 27599, United States
| | - Wren Tracy
- ICF, 2635 Meridian Pkwy Suite 200, Durham, North Carolina, 27713, United States
| | - Emma Kelly
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, North Carolina 27599, United States
- The Water Project, PO Box 3353, Concord, New Hampshire, 03302, USA
| | - Michelle Moffa
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, North Carolina 27599, United States
| | - Robert Bain
- Regional Office for the Middle East and North Africa, UNICEF, Amman, Jordan
| | - Jamie Bartram
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, North Carolina 27599, United States
- School of Civil Engineering, University of Leeds, Leeds, United Kingdom
| | - Darcy Anderson
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, North Carolina 27599, United States
| | - Ryan Cronk
- The Water Institute, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7431, Chapel Hill, North Carolina 27599, United States
| |
Collapse
|
7
|
Laauwen M, Nowicki S. Reinforcing Feedbacks for Sustainable Implementation of Rural Drinking-Water Treatment Technology. ACS ES&T WATER 2024; 4:1763-1774. [PMID: 38633363 PMCID: PMC11019543 DOI: 10.1021/acsestwater.3c00779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
Progress toward universal access to safe drinking water depends on rural water service delivery models that incorporate water safety management. Water supplies of all types have high rates of fecal contamination unless water safety risks are actively managed through water source protection, treatment, distribution, and storage. Recognizing the role of treatment within this broader risk-based framework, this study focuses on the implementation of passive chlorination and ultraviolet (UV) disinfection technologies in rural settings. These technologies can reduce the health risk from microbiological contaminants in drinking water; however, technology-focused treatment interventions have had limited sustainability in rural settings. This study examines the requirements for sustainable implementation of rural water treatment through qualitative content analysis of 26 key informant interviews, representing passive chlorination and UV disinfection projects in rural areas in South America, Africa, and Asia. The analysis is aligned with the RE-AIM framework and delivers insight into 18 principal enablers and barriers to rural water treatment sustainability. Analysis of the interrelationships among these factors identifies leverage points and encourages fit-for-purpose intervention design reinforced by collaboration between facilitating actors through hybrid service delivery models. Further work should prioritize health impact evidence, water quality reporting guidance, and technological capabilities that optimize trade-offs in fit-for-purpose treatment design.
Collapse
Affiliation(s)
- Merel Laauwen
- School
of Geography and the Environment, University
of Oxford, South Parks Road, Oxford OX1 3QY, U.K.
| | - Saskia Nowicki
- School
of Geography and the Environment, University
of Oxford, South Parks Road, Oxford OX1 3QY, U.K.
| |
Collapse
|
8
|
Rhoades NS, Cinco IR, Hendrickson SM, Prongay K, Haertel AJ, Flores GE, Slifka MK, Messaoudi I. Infant diarrheal disease in rhesus macaques impedes microbiome maturation and is linked to uncultured Campylobacter species. Commun Biol 2024; 7:37. [PMID: 38182754 PMCID: PMC10770169 DOI: 10.1038/s42003-023-05695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
Diarrheal diseases remain one of the leading causes of death for children under 5 globally, disproportionately impacting those living in low- and middle-income countries (LMIC). Campylobacter spp., a zoonotic pathogen, is one of the leading causes of food-borne infection in humans. Yet to be cultured Campylobacter spp. contribute to the total burden in diarrheal disease in children living in LMIC thus hampering interventions. We performed microbiome profiling and metagenomic genome assembly on samples collected from over 100 infant rhesus macaques longitudinally and during cases of clinical diarrhea within the first year of life. Acute diarrhea was associated with long-lasting taxonomic and functional shifts of the infant gut microbiome indicative of microbiome immaturity. We constructed 36 Campylobacter metagenomic assembled genomes (MAGs), many of which fell within 4 yet to be cultured species. Finally, we compared the uncultured Campylobacter MAGs assembled from infant macaques with publicly available human metagenomes to show that these uncultured species are also found in human fecal samples from LMIC. These data highlight the importance of unculturable Campylobacter spp. as an important target for reducing disease burden in LMIC children.
Collapse
Affiliation(s)
- Nicholas S Rhoades
- Department of Molecular biology and Biochemistry, University of California Irvine, Irvine, CA, USA
- Department of Microbiology, Immunology and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Isaac R Cinco
- Department of Microbiology, Immunology and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Sara M Hendrickson
- Division of Neuroscience, Oregon National Primate Research Center, Portland, OR, USA
| | - Kamm Prongay
- Division of Animal Resources and Research Support, Oregon National Primate Research Center, Oregon Health and Science University West Campus, Portland, OR, USA
| | - Andrew J Haertel
- Division of Animal Resources and Research Support, Oregon National Primate Research Center, Oregon Health and Science University West Campus, Portland, OR, USA
| | - Gilberto E Flores
- Department of Biology, California State University, Northridge, Northridge, CA, USA
| | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Portland, OR, USA
| | - Ilhem Messaoudi
- Department of Microbiology, Immunology and Molecular Genetics, College of Medicine, University of Kentucky, Lexington, KY, USA.
| |
Collapse
|
9
|
Rowles LS, Tso D, Dolocan A, Kirisits MJ, Lawler DF, Saleh NB. Integrating Navajo Pottery Techniques To Improve Silver Nanoparticle-Enabled Ceramic Water Filters for Disinfection. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:17132-17143. [PMID: 37870911 DOI: 10.1021/acs.est.3c03462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Point-of-use treatment technologies can increase access to safe drinking water in rural areas. Sustained use of these technologies is uncommon due to oversight of community needs, user-perceived risks, long-term maintenance, and conflict with traditional practices. Nanosilver-enabled ceramic water filters are unique due to the use of locally sourced materials available at or near the target community; however, technical limitations persist (e.g., nanosilver's uncontrolled release and passivation from sulfide or chloride). This work aims to overcome these limitations by impregnating nanosilver onto ceramics with a Navajo pottery rosin, collected from pinyon trees with a third-generation artisan. Here, we investigate this sustainable and novel material for drinking water treatment; the study ranges from a proof of concept to testing under realistic conditions. Results show that when embedded in a thin film, the biopolymer controlled ionic silver dissolution and prevented silver passivation from sulfide and chloride. When applied to ceramic filters, the biopolymer effectively immobilized nanosilver in a range of waters. Over a 25 day study to emulate household-use conditions, this coating method sustained disinfection of a coculture of Gram-positive and Gram-negative bacteria while controlling biofouling. Overall, the use of this Navajo pottery material can facilitate adoption while providing the needed technological advancement to these widely used treatment devices.
Collapse
Affiliation(s)
- Lewis S Rowles
- Fariborz Maseeh Department of Civil, Architectural and Environmental Engineering, University of Texas, Austin, Texas 78712, United States
| | - Deanna Tso
- Navajo Nation, Tuba City Chapter, Tuba, Arizona 86045, United States
| | - Andrei Dolocan
- Texas Materials Institute, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Mary Jo Kirisits
- Fariborz Maseeh Department of Civil, Architectural and Environmental Engineering, University of Texas, Austin, Texas 78712, United States
| | - Desmond F Lawler
- Fariborz Maseeh Department of Civil, Architectural and Environmental Engineering, University of Texas, Austin, Texas 78712, United States
| | - Navid B Saleh
- Fariborz Maseeh Department of Civil, Architectural and Environmental Engineering, University of Texas, Austin, Texas 78712, United States
| |
Collapse
|
10
|
Hadeed SJ, Broadway KM, Schwartz-Watjen KT, Tigabu B, Woodards AJ, Swiatecka AL, Owens AN, Wu A. Notional Spread of Cholera in Haiti Following a Natural Disaster: Considerations for Military and Disaster Relief Personnel. Mil Med 2023; 188:e2074-e2081. [PMID: 36573576 DOI: 10.1093/milmed/usac415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/29/2022] [Accepted: 12/16/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Cholera remains a significant public health threat for many countries, and the severity largely varies by the population and local conditions that drive disease spread, especially in endemic areas prone to natural disasters and flooding. Epidemiological models can provide useful information to military planners for understanding disease spread within populations and the effectiveness of response options for preventing the transmission among deployed and stationed personnel. This study demonstrates the use of epidemiological modeling to understand the dynamics of cholera transmission to inform emergency planning and military preparedness in areas with highly communicable diseases. MATERIALS AND METHODS Areas with higher probability for a potential cholera outbreak in Haiti followed by a natural disaster were identified. The hotspots were then used to seed an extended compartmental model, EpiGrid, to simulate notional spread scenarios of cholera originating in three distinct areas in Haiti. Disease parameters were derived from the 2010 cholera outbreak in Haiti, and disease spread was simulated over a 12-week period under uncontrolled and controlled spread. RESULTS For each model location, scenarios of mitigated (intervention with 30% transmission reduction via international aid) and unmitigated (without intervention) are simulated. The results depict the geographical spread and estimate the cumulative cholera infection for each notional scenario over the course of 3 months. Disease transmission differs considerably across origin site with an outbreak originating in the department of Nippes spanning the largest geographic area and resulting in the largest number of cumulative cases after 12 weeks under unmitigated (79,518 cases) and mitigated (35,667 cases) spread scenarios. CONCLUSIONS We modeled the notional re-emergence and spread of cholera following the August 2021 earthquake in Haiti while in the midst of the global COVID-19 pandemic. This information can help guide military and emergency response decision-making during an infectious disease outbreak and considerations for protecting military personnel in the midst of a humanitarian response. Military planners should consider the use of epidemiological models to assess the health risk posed to deployed and stationed personnel in high-risk areas.
Collapse
Affiliation(s)
- Steven J Hadeed
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA
| | - Katherine M Broadway
- Defense Sciences, Inc. (DSI), Support to DTRA Technical Reachback, San Antonio, TX 78230, USA
| | | | - Bersabeh Tigabu
- Global Systems Engineering (GSE), Support to DTRA Technical Reachback, Alexandria, VA 22312, USA
| | - Ashley J Woodards
- Battelle Memorial Institute, Support to DTRA Technical Reachback, Columbus, OH 43201, USA
| | - Anna L Swiatecka
- Noblis, Inc., Support to DTRA Technical Reachback, Reston, VA 20191, USA
| | - Akeisha N Owens
- Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
| | - Aiguo Wu
- Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
| |
Collapse
|
11
|
Onohuean H, Nwodo UU. Demographic dynamics of waterborne disease and perceived associated WASH factors in Bushenyi and Sheema districts of South-Western Uganda. ENVIRONMENTAL MONITORING AND ASSESSMENT 2023; 195:864. [PMID: 37338629 DOI: 10.1007/s10661-023-11270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/19/2023] [Indexed: 06/21/2023]
Abstract
Water remains a significant player in spreading pathogens, including those associated with neglected tropical diseases. The implications of socio-demographic delineations of water quality, sanitation, and hygiene ("WASH") interventions are on the downswing. This study assessed waterborne diseases and perceived associated WASH factors in the Bushenyi and Sheema districts of South-Western Uganda. This study examines the linear relationship between WASH and identifies the association of specific demographic factors as well as their contributions/correlations to waterborne disease in the study area. A structured qualitative and quantitative data collection approach was adopted in face-to-face questionnaire-guided interviews of 200 respondents on eight surface water usage. Most participants, 65.5%, were females and had a higher score of knowledge of WASH (71%), 68% score on the improper practice of WASH, and 64% score on unsafe water quality. Low score for basic economic status was (57%), report of common diarrhoea was (47%), and a low incidence of waterborne disease outbreaks (27%). The principal component analysis (PCA) depicts the knowledge and practice of WASH to have a strong positive correlation (r = 0.84, p < 0.001; r = 0.82, p < 0.001); also economic status positively correlated with grade of water source, knowledge, and practice of WASH (correlation coefficient = 0.72; 0.99; 0.76 and p-values = 0.001; < 0.001; < 0.001 respectively). Occupation (p = 0.0001, OR = 6.798) was significantly associated with knowledge and practice of WASH, while age (r = -0.21, p < 0.001) was negatively associated with knowledge and practice of WASH. The basic economic status explains why "low economic population groups" in the remote villages may not effectively implement WASH, and diarrhoea was common among the population. Diarrhoea associated with unsafe water quality and improper practice of WASH is common among the study population, and there is a low incidence of waterborne disease outbreaks. Therefore, government, stakeholders, and non-governmental organisations should work together to promote proper practice of WASH conditions to limit the occurrence of diarrhoea and prevent potential waterborne disease outbreaks.
Collapse
Affiliation(s)
- Hope Onohuean
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, School of Pharmacy, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda.
- Patho-Biocatalysis Group (PBG), Department of Biochemistry and Microbiology, University of Fort Hare, Private Bag 1314, Alice, 5700 Eastern Cape, South Africa.
| | - Uchechukwu U Nwodo
- Patho-Biocatalysis Group (PBG), Department of Biochemistry and Microbiology, University of Fort Hare, Private Bag 1314, Alice, 5700 Eastern Cape, South Africa
| |
Collapse
|
12
|
Li J, Feng S, Wang Z, He J, Zhang Z, Zou H, Wu Z, Liu X, Wei H, Tao S. Limosilactobacillus mucosae-derived extracellular vesicles modulates macrophage phenotype and orchestrates gut homeostasis in a diarrheal piglet model. NPJ Biofilms Microbiomes 2023; 9:33. [PMID: 37280255 DOI: 10.1038/s41522-023-00403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
The diarrheal disease causes high mortality, especially in children and young animals. The gut microbiome is strongly associated with diarrheal disease, and some specific strains of bacteria have demonstrated antidiarrheal effects. However, the antidiarrheal mechanisms of probiotic strains have not been elucidated. Here, we used neonatal piglets as a translational model and found that gut microbiota dysbiosis observed in diarrheal piglets was mainly characterized by a deficiency of Lactobacillus, an abundance of Escherichia coli, and enriched lipopolysaccharide biosynthesis. Limosilactobacillus mucosae and Limosilactobacillus reuteri were a signature bacterium that differentiated healthy and diarrheal piglets. Germ-free (GF) mice transplanted with fecal microbiota from diarrheal piglets reproduced diarrheal disease symptoms. Administration of Limosilactobacillus mucosae but not Limosilactobacillus reuteri alleviated diarrheal disease symptoms induced by fecal microbiota of diarrheal piglets and by ETEC K88 challenge. Notably, Limosilactobacillus mucosae-derived extracellular vesicles alleviated diarrheal disease symptoms caused by ETEC K88 by regulating macrophage phenotypes. Macrophage elimination experiments demonstrated that the extracellular vesicles alleviated diarrheal disease symptoms in a macrophage-dependent manner. Our findings provide insights into the pathogenesis of diarrheal disease from the perspective of intestinal microbiota and the development of probiotic-based antidiarrheal therapeutic strategies.
Collapse
Affiliation(s)
- Jingjing Li
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China
| | - Shuaifei Feng
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China
| | - Zhenyu Wang
- State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, No. 2 Yuanmingyuan West Road, Beijing, 100193, China
| | - Jinhui He
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China
| | - Zeyue Zhang
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China
| | - Huicong Zou
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China
| | - Zhifeng Wu
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China
| | - Xiangdong Liu
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China.
| | - Hong Wei
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China.
| | - Shiyu Tao
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan, 430070, China.
| |
Collapse
|
13
|
Mogaji HO, Adekunle ON, Omitola OO, Yaro CA, Babalola AS, Odoemene SN, Adeaga DO, Adubi TO, Ekpo UF. Understanding the relationship between WASH and malnutrition: Analysis of anthropometric data of children attending WASH-supported schools in Ogun State, Nigeria. Nutr Health 2023:2601060231168007. [PMID: 37093799 DOI: 10.1177/02601060231168007] [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: 04/25/2023]
Abstract
BACKGROUND There has been a growing interest in better understanding the association between water, sanitation, and hygiene (WASH) and malnutrition. AIM We analysed anthropometric data of children attending WASH intervention schools and those from non-intervention schools in Ogun State, Nigeria. METHODS A total of 353 children across six schools (three interventions and three non-interventions) participated in this study. WASH conditions were assessed using WHO standardized tools and anthropometric data of children were analysed in WHO AnthroPlus and R Software. RESULTS The prevalence of stunting was 26.2% in the intervention group, and 29.4% in the control group (p = 0.045). Underweight was lower in the intervention group (3.9% vs. 10.1%) (p = 0.45). However, wasting was higher in the intervention group (32.3% vs. 8.2%) (p = 0.001). Of the variables included in our multivariate model (age, gender, and school category, i.e. intervention/control and class grade), only age was selected, and negatively associated with underweight, stunting and wasting (p = 0.000). CONCLUSION Regardless of WASH programming status, nutritional outcomes were significantly influenced by age of the children. Children are more likely to have lower z-scores as they grow older.
Collapse
Affiliation(s)
- Hammed Oladeji Mogaji
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Ekiti, Nigeria
| | - Oladunni Nimota Adekunle
- Department of Zoology and Environmental Biology, Olabisi Onabanjo University, Ago-Iwoye, Ogun, Nigeria
| | - Olaitan Olamide Omitola
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| | - Clement Ameh Yaro
- Department of Animal and Environmental Biology, University of Uyo, Uyo, Nigeria
| | - Ayodele Samuel Babalola
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
- Department of Public Health and Epidemiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | | | | | - Uwem Friday Ekpo
- Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria
| |
Collapse
|
14
|
Levy K, Garn JV, Cumbe ZA, Muneme B, Fagnant-Sperati CS, Hubbard S, Júnior A, Manuel JL, Mangamela M, McGunegill S, Miller-Petrie MK, Snyder JS, Victor C, Waller LA, Konstantinidis KT, Clasen TF, Brown J, Nalá R, Freeman MC. Study design and rationale for the PAASIM project: a matched cohort study on urban water supply improvements and infant enteric pathogen infection, gut microbiome development and health in Mozambique. BMJ Open 2023; 13:e067341. [PMID: 36863743 PMCID: PMC9990653 DOI: 10.1136/bmjopen-2022-067341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Despite clear linkages between provision of clean water and improvements in child health, limited information exists about the health impacts of large water infrastructure improvements in low-income settings. Billions of dollars are spent annually to improve urban water supply, and rigorous evaluation of these improvements, especially targeting informal settlements, is critical to guide policy and investment strategies. Objective measures of infection and exposure to pathogens, and measures of gut function, are needed to understand the effectiveness and impact of water supply improvements. METHODS AND ANALYSIS In the PAASIM study, we examine the impact of water system improvements on acute and chronic health outcomes in children in a low-income urban area of Beira, Mozambique, comprising 62 sub-neighbourhoods and ~26 300 households. This prospective matched cohort study follows 548 mother-child dyads from late pregnancy through 12 months of age. Primary outcomes include measures of enteric pathogen infections, gut microbiome composition and source drinking water microbiological quality, measured at the child's 12-month visit. Additional outcomes include diarrhoea prevalence, child growth, previous enteric pathogen exposure, child mortality and various measures of water access and quality. Our analyses will compare (1) subjects living in sub-neighbourhoods with the improved water to those living in sub-neighbourhoods without these improvements; and (2) subjects with household water connections on their premises to those without such a connection. This study will provide critical information to understand how to optimise investments for improving child health, filling the information gap about the impact of piped water provision to low-income urban households, using novel gastrointestinal disease outcomes. ETHICS AND DISSEMINATION This study was approved by the Emory University Institutional Review Board and the National Bio-Ethics Committee for Health in Mozambique. The pre-analysis plan is published on the Open Science Framework platform (https://osf.io/4rkn6/). Results will be shared with relevant stakeholders locally, and through publications.
Collapse
Affiliation(s)
- Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joshua V Garn
- Division of Biostatistics, Epidemiology and Environmental Health, School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | | | | | - Christine S Fagnant-Sperati
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Sydney Hubbard
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - João Luís Manuel
- Beira Operations Research Center, National Health Institute (INS), Ministry of Health of Mozambique, Beira, Mozambique
| | | | - Sandy McGunegill
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Molly K Miller-Petrie
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Jedidiah S Snyder
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Courtney Victor
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Thomas F Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joe Brown
- Environmental Science and Engineering, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Rassul Nalá
- Ministry of Health, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
15
|
Bauza V, Ye W, Liao J, Majorin F, Clasen T. Interventions to improve sanitation for preventing diarrhoea. Cochrane Database Syst Rev 2023; 1:CD013328. [PMID: 36697370 PMCID: PMC9969045 DOI: 10.1002/14651858.cd013328.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Diarrhoea is a major contributor to the global disease burden, particularly amongst children under five years in low- and middle-income countries (LMICs). As many of the infectious agents associated with diarrhoea are transmitted through faeces, sanitation interventions to safely contain and manage human faeces have the potential to reduce exposure and diarrhoeal disease. OBJECTIVES To assess the effectiveness of sanitation interventions for preventing diarrhoeal disease, alone or in combination with other WASH interventions. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and Chinese language databases available under the China National Knowledge Infrastructure (CNKI-CAJ). We also searched the metaRegister of Controlled Trials (mRCT) and conference proceedings, contacted researchers, and searched references of included studies. The last search date was 16 February 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs, non-randomized controlled trials (NRCTs), controlled before-and-after studies (CBAs), and matched cohort studies of interventions aimed at introducing or expanding the coverage and/or use of sanitation facilities in children and adults in any country or population. Our primary outcome of interest was diarrhoea and secondary outcomes included dysentery (bloody diarrhoea), persistent diarrhoea, hospital or clinical visits for diarrhoea, mortality, and adverse events. We included sanitation interventions whether they were conducted independently or in combination with other interventions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligible studies, extracted relevant data, assessed risk of bias, and assessed the certainty of evidence using the GRADE approach. We used meta-analyses to estimate pooled measures of effect, described results narratively, and investigated potential sources of heterogeneity using subgroup analyses. MAIN RESULTS Fifty-one studies met our inclusion criteria, with a total of 238,535 participants. Of these, 50 studies had sufficient information to be included in quantitative meta-analysis, including 17 cluster-RCTs and 33 studies with non-randomized study designs (20 NRCTs, one CBA, and 12 matched cohort studies). Most were conducted in LMICs and 86% were conducted in whole or part in rural areas. Studies covered three broad types of interventions: (1) providing access to any sanitation facility to participants without existing access practising open defecation, (2) improving participants' existing sanitation facility, or (3) behaviour change messaging to improve sanitation access or practices without providing hardware or subsidy, although many studies overlapped multiple categories. There was substantial heterogeneity amongst individual study results for all types of interventions. Providing access to any sanitation facility Providing access to sanitation facilities was evaluated in seven cluster-RCTs, and may reduce diarrhoea prevalence in all age groups (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.73 to 1.08; 7 trials, 40,129 participants, low-certainty evidence). In children under five years, access may have little or no effect on diarrhoea prevalence (RR 0.98, 95% CI 0.83 to 1.16, 4 trials, 16,215 participants, low-certainty evidence). Additional analysis in non-randomized studies was generally consistent with these findings. Pooled estimates across randomized and non-randomized studies provided similar protective estimates (all ages: RR 0.79, 95% CI 0.66 to 0.94; 15 studies, 73,511 participants; children < 5 years: RR 0.83, 95% CI 0.68 to 1.02; 11 studies, 25,614 participants). Sanitation facility improvement Interventions designed to improve existing sanitation facilities were evaluated in three cluster-RCTs in children under five and may reduce diarrhoea prevalence (RR 0.85, 95% CI 0.69 to 1.06; 3 trials, 14,900 participants, low-certainty evidence). However, some of these interventions, such as sewerage connection, are not easily randomized. Non-randomized studies across participants of all ages provided estimates that improving sanitation facilities may reduce diarrhoea, but may be subject to confounding (RR 0.61, 95% CI 0.50 to 0.74; 23 studies, 117,639 participants, low-certainty evidence). Pooled estimates across randomized and non-randomized studies provided similar protective estimates (all ages: RR 0.65, 95% CI 0.55 to 0.78; 26 studies, 132,539 participants; children < 5 years: RR 0.70, 95% CI 0.54 to 0.91, 12 studies, 23,353 participants). Behaviour change messaging only (no hardware or subsidy provided) Strategies to promote behaviour change to construct, upgrade, or use sanitation facilities were evaluated in seven cluster-RCTs in children under five, and probably reduce diarrhoea prevalence (RR 0.82, 95% CI 0.69 to 0.98; 7 studies, 28,909 participants, moderate-certainty evidence). Additional analysis from two non-randomized studies found no effect, though with very high uncertainty. Pooled estimates across randomized and non-randomized studies provided similar protective estimates (RR 0.85, 95% CI 0.73 to 1.01; 9 studies, 31,080 participants). No studies measured the effects of this type of intervention in older populations. Any sanitation intervention A pooled analysis of cluster-RCTs across all sanitation interventions demonstrated that the interventions may reduce diarrhoea prevalence in all ages (RR 0.85, 95% CI 0.76 to 0.95, 17 trials, 83,938 participants, low-certainty evidence) and children under five (RR 0.87, 95% CI 0.77 to 0.97; 14 trials, 60,024 participants, low-certainty evidence). Non-randomized comparisons also demonstrated a protective effect, but may be subject to confounding. Pooled estimates across randomized and non-randomized studies provided similar protective estimates (all ages: RR 0.74, 95% CI 0.67 to 0.82; 50 studies, 237,130 participants; children < 5 years: RR 0.80, 95% CI 0.71 to 0.89; 32 studies, 80,047 participants). In subgroup analysis, there was some evidence of larger effects in studies with increased coverage amongst all participants (75% or higher coverage levels) and also some evidence that the effect decreased over longer follow-up times for children under five years. There was limited evidence on other outcomes. However, there was some evidence that any sanitation intervention was protective against dysentery (RR 0.74, 95% CI 0.54 to 1.00; 5 studies, 34,025 participants) and persistent diarrhoea (RR 0.57, 95% CI 0.43 to 0.75; 2 studies, 2665 participants), but not against clinic visits for diarrhoea (RR 0.86, 95% CI 0.44 to 1.67; 2 studies, 3720 participants) or all-cause mortality (RR 0.99, 95% CI 0.89 to1.09; 7 studies, 46,123 participants). AUTHORS' CONCLUSIONS There is evidence that sanitation interventions are effective at preventing diarrhoea, both for young children and all age populations. The actual level of effectiveness, however, varies by type of intervention and setting. There is a need for research to better understand the factors that influence effectiveness.
Collapse
Affiliation(s)
- Valerie Bauza
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Wenlu Ye
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Jiawen Liao
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Fiona Majorin
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
16
|
Kelly GC, Rachmat A, Hontz RD, Sklar MJ, Tran LK, Supaprom C, Luy M, Lina S, Gregory MJ, Sopheab H, Brooks JS, Sutherland IW, Corson KS, Letizia AG. Etiology and risk factors for diarrheal disease amongst rural and peri-urban populations in Cambodia, 2012-2018. PLoS One 2023; 18:e0283871. [PMID: 37000848 PMCID: PMC10065300 DOI: 10.1371/journal.pone.0283871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
Diarrheal diseases are a leading cause of mortality and morbidity, disproportionally affecting persons residing in low and middle-income countries. Accessing high-resolution surveillance data to understand community-level etiology and risk remains challenging, particularly in remote and resource limited populations. A multi-year prospective cohort study was conducted in two rural and two peri-urban villages in Cambodia from 2012 to 2018 to describe the epidemiology and etiology of acute diarrheal diseases within the population. Suspected diarrheal episodes among participants were self-reported or detected via routine weekly household visits. Fresh stool and fecal swabs were tested, and acute-illness and follow-up participant questionnaires collected. Of 5027 enrolled participants, 1450 (28.8%) reported at least one diarrheal incident. A total of 4266 individual diarrhea case events were recorded. Diarrhea incidence rate was calculated to be 281.5 persons per 1000 population per year, with an event rate of 664.3 individual diarrhea events occurring per 1000 population per year. Pathogenic Escherichia coli, Aeromonas spp., and Plesiomonas shigelloides were the most prevalent bacterial infections identified. Hookworm and Strongyloides stercoralis were the predominant helminth species, while Blastocystis hominis and Giardia lamblia were the predominant protozoan species found. Norovirus genotype 2 was the predominant virus identified. Mixed infections of two or more pathogens were detected in 36.2% of positive cases. Risk analyses identified unemployed status increased diarrhea risk by 63% (HR = 1.63 [95% CI 1.46, 1.83]). Individuals without access to protected water sources or sanitation facilities were 59% (HR = 1.59 [95% CI 1.49, 1.69]) and 19% (HR = 1.19 [95% CI 1.12, 1.28]) greater risk of contracting diarrhea, respectively. Patient-level surveillance data captured in this long-term study has generated a unique spatiotemporal profile of diarrheal disease in Cambodia. Understanding etiologies, together with associated epidemiological and community-level risk, provides valuable public health insight to support effective planning and delivery of appropriate local population-targeted interventions.
Collapse
Affiliation(s)
- Gerard C. Kelly
- Vysnova Partners, Inc., Landover, Maryland, United States of America
- * E-mail:
| | - Agus Rachmat
- AC Investment Co, Contractor for NAMRU-2 Phnom Penh, Phnom Penh, Cambodia
| | | | | | - Long Khanh Tran
- Vysnova Partners, Inc., Landover, Maryland, United States of America
| | - Chonthida Supaprom
- AC Investment Co, Contractor for NAMRU-2 Phnom Penh, Phnom Penh, Cambodia
| | - Malen Luy
- AC Investment Co, Contractor for NAMRU-2 Phnom Penh, Phnom Penh, Cambodia
| | - Sin Lina
- AC Investment Co, Contractor for NAMRU-2 Phnom Penh, Phnom Penh, Cambodia
| | | | - Heng Sopheab
- National Institute of Public Health, Ministry of Health, Cambodia
| | - John S. Brooks
- U.S. Naval Medical Research Unit TWO, Phnom Penh, Cambodia
| | | | - Karen S. Corson
- U.S. Naval Medical Research Unit TWO, Singapore, Singapore
- U.S. Naval Medical Research Unit TWO, Phnom Penh, Cambodia
| | | |
Collapse
|
17
|
Crider YS, Tsuchiya M, Mukundwa M, Ray I, Pickering AJ. Adoption of Point-of-Use Chlorination for Household Drinking Water Treatment: A Systematic Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:16001. [PMID: 36715546 PMCID: PMC9885856 DOI: 10.1289/ehp10839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Centralized chlorination of urban piped water supplies has historically contributed to major reductions in waterborne illness. In locations without effective centralized water treatment, point-of-use (POU) chlorination for households is widely promoted to improve drinking water quality and health. Realizing these health benefits requires correct, consistent, and sustained product use, but real-world evaluations have often observed low levels of use. To our knowledge, no prior reviews exist on adoption of chlorine POU products. OBJECTIVES Our objectives were to identify which indicators of adoption are most often used in chlorine POU studies, summarize levels of adoption observed, understand how adoption changes over time, and determine how adoption is affected by frequency of contact between participants and study staff. METHODS We conducted a systematic review of household POU chlorination interventions or programs from 1990 through 2021 that reported a quantitative measure of adoption, were conducted in low- and middle-income countries, included data collection at households, and reported the intervention start date. RESULTS We identified 36 studies of household drinking water chlorination products that met prespecified eligibility criteria and extracted data from 46 chlorine intervention groups with a variety of chlorine POU products and locations. There was no consensus definition of adoption of household water treatment; the most common indicator was the proportion of household stored water samples with free chlorine residual > 0.1 or 0.2 mg / L . Among studies that reported either free or total chlorine-confirmed adoption of chlorine POU products, use was highly variable (across all chlorine intervention groups at the last time point measured in each study; range: 1.5%-100%; sample size-weighted median = 47 % ; unweighted median = 58 % ). The median follow-up duration among intervention groups was 3 months. On average, adoption declined over time and was positively associated with frequency of contact between respondents and study staff. DISCUSSION Although prior research has shown that POU chlorine products improve health when correctly and consistently used, a reliance on individual adoption for effective treatment is unlikely to lead to the widespread public health benefits historically associated with pressurized, centralized treatment of piped water supplies. https://doi.org/10.1289/EHP10839.
Collapse
Affiliation(s)
- Yoshika S. Crider
- Energy and Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
- Division of Epidemiology and Biostatistics, UC Berkeley, Berkeley, California, USA
- King Center on Global Development, Stanford University, Stanford, California, USA
| | - Miki Tsuchiya
- Master of Development Practice Program, UC Berkeley, Berkeley, California, USA
| | - Magnifique Mukundwa
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, UC Berkeley, Berkeley, California, USA
| |
Collapse
|
18
|
Busse MM, Hawes JK, Blatchley ER. Comparative Life Cycle Assessment of Water Disinfection Processes Applicable in Low-Income Settings. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:16336-16346. [PMID: 36215720 DOI: 10.1021/acs.est.2c02393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Access to safe, sufficient water for health and sanitation is a human right, and the reliable disinfection of water plays a critical role in addressing this need. The environmental impact and sustainability of water disinfection methods will also play a role in overall public health. This study presents an investigation of the environmental life cycle impacts of four ultraviolet disinfection systems utilizing ambient solar radiation directly and indirectly for water disinfection in comparison to chlorination and water delivery for application in low-income settings. Product inspection and existing literature were used to define a life cycle functional unit of 1 m3 of water for each system, which allowed quantification of material use, infrastructure requirements, and life cycle of the original components of each system and those needed to keep them operational for the studied lifespans (1, 5, 10, and 20 years) and scales (30, 100, 500, and 1000 L per day). For all studied cases, chlorine had the lowest impact in all impact categories, but end-user acceptance of chlorine in some settings is low, driving interest in low-impact alternatives. Disinfection based on low-pressure mercury lamps had the next lowest normalized impact in most categories and may represent a viable alternative, particularly for long-term (10+ years), high production (500+ liters per day) scenarios.
Collapse
Affiliation(s)
- Margaret M Busse
- Lyles School of Civil Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | - Jason K Hawes
- School for Environment and Sustainability, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Ernest R Blatchley
- Lyles School of Civil Engineering, Purdue University, West Lafayette, Indiana 47907, United States
- Division of Environmental and Ecological Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| |
Collapse
|
19
|
Haque S, Kirby MA, Iyakaremye L, Gebremariam A, Tessema G, Thomas E, Chang HH, Clasen T. Effects of adding household water filters to Rwanda's Community-Based Environmental Health Promotion Programme: a cluster-randomized controlled trial in Rwamagana district. NPJ CLEAN WATER 2022; 5:42. [PMID: 36118619 PMCID: PMC9464616 DOI: 10.1038/s41545-022-00185-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Unsafe drinking water remains a major cause of mortality and morbidity. While Rwanda's Community-Based Environmental Health Promotion Programme (CBEHPP) promotes boiling and safe storage, previous research found these efforts to be ineffective in reducing fecal contamination of drinking water. We conducted a cluster randomized control led trial to determine if adding a household water filter with safe storage to the CBEHPP would improve drinking water quality and reduce child diarrhea. We enrolled 1,199 households with a pregnant person or child under 5 across 60 randomly selected villages in Rwamagana district. CBEHPP implementers distributed and promoted water purifiers to a random half of villages. We conducted two unannounced follow-up visits over 13-16 months after the intervention delivery. The intervention reduced the proportions of households with detectable E. coli in drinking water samples (primary outcome) by 20% (PR 0.80, 95% CI 0.74-0.87, p < 0.001) and with moderate and higher fecal contamination (≥10 CFU/100 mL) by 35% (PR 0.65, 95% CI 0.57-0.74, p < 0.001). The proportion of children under 5 experiencing diarrhea in the last week was reduced by 49% (aPR 0.51, 95%CI 0.35-0.73, p < 0.001). Our findings identify an effective intervention for improving water quality and child health that can be added to the CBEHPP.
Collapse
Affiliation(s)
- Sabrina Haque
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Miles A. Kirby
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | | | | | | | - Evan Thomas
- Mortenson Center in Global Engineering, University of Colorado, Boulder, CO USA
| | - Howard H. Chang
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA USA
| |
Collapse
|
20
|
Khatib MN, Sinha A, Mishra G, Quazi SZ, Gaidhane S, Saxena D, Gaidhane AM, Bhardwaj P, Sawleshwarkar S, Zahiruddin QS. WASH to control COVID-19: A rapid review. Front Public Health 2022; 10:976423. [PMID: 36033810 PMCID: PMC9403322 DOI: 10.3389/fpubh.2022.976423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 01/25/2023] Open
Abstract
Background Preventive public health has been suggested as methods for reducing the transmission of COVID-19. Safety and efficacy of one such public health measure: WASH intervention for COVID-19 has not been systematically reviewed. We undertook a rapid review to assess the effect of WASH intervention in reducing the incidence of COVID-19. Methods We conducted searches in PubMed, MEDLINE, and EMBASE. We undertook screening of studies in two stages and extracted data and assessed the quality of evidence for the primary outcome using GRADE recommendations. Main results We included a total of 13 studies with three studies on COVID-19 and 10 on SARS. The study found that hand washing, sterilization of hands, gargling, cleaning/shower after attending patients of COVID-19, or SARS was protective. Evidence also found that frequent washes can prevent SARS transmission among HCWs. However; one study reported that due to enhanced infection-prevention measures, front-line HCWs are more prone to hand-skin damage. The certainty of the evidence for our primary outcome as per GRADE was very low. We did not find any studies that assessed the effect of WASH on hospitalizations, and mortality due to COVID-19. Also; we did not find any study that compared WASH interventions with any other public health measures. Conclusions Current evidence of WASH interventions for COVID-19 is limited as it is largely based on indirect evidence from SARS. Findings from the included studies consistently show that WASH is important in reducing the number of cases during a pandemic. Timely implementation of WASH along with other public health interventions can be vital to ensure the desired success. Further good-quality studies providing direct evidence of the efficacy of WASH on COVID-19 are needed.
Collapse
Affiliation(s)
- Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Anju Sinha
- Division of Reproductive, Maternal and Child Health, Indian Council of Medical Research Headquarters, New Delhi, India
| | - Gaurav Mishra
- Department of Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Syed Ziauddin Quazi
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Shilpa Gaidhane
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Deepak Saxena
- Department of Public Health, Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Abhay M. Gaidhane
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Pankaj Bhardwaj
- Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Shailendra Sawleshwarkar
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Quazi Syed Zahiruddin
- Centre for Global Evidence Synthesis Initiative (GESI), School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
| |
Collapse
|
21
|
Bastidas-Caldes C, Ochoa J, Guerrero-Latorre L, Moyota-Tello C, Tapia W, Rey-Pérez JM, Baroja MI. Removal of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli, ST98, in Water for Human Consumption by Black Ceramic Water Filters in Low-Income Ecuadorian Highlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084736. [PMID: 35457602 PMCID: PMC9028703 DOI: 10.3390/ijerph19084736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023]
Abstract
Fecal contamination in natural water sources is a common problem in low-income countries. Several health risks are associated with unprotected water sources, such as gastrointestinal infections caused by parasites, viruses, and bacteria. Moreover, antibiotic-resistant bacteria in water sources have become an increasing problem worldwide. This study aimed to evaluate the bacterial pathogens present in water within a rural context in Ecuador, along with the efficiency of black ceramic water filters (BCWFs) as a sustainable household water treatment. We monitored five natural water sources that were used for human consumption in the highlands of Ecuador and analyzed the total coliforms and E. coli before and after BCWF installation. The results indicated a variable bacterial contamination (29–300 colony-forming units/100mL) in all unfiltered samples, and they were considered as high risk for human consumption, but after filtration, no bacteria were present. Moreover, extended-spectrum beta-lactamase-producing E. coli with blaTEM, blaCTX-M9, and blaCTX-M1 genes, and two E. coli classified in the clonal complex ST10 (ST98) were detected in two of the locations sampled; these strains can severely impact public health. The clonal complex ST10, found in the E. coli isolates, possesses the potential to spread bacteria-resistant genes to humans and animals. The results of the use of BCWFs, however, argue for the filters’ potential impact within those contexts, as the BCWFs completely removed even antibiotic-resistant contaminants from the water.
Collapse
Affiliation(s)
- Carlos Bastidas-Caldes
- One Health Research Group, Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador
- Programa de Doctorado en Salud Pública y Animal, Universidad de Extremadura, 10003 Mérida, Spain
- Correspondence: (C.B.-C.); (M.I.B.); Tel.: +593-983174949 (C.B.-C.)
| | - Juan Ochoa
- Ingeniería en Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador; (J.O.); (C.M.-T.); (W.T.)
| | - Laura Guerrero-Latorre
- Catalan Institute for Water Research (ICRA), Water Quality Area, Emili Grahit 101, 17003 Girona, Spain;
| | - Carlos Moyota-Tello
- Ingeniería en Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador; (J.O.); (C.M.-T.); (W.T.)
| | - Wilson Tapia
- Ingeniería en Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador; (J.O.); (C.M.-T.); (W.T.)
| | - Joaquín María Rey-Pérez
- Unidad de Patología Infecciosa, Facultad de Veterinaria, Universidad de Extremadura, 10003 Mérida, Spain;
| | - Maria Isabel Baroja
- Ingeniería en Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito 170125, Ecuador; (J.O.); (C.M.-T.); (W.T.)
- Programa de Doctorado en Biología Molecular y Celular, Biomedicina y Biotecnología, Universidad de Extremadura, 10003 Mérida, Spain
- Correspondence: (C.B.-C.); (M.I.B.); Tel.: +593-983174949 (C.B.-C.)
| |
Collapse
|
22
|
Stories of change in nutrition in Burkina Faso 1992–2018: a micro-level perspective. Food Secur 2022; 14:937-950. [PMID: 35911869 PMCID: PMC9325828 DOI: 10.1007/s12571-022-01274-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/13/2022] [Indexed: 11/18/2022]
Abstract
Looking back at what has effectively improved nutrition may inform policy makers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, we analyzed its nutrition story at the micro-level. We conducted a regression-decomposition analysis to identify demographic and health drivers associated with change in height-for-age using longitudinal, secondary, nationally-representative data. We triangulated results with findings from semi-structured community interviews (n = 91) in two “model communities” with a history of large stunting reduction. We found that improvement in immunization coverage, assets accumulation and reduction in open defecation were associated with 23%, 10% and 6.1% of the improvement in height-for-age, respectively. Associations were also found with other education, family planning, health and WASH indicators. Model communities acknowledged progress in the coverage and quality of nutrition-specific and nutrition-sensitive sectoral programs co-located at the community level, especially those delivered through the health and food security sectors, though delivery challenges remained in a context of systemic poverty and persistent food insecurity. Burkina Faso’s health sector’s success in improving coverage of nutrition and healthcare programs may have contributed to improvements in child nutrition alongside other programmatic improvements in the food security, WASH and education sectors. Burkina Faso should continue to operationalize sectoral nutrition-sensitive policies into higher-quality programs at scale, building on its success stories such as vaccination. Community leverage gaps and data gaps need to be filled urgently to pressure for and monitor high coverage, quality delivery, and nutrition impact of agriculture, education, and WASH interventions.
Collapse
|
23
|
Kann S, Concha G, Hartmann M, Köller T, Alker J, Schotte U, Kreienbrock L, Frickmann H, Warnke P. Only Low Effects of Water Filters on the Enteric Carriage of Gastrointestinal Pathogen DNA in Colombian Indigenous People. Microorganisms 2022; 10:microorganisms10030658. [PMID: 35336233 PMCID: PMC8955181 DOI: 10.3390/microorganisms10030658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/28/2022] [Accepted: 03/17/2022] [Indexed: 12/18/2022] Open
Abstract
Water filtration is a common strategy of water sanitation in resource-poor tropical settings. Here, we assessed the intermediate term effect of this preventive procedure including specific filter-related as well as general hygiene training on the molecular detection of enteric pathogens in stool samples from Colombian Indigenous people. From a total of 89 individuals from an Indigenous tribe called Wiwa, stool samples were assessed by real-time PCR for enteropathogenic microorganisms prior to the implementation of water filtration-based infection prevention. Three years after the onset of the preventive strategy, a follow-up assessment was performed. A significantly beneficial effect of water filtration could be shown for Ascaris spp. only (p = 0.035) and a tendency (p = 0.059) for Hymenolepis nana. No hints for effects on the gastrointestinal shedding of Giardia duodenalis, Entamoeba histolytica, Cryptosporidium spp., Campylobacter spp., Shigella spp./enteroinvasive Escherichia coli, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, and Taenia spp. were seen. In conclusion, the study indicates that water filtration can only be an element of a multi-modal hygiene concept to reduce enteric pathogen carriage in inhabitants of resource-poor tropical settings in spite of tendencies of beneficial effects.
Collapse
Affiliation(s)
- Simone Kann
- Medical Mission Institute, 97074 Würzburg, Germany
- Correspondence: (S.K.); (P.W.)
| | - Gustavo Concha
- Organization Wiwa Yugumaiun Bunkauanarrua Tayrona (OWYBT), Department Health Advocacy, Valledupar 2000001, Colombia;
| | - Maria Hartmann
- Institute for Biometry, Epidemiology and Information Processing, Veterinary Medical University Hannover, 30559 Hannover, Germany; (M.H.); (L.K.)
| | - Thomas Köller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (T.K.); (H.F.)
| | - Juliane Alker
- Department A-Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, 24119 Kronshagen, Germany; (J.A.); (U.S.)
| | - Ulrich Schotte
- Department A-Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, 24119 Kronshagen, Germany; (J.A.); (U.S.)
| | - Lothar Kreienbrock
- Institute for Biometry, Epidemiology and Information Processing, Veterinary Medical University Hannover, 30559 Hannover, Germany; (M.H.); (L.K.)
| | - Hagen Frickmann
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (T.K.); (H.F.)
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
| | - Philipp Warnke
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
- Correspondence: (S.K.); (P.W.)
| |
Collapse
|
24
|
Fischer Walker CL, Walker N, Black RE. Updating the assumptions on the impact of household water, sanitation and hygiene interventions on diarrhea morbidity in young children. J Glob Health 2022; 12:08003. [PMID: 35310420 PMCID: PMC8910783 DOI: 10.7189/jogh.12.08003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The Lives Saved Tool (LiST) is a publicly available and widely used model used to estimate the impact of scaling up interventions on maternal and child health. A strength of the model is that it is continuously updated with country-specific information about intervention coverage, risk factors and causes of death. This paper reports an updated review and meta-analysis on the efficacy of water, sanitation and hygiene (WASH) interventions in reducing diarrhea morbidity among children under the age of five years. Methods We updated previous LiST systematic reviews for improved WASH interventions according to standard LiST criteria. We sought to identify more recent WASH studies to update LiST efficacy estimates for each WASH intervention on diarrhea morbidity. In addition, we conducted a search to identify studies that reported an effect size for combined improved WASH interventions. For interventions where we found new studies, we conducted a weighted meta-analysis to produce an updated effect size estimate. Results We did not find new studies demonstrating an effect of improved water source alone on diarrhea morbidity among children under 5 years of age. For improved sanitation, we conducted an updated meta-analysis among 4 studies and found no difference between intervention and control arms (weighted mean difference (WMD) = -5% (95% confidence interval (CI) = -11% to 2%). We identified four trials that assessed the effect of combined interventions targeting improved water, sanitation and hygiene. The weighted mean difference also showed no effect on diarrhea morbidity among children under 5 years of age (WMD = -6%, 95% CI = -15% to 4%). Our updated results for handwashing promotion estimate the effects to results in a 17% reduction in childhood diarrhea morbidity (95% CI = 7% to 27%). Conclusions Despite widespread acceptance that WASH interventions can improve diarrhea morbidity, the evidence supporting this specifically for children under 5 years of age remains weak. Children interact with the environment in ways that differ from adults and these constant exposures may limit the effect that these WASH interventions can have on diarrhea morbidity.
Collapse
Affiliation(s)
- Christa L Fischer Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Neff Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
25
|
Anderson DM, Birken SA, Bartram JK, Freeman MC. Adaptation of Water, Sanitation, and Hygiene Interventions: A Model and Scoping Review of Key Concepts and Tools. FRONTIERS IN HEALTH SERVICES 2022; 2:896234. [PMID: 36925880 PMCID: PMC10012759 DOI: 10.3389/frhs.2022.896234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022]
Abstract
Background Safe water, sanitation, and hygiene (WaSH) is important for health, livelihoods, and economic development, but WaSH programs have often underdelivered on expected health benefits. Underperformance has been attributed partly to poor ability to retain effectiveness following adaptation to facilitate WaSH programs' implementation in diverse contexts. Adaptation of WaSH interventions is common but often not done systematically, leading to poor outcomes. Models and frameworks from the adaptation literature have potential to improve WaSH adaptation to facilitate implementation and retain effectiveness. However, these models and frameworks were designed in a healthcare context, and WaSH interventions are typically implemented outside traditional health system channels. The purpose of our work was to develop an adaptation model tailored specifically to the context of WaSH interventions. Methods We conducted a scoping review to identify key adaptation steps and identify tools to support systematic adaptation. To identify relevant literature, we conducted a citation search based on three recently published reviews on adaptation. We also conducted a systematic database search for examples of WaSH adaptation. We developed a preliminary model based on steps commonly identified across models in adaptation literature, and then tailored the model to the WaSH context using studies yielded by our systematic search. We compiled a list of tools to support systematic data collection and decision-making throughout adaptation from all included studies. Results and Conclusions Our model presents adaptation steps in five phases: intervention selection, assessment, preparation, implementation, and sustainment. Phases for assessment through sustainment are depicted as iterative, reflecting that once an intervention is selected, adaptation is a continual process. Our model reflects the specific context of WaSH by including steps to engage non-health and lay implementers and to build consensus among diverse stakeholders with potentially competing priorities. We build on prior adaptation literature by compiling tools to support systematic data collection and decision-making, and we describe how they can be used throughout adaptation steps. Our model is intended to improve program outcomes by systematizing adaptation processes and provides an example of how systematic adaptation can occur for interventions with health goals but that are implemented outside conventional health system channels.
Collapse
Affiliation(s)
- Darcy M Anderson
- Public Health and Environment, The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, United States
| | - Jamie K Bartram
- Public Health and Environment, The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,School of Civil Engineering, University of Leeds, Leeds, United Kingdom
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| |
Collapse
|
26
|
Dagnaw A, Sahlie M, Mulugeta H, Shine S, Bediru W, Zebene A, Weldetensay Y, Abebe AM. Magnitude of Intestinal Parasite Infection and Associated Factors Among Pregnant Women Attending Antenatal Care Service in Shewarobit Town Health Facilities, North Shoa Zone, Amhara Region, Ethiopia. Infect Drug Resist 2021; 14:4921-4930. [PMID: 34853520 PMCID: PMC8627855 DOI: 10.2147/idr.s338326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Intestinal parasites are the most common infectious gastrointestinal parasites in developing countries including Ethiopia. Globally, it remains a public health problem by affecting 3.2 billion people, of which 10% were pregnant women. In Sub-Saharan Africa, pregnant women are the risky group next to children for this infection. This study aimed to assess the magnitude and associated factors of intestinal parasite infection among pregnant women. Methods Facility-based cross-sectional study was conducted among 365 pregnant women attending antenatal care service in Shewarobit town health facilities, North Shoa Zone, Amhara Region, Ethiopia. Data were collected using an interview questionnaire and laboratory microscopic stool examination from February 1, 2020, to March 30, 2020. Descriptive statistics and multivariable analyses were used to characterize the data and to identify the associated factors with the outcome variable at a p-value <0.05, respectively. Results A total of 347 (95.1%) pregnant women participated in this study. The magnitude of intestinal parasite infection was 27.7% during the study period. Among the parasites, G. lamblia and S. mansoni were the most prevalent identified parasites. Pregnant mother, who did not have handwashing practice after using the toilet [AOR: 3.89, 95% CI (1.86–8.13)], had a habit of walking on barefoot [AOR: 5.65, 95% CI (1.72, 18.56)], had uncooked food meal habit [AOR: 5.12, 95% CI (1.24, 21.14)], use of water in unimproved water source [AOR: 3.20, 95% CI (1.11–9.24)], lack of health education [AOR: 4.08, 95% CI (2.01–8.27)], and not dewormed [AOR: 3.09, 95% CI (2.01–7.94)] were predictors for parasitic infection. Conclusion High prevalence of intestinal parasite infection is observed in pregnant women. Personal hygiene practice, health education, and water quality were factors identified as contributors to intestinal parasite infection in pregnant women. Public health measures on water and environmental sanitation, health education for intestinal parasite infection and personal hygiene practices, and early deworming are vital to reduce the intestinal parasites’ infection and assure safe pregnancy.
Collapse
Affiliation(s)
- Abinet Dagnaw
- Department of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Hailemichael Mulugeta
- Department of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Sisay Shine
- Department of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Woinshet Bediru
- Department of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Asmare Zebene
- Shewarobit Health Center, North Shoa Zone, Amhara Region, Ethiopia
| | | | - Ayele Mamo Abebe
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| |
Collapse
|
27
|
Chirgwin H, Cairncross S, Zehra D, Sharma Waddington H. Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1194. [PMID: 36951806 PMCID: PMC8988822 DOI: 10.1002/cl2.1194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Background Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vulnerable populations, especially for women and girls. The hardest hit regions are sub-Saharan Africa and South Asia. Sustainable Development Goal (SDG) 6 calls for the end of open defecation, and universal access to safely managed water and sanitation facilities, and basic hand hygiene, by 2030. WASH access and use also underpin progress in other areas such as SDG1 poverty targets, SDG3 health and SDG4 education targets. Meeting the SDG equity agenda to "leave none behind" will require WASH providers prioritise the hardest to reach including those living remotely and people who are disadvantaged. Objectives Decision makers need access to high-quality evidence on what works in WASH promotion in different contexts, and for different groups of people, to reach the most disadvantaged populations and thereby achieve universal targets. The WASH evidence map is envisioned as a tool for commissioners and researchers to identify existing studies to fill synthesis gaps, as well as helping to prioritise new studies where there are gaps in knowledge. It also supports policymakers and practitioners to navigate the evidence base, including presenting critically appraised findings from existing systematic reviews. Methods This evidence map presents impact evaluations and systematic reviews from the WASH sector, organised according to the types of intervention mechanisms, WASH technologies promoted, and outcomes measured. It is based on a framework of intervention mechanisms (e.g., behaviour change triggering or microloans) and outcomes along the causal pathway, specifically behavioural outcomes (e.g., handwashing and food hygiene practices), ill-health outcomes (e.g., diarrhoeal morbidity and mortality), nutrition and socioeconomic outcomes (e.g., school absenteeism and household income). The map also provides filters to examine the evidence for a particular WASH technology (e.g., latrines), place of use (e.g., home, school or health facility), location (e.g., global region, country, rural and urban) and group (e.g., people living with disability). Systematic searches for published and unpublished literature and trial registries were conducted of studies in low- and middle-income countries (LMICs). Searches were conducted in March 2018, and searches for completed trials were done in May 2020. Coding of information for the map was done by two authors working independently. Impact evaluations were critically appraised according to methods of conduct and reporting. Systematic reviews were critically appraised using a new approach to assess theory-based, mixed-methods evidence synthesis. Results There has been an enormous growth in impact evaluations and systematic reviews of WASH interventions since the International Year of Sanitation, 2008. There are now at least 367 completed or ongoing rigorous impact evaluations in LMICs, nearly three-quarters of which have been conducted since 2008, plus 43 systematic reviews. Studies have been done in 83 LMICs, with a high concentration in Bangladesh, India, and Kenya. WASH sector programming has increasingly shifted in focus from what technology to supply (e.g., a handwashing station or child's potty), to the best way in which to do so to promote demand. Research also covers a broader set of intervention mechanisms. For example, there has been increased interest in behaviour change communication using psychosocial "triggering", such as social marketing and community-led total sanitation. These studies report primarily on behavioural outcomes. With the advent of large-scale funding, in particular by the Bill & Melinda Gates Foundation, there has been a substantial increase in the number of studies on sanitation technologies, particularly latrines. Sustaining behaviour is fundamental for sustaining health and other quality of life improvements. However, few studies have been done of intervention mechanisms for, or measuring outcomes on sustained adoption of latrines to stop open defaecation. There has also been some increase in the number of studies looking at outcomes and interventions that disproportionately affect women and girls, who quite literally carry most of the burden of poor water and sanitation access. However, most studies do not report sex disaggregated outcomes, let alone integrate gender analysis into their framework. Other vulnerable populations are even less addressed; no studies eligible for inclusion in the map were done of interventions targeting, or reporting on outcomes for, people living with disabilities. We were only able to find a single controlled evaluation of WASH interventions in a health care facility, in spite of the importance of WASH in health facilities in global policy debates. The quality of impact evaluations has improved, such as the use of controlled designs as standard, attention to addressing reporting biases, and adequate cluster sample size. However, there remain important concerns about quality of reporting. The quality and usefulness of systematic reviews for policy is also improving, which draw clearer distinctions between intervention mechanisms and synthesise the evidence on outcomes along the causal pathway. Adopting mixed-methods approaches also provides information for programmes on barriers and enablers affecting implementation. Conclusion Ensuring everyone has access to appropriate water, sanitation, and hygiene facilities is one of the most fundamental of challenges for poverty elimination. Researchers and funders need to consider carefully where there is the need for new primary evidence, and new syntheses of that evidence. This study suggests the following priority areas:Impact evaluations incorporating understudied outcomes, such as sustainability and slippage, of WASH provision in understudied places of use, such as health care facilities, and of interventions targeting, or presenting disaggregated data for, vulnerable populations, particularly over the life-course and for people living with a disability;Improved reporting in impact evaluations, including presentation of participant flow diagrams; andSynthesis studies and updates in areas with sufficient existing and planned impact evaluations, such as for diarrhoea mortality, ARIs, WASH in schools and decentralisation. These studies will preferably be conducted as mixed-methods systematic reviews that are able to answer questions about programme targeting, implementation, effectiveness and cost-effectiveness, and compare alternative intervention mechanisms to achieve and sustain outcomes in particular contexts, preferably using network meta-analysis.
Collapse
Affiliation(s)
- Hannah Chirgwin
- International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
| | | | | | - Hugh Sharma Waddington
- London School of Hygiene and Tropical Medicine and International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
| |
Collapse
|
28
|
Chan EYY, Tong KHY, Dubois C, Mc Donnell K, Kim JH, Hung KKC, Kwok KO. Narrative Review of Primary Preventive Interventions against Water-Borne Diseases: Scientific Evidence of Health-EDRM in Contexts with Inadequate Safe Drinking Water. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312268. [PMID: 34885995 PMCID: PMC8656607 DOI: 10.3390/ijerph182312268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/22/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Waterborne diseases account for 1.5 million deaths a year globally, particularly affecting children in low-income households in subtropical areas. It is one of the most enduring and economically devastating biological hazards in our society today. The World Health Organization Health Emergency and Disaster Risk Management (health-EDRM) Framework highlights the importance of primary prevention against biological hazards across all levels of society. The framework encourages multi-sectoral coordination and lessons sharing for community risk resilience. A narrative review, conducted in March 2021, identified 88 English-language articles published between January 2000 and March 2021 examining water, sanitation, and hygiene primary prevention interventions against waterborne diseases in resource-poor settings. The literature identified eight main interventions implemented at personal, household and community levels. The strength of evidence, the enabling factors, barriers, co-benefits, and alternative measures were reviewed for each intervention. There is an array of evidence available across each intervention, with strong evidence supporting the effectiveness of water treatment and safe household water storage. Studies show that at personal and household levels, interventions are effective when applied together. Furthermore, water and waste management will have a compounding impact on vector-borne diseases. Mitigation against waterborne diseases require coordinated, multi-sectoral governance, such as building sanitation infrastructure and streamlined waste management. The review showed research gaps relating to evidence-based alternative interventions for resource-poor settings and showed discrepancies in definitions of various interventions amongst research institutions, creating challenges in the direct comparison of results across studies.
Collapse
Affiliation(s)
- Emily Ying Yang Chan
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, Hong Kong, China;
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-2252-8850
| | - Kimberley Hor Yee Tong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
| | - Caroline Dubois
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- GX Foundation, Hong Kong, China;
| | | | - Jean H. Kim
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
| | - Kevin Kei Ching Hung
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, Hong Kong, China;
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Kin On Kwok
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (K.H.Y.T.); (C.D.); (J.H.K.); (K.O.K.)
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
29
|
Tafesse B, Gobena T, Baraki N, Alemeshet Asefa Y, Adare Mengistu D. Household Water Treatment Practice and Associated Factors in Gibe District Southern Ethiopia: A Community Based Cross-Sectional Study. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211060150. [PMID: 34866908 PMCID: PMC8637709 DOI: 10.1177/11786302211060150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/25/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Household water treatment practice or managing water at the point-of-use provides a means of improving drinking water quality and preventing diarrheal diseases. However, evidence regarding household water treatment practice and associated factors in Ethiopia, particularly in Southern Ethiopia are limited. This study was, therefore, designed to assess household water treatment practice and associated factors among households in Southern Ethiopia. METHODS A community-based cross-sectional study design was conducted among 627 households in Southern Ethiopia. A stratified random sampling technique was used in this study and a pre-tested structured questionnaire was used to collect data about household water treatment practice and associated factors among selected households through face-to-face interviews. The data were analyzed using descriptive statistical tests and binary logistic regression was performed to assess the association between independent and dependent variables. Odds ratio with 95% confidence intervals were used to determine the level of association. RESULTS This study revealed that the level of household water treatment practice was 34.3% with 95% CI (30.7-38.1) and boiling was the most common method of household water treatment in the study area. Educational status of having formal education (AOR = 2.01, 95% CI = 1.34-3), withdrawing water from storage vessel by dipping (AOR = 1.86, 95% CI = 1.2-2.87) and frequency of fetching water 3 or more times and above a day (AOR = 2.65, 95% CI = 1.45-4.88) were significantly associated with household water treatment practice. CONCLUSION Household water treatment practice is low in the study area. Educational status of having a formal education, drawing water by dipping, and those who collect their drinking water 3 or more times a day were predictors of household water treatment practice. Thus, efforts should be made to increase the level of household water treatment practice especially among those with no formal education and further studies should be conducted to understand the behavioral factors associated with household water treatment practice.
Collapse
Affiliation(s)
- Bereket Tafesse
- Gibe Woreda Enterprise and Industry
Development Office, Hadiya, Ethiopia
| | - Tesfaye Gobena
- Department of Environmental Health,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Negga Baraki
- Department of Environmental Health,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohanis Alemeshet Asefa
- Department of Environmental Health,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dechasa Adare Mengistu
- Department of Environmental Health,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
30
|
Chen D, Mechlowitz K, Li X, Schaefer N, Havelaar AH, McKune SL. Benefits and Risks of Smallholder Livestock Production on Child Nutrition in Low- and Middle-Income Countries. Front Nutr 2021; 8:751686. [PMID: 34778344 PMCID: PMC8579112 DOI: 10.3389/fnut.2021.751686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022] Open
Abstract
Livestock production may improve nutritional outcomes of pregnant women and children by increasing household income, availability of nutrient-dense foods, and women's empowerment. Nevertheless, the relationship is complex, and the nutritional status of children may be impaired by presence of or proximity to livestock and their pathogens. In this paper, we review the benefits and risks of livestock production on child nutrition. Evidence supports the nutritional benefits of livestock farming through income, production, and women's empowerment. Increasing animal source food consumption requires a combination of efforts, including improved animal management so that herd size is adequate to meet household income needs and consumption and addressing sociocultural and gendered norms. Evidence supports the inclusion of behavior change communication strategies into livestock production interventions to facilitate the sustainability of nutritional benefits over time, particularly interventions that engage women and foster dimensions of women's empowerment. In evaluating the risks of livestock production, evidence indicates that a broad range of enteric pathogens may chronically infect the intestines of children and, in combination with dietary deficits, may cause environmental enteric dysfunction (EED), a chronic inflammation of the gut. Some of the most important pathogens associated with EED are zoonotic in nature with livestock as their main reservoir. Very few studies have aimed to understand which livestock species contribute most to colonization with these pathogens, or how to reduce transmission. Control at the point of exposure has been investigated in a few studies, but much less effort has been spent on improving animal husbandry practices, which may have additional benefits. There is an urgent need for dedicated and long-term research to understand which livestock species contribute most to exposure of young children to zoonotic enteric pathogens, to test the potential of a wide range of intervention methods, to assess their effectiveness in randomized trials, and to assure their broad adaptation and sustainability. This review highlights the benefits and risks of livestock production on child nutrition. In addition to identifying research gaps, findings support inclusion of poor gut health as an immediate determinant of child undernutrition, expanding the established UNICEF framework which includes only inadequate diet and disease.
Collapse
Affiliation(s)
- Dehao Chen
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
| | - Karah Mechlowitz
- Department of Social and Behavioral Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Xiaolong Li
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
| | - Nancy Schaefer
- Health Science Center Libraries, University of Florida, Gainesville, FL, United States
| | - Arie H. Havelaar
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, United States
- Department of Animal Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, United States
- Institute for Sustainable Food Systems, University of Florida, Gainesville, FL, United States
| | - Sarah L. McKune
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
- Center for African Studies, University of Florida, Gainesville, FL, United States
| |
Collapse
|
31
|
Dolstad HA, Franke MF, Vissieres K, Jerome JG, Ternier R, Ivers LC. Factors associated with diarrheal disease among children aged 1-5 years in a cholera epidemic in rural Haiti. PLoS Negl Trop Dis 2021; 15:e0009726. [PMID: 34679083 PMCID: PMC8535179 DOI: 10.1371/journal.pntd.0009726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/12/2021] [Indexed: 11/18/2022] Open
Abstract
Diarrheal illness is a major cause of morbidity and mortality among children in Haiti, and the impact of diarrheal illness was compounded by a cholera outbreak between 2010 and 2019. Our understanding of risk factors for diarrhea among children during this outbreak is limited. We conducted a secondary analysis of data collected as part of a cholera vaccine effectiveness study to identify factors associated with medically attended diarrhea among children in central Haiti from October of 2012 through November of 2016. We identified 47 children aged one to five years old who presented to medical clinics with acute, watery diarrhea, and 166 matched controls who did not have diarrhea, and we performed conditional logistic regression to identify factors associated with diarrhea. Discontinuing exclusive breastfeeding within one month of birth was associated with increased risk of diarrhea (RR 6.9, 95% CI 1.46–32.64), and diarrhea was inversely associated with reported history of supplementation with vitamin A (RR 0.05, 95% CI 0.004–0.56) and zinc (reported among 0% of cases vs. 17% of controls). Because of the concordance in supplementation patterns, it was not possible to attribute the association to vitamin A or zinc independently. While having a respondent who correctly identified ≥3 means of avoiding cholera was associated with reduced risk of diarrhea (RR 0.43, 95% CI 0.19–1.01), reported household sanitation practices and knowledge of cholera were not consistently associated with risk of diarrhea. These findings support ongoing efforts to reduce barriers to breastfeeding and promote pediatric supplementation with vitamin A and zinc in Haiti. Given the reduced efficacy of current oral cholera vaccines (OCV) among children, the results reinforce the importance of breastfeeding and micronutrient supplementation in preventing all-cause pediatric diarrheal illness generally and during cholera outbreaks. Diarrheal diseases are leading causes of illness and death among children throughout the world, and children in Haiti were particularly impacted by diarrhea during the cholera outbreak that started in 2010. Between 2012 and 2016, data were collected as part of a case-control study of oral cholera vaccine (OCV) effectiveness in Haiti. We analyzed data from that study to identify factors associated with diarrheal illness, including cholera and non-cholera diarrhea, among children ages one through five years old. We found a direct association between longer duration of exclusive breastfeeding and supplementation with vitamin A and zinc and a reduced risk of diarrhea. These findings shed light on potentially important components of efforts to reduce pediatric diarrheal illness in Haiti generally, and to reduce pediatric diarrhea in the context of cholera outbreaks in Haiti and elsewhere.
Collapse
Affiliation(s)
- Hilary A. Dolstad
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | - Louise C. Ivers
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
32
|
French MA, Fiona Barker S, Taruc RR, Ansariadi A, Duffy GA, Saifuddaolah M, Zulkifli Agussalim A, Awaluddin F, Zainal Z, Wardani J, Faber PA, Fleming G, Ramsay EE, Henry R, Lin A, O'Toole J, Openshaw J, Sweeney R, Sinharoy SS, Kolotelo P, Jovanovic D, Schang C, Higginson EE, Prescott MF, Burge K, Davis B, Ramirez-Lovering D, Reidpath D, Greening C, Allotey P, Simpson JA, Forbes A, Chown SL, McCarthy D, Johnston D, Wong T, Brown R, Clasen T, Luby S, Leder K. A planetary health model for reducing exposure to faecal contamination in urban informal settlements: Baseline findings from Makassar, Indonesia. ENVIRONMENT INTERNATIONAL 2021; 155:106679. [PMID: 34126296 DOI: 10.1016/j.envint.2021.106679] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The intense interactions between people, animals and environmental systems in urban informal settlements compromise human and environmental health. Inadequate water and sanitation services, compounded by exposure to flooding and climate change risks, expose inhabitants to environmental contamination causing poor health and wellbeing and degrading ecosystems. However, the exact nature and full scope of risks and exposure pathways between human health and the environment in informal settlements are uncertain. Existing models are limited to microbiological linkages related to faecal-oral exposures at the individual level, and do not account for a broader range of human-environmental variables and interactions that affect population health and wellbeing. METHODS We undertook a 12-month health and environmental assessment in 12 flood-prone informal settlements in Makassar, Indonesia. We obtained caregiver-reported health data, anthropometric measurements, stool and blood samples from children < 5 years, and health and wellbeing data for children 5-14 years and adult respondents. We collected environmental data including temperature, mosquito and rat species abundance, and water and sediment samples. Demographic, built environment and household asset data were also collected. We combined our data with existing literature to generate a novel planetary health model of health and environment in informal settlements. RESULTS Across the 12 settlements, 593 households and 2764 participants were enrolled. Two-thirds (64·1%) of all houses (26·3-82·7% per settlement) had formal land tenure documentation. Cough, fever and diarrhoea in the week prior to the survey were reported among an average of 34.3%, 26.9% and 9.7% of children aged < 5 years, respectively; although proportions varied over time, prevalence among these youngest children was consistently higher than among children 5-14 years or adult respondents. Among children < 5 years, 44·3% experienced stunting, 41·1% underweight, 12.4% wasting, and 26.5% were anaemic. There was self- or carer-reported poor mental health among 16.6% of children aged 5-14 years and 13.9% of adult respondents. Rates of potential risky exposures from swimming in waterways, eating uncooked produce, and eating soil or dirt were high, as were exposures to flooding and livestock. Just over one third of households (35.3%) had access to municipal water, and contamination of well water with E. coli and nitrogen species was common. Most (79·5%) houses had an in-house toilet, but no houses were connected to a piped sewer network or safe, properly constructed septic tank. Median monthly settlement outdoor temperatures ranged from 26·2 °C to 29.3 °C, and were on average, 1·1 °C warmer inside houses than outside. Mosquito density varied over time, with Culex quinquefasciatus accounting for 94·7% of species. Framed by a planetary health lens, our model includes four thematic domains: (1) the physical/built environment; (2) the ecological environment; (3) human health; and (4) socio-economic wellbeing, and is structured at individual, household, settlement, and city/beyond spatial scales. CONCLUSIONS Our planetary health model includes key risk factors and faecal-oral exposure pathways but extends beyond conventional microbiological faecal-oral enteropathogen exposure pathways to comprehensively account for a wider range of variables affecting health in urban informal settlements. It includes broader ecological interconnections and planetary health-related variables at the household, settlement and city levels. It proposes a composite framework of markers to assess water and sanitation challenges and flood risks in urban informal settlements for optimal design and monitoring of interventions.
Collapse
Affiliation(s)
- Matthew A French
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - S Fiona Barker
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Ruzka R Taruc
- RISE Program, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | | | - Grant A Duffy
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | | | | | - Fitriyanty Awaluddin
- RISE Program, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Zainal Zainal
- RISE Program, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Jane Wardani
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - Peter A Faber
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | - Genie Fleming
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | - Emma E Ramsay
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | - Rebekah Henry
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - Audrie Lin
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Joanne O'Toole
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - John Openshaw
- Woods Institute and the Freeman Spogli Institute, Stanford University, Stanford, CA 94305, USA
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Victoria 3145, Australia
| | - Sheela S Sinharoy
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Peter Kolotelo
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - Dusan Jovanovic
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - Christelle Schang
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - Ellen E Higginson
- Cambridge Institute for Therapeutic Immunology and Infectious Disease, University of Cambridge, Cambridge, UK
| | - Michaela F Prescott
- Informal Cities Lab, Monash Art Design & Architecture, Monash University, Victoria 3145, Australia
| | - Kerrie Burge
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - Brett Davis
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - Diego Ramirez-Lovering
- Informal Cities Lab, Monash Art Design & Architecture, Monash University, Victoria 3145, Australia
| | - Daniel Reidpath
- The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Chris Greening
- Biomedicine Discovery Institute, Department of Microbiology, Monash University, Victoria 3800, Australia
| | - Pascale Allotey
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia; International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Andrew Forbes
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Steven L Chown
- School of Biological Sciences, Monash University, Victoria 3800, Australia
| | - David McCarthy
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Victoria 3800, Australia
| | - David Johnston
- Centre for Health Economics, Monash Business School, Monash University, Victoria 3145, Australia
| | - Tony Wong
- Water Sensitive Cities Institute, Monash University, Victoria 3800, Australia
| | - Rebekah Brown
- Monash Sustainable Development Institute, Monash University, Victoria 3800, Australia
| | - Thomas Clasen
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Stephen Luby
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia.
| |
Collapse
|
33
|
Rhoades NS, Hendrickson SM, Prongay K, Haertel A, Gill L, Edwards RA, Garzel L, Slifka MK, Messaoudi I. Growth faltering regardless of chronic diarrhea is associated with mucosal immune dysfunction and microbial dysbiosis in the gut lumen. Mucosal Immunol 2021; 14:1113-1126. [PMID: 34158595 PMCID: PMC8379072 DOI: 10.1038/s41385-021-00418-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 02/04/2023]
Abstract
Despite the impact of childhood diarrhea on morbidity and mortality, our understanding of its sequelae has been significantly hampered by the lack of studies that examine samples across the entire intestinal tract. Infant rhesus macaques are naturally susceptible to human enteric pathogens and recapitulate the hallmarks of diarrheal disease such as intestinal inflammation and growth faltering. Here, we examined intestinal biopsies, lamina propria leukocytes, luminal contents, and fecal samples from healthy infants and those experiencing growth faltering with distant acute or chronic active diarrhea. We show that growth faltering in the presence or absence of active diarrhea is associated with a heightened systemic and mucosal pro-inflammatory state centered in the colon. Moreover, polyclonal stimulation of colonic lamina propria leukocytes resulted in a dampened cytokine response, indicative of immune exhaustion. We also detected a functional and taxonomic shift in the luminal microbiome across multiple gut sites including the migration of Streptococcus and Prevotella species between the small and large intestine, suggesting a decompartmentalization of gut microbial communities. Our studies provide valuable insight into the outcomes of diarrheal diseases and growth faltering not attainable in humans and lays the groundwork to test interventions in a controlled and reproducible setting.
Collapse
Affiliation(s)
- Nicholas S Rhoades
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA
| | - Sara M Hendrickson
- Division of Neuroscience, Oregon National Primate Research Center, Portland, OR, USA
| | - Kamm Prongay
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health and Science University West Campus, Portland, OR, USA
| | - Andrew Haertel
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health and Science University West Campus, Portland, OR, USA
| | - Leanne Gill
- California National Primate Research Center, Davis, Davis, CA, USA
| | - Robert A Edwards
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
| | - Laura Garzel
- California National Primate Research Center, Davis, Davis, CA, USA
| | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Portland, OR, USA
| | - Ilhem Messaoudi
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA.
| |
Collapse
|
34
|
Johnstone SL, Page NA, Thomas J, Madhi SA, Mutevedzi P, Myburgh N, Herrera C, Groome MJ. Diarrhoeal diseases in Soweto, South Africa, 2020: a cross-sectional community survey. BMC Public Health 2021; 21:1431. [PMID: 34284738 PMCID: PMC8293521 DOI: 10.1186/s12889-021-11470-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background In South Africa, there are limited data on the burden of diarrhoea at a community level, specifically in older children and adults. This community survey estimated rates of and factors associated with diarrhoea across all ages and determined the proportion of cases presenting to healthcare facilities. Methods Households were enrolled from an existing urban health and demographic surveillance site. A household representative was interviewed to determine associated factors and occurrence of diarrhoea in the household, for all household members, in the past 2 weeks (including symptoms and health seeking behaviour). Diarrhoeal rate of any severity was calculated for < 5 years, 5–15 years and > 15 years age groups. Factors associated with diarrhoea and health seeking behaviour were investigated using binomial logistic regression. Results Diarrhoeal rate among respondents (2.5 episodes/person-year (95% CI, 1.8–3.5)) was significantly higher than for other household members (1.0 episodes/person-year (95% CI, 0.8–1.4); IRR = 2.4 (95% CI, 1.5–3.7) p < 0.001). Diarrhoeal rates were similar between age groups, however younger children (< 5 years) were more likely to present to healthcare facilities than adults (OR = 5.9 (95% CI, 1.1–31.4), p = 0.039). Oral rehydration solution was used in 44.8% of cases. Having a child between 5 and 15 years in the household was associated with diarrhoea (OR = 2.3 (95% CI, 1.3–3.9), p = 0.003) and, while 26.4% of cases sought healthcare, only 4.6% were hospitalised and only 3.4% of cases had a stool specimen collected. While the majority of cases were mild, 13.8% of cases felt they required healthcare but were unable to access it. Conclusion Diarrhoeal rate was high across all age groups in this community; however, older children and adults were less likely to present to healthcare, and are therefore underrepresented through facility-based clinical surveillance. Current diarrhoeal surveillance represents a fraction of the overall cases occurring in the community. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11470-9.
Collapse
Affiliation(s)
- Siobhan L Johnstone
- Center for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa. .,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Nicola A Page
- Center for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa.,Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, 0007, South Africa
| | - Juno Thomas
- Center for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nellie Myburgh
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlos Herrera
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle J Groome
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
35
|
Meyer DD, Hill C, McCain K, Smith JA, Bessong PO, Rogawski McQuade ET, Wright NC. Embedding Usage Sensors in Point-of-Use Water Treatment Devices: Sensor Design and Application in Limpopo, South Africa. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:8955-8964. [PMID: 34133882 PMCID: PMC9207768 DOI: 10.1021/acs.est.0c08683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Health benefits from point-of-use (POU) water treatment devices come only with consistent use. Embedded sensors can measure the consistency of POU-device use and can provide insights about improving it. We demonstrate both potentials with data from SmartSpouts: accelerometer-based sensors embedded in spigot handles that record the duration and timing of use. In the laboratory, most sensor readings correlated well (>0.98) with manually timed water withdrawals. In the field, SmartSpouts measured >60,000 water withdrawals across 232 households in Limpopo, South Africa. Sensors proved critical to understanding consistent use; surveys overestimated it by 53 percentage points. Sensor data showed when households use POU devices (evening peaks and delayed weekend routines) and user preferences (safe storage over filters). We demonstrate analytically and with data that (i) consistent use (e.g., 7 continuous days) is extremely sensitive to single-day use prevalence and (ii) use prevalence affects the performance of contact-time-based POU devices, exemplified with silver tablets. Deployed SmartSpouts had limitations, including memory overflows and confounding device relocation with water withdrawal. Nevertheless, SmartSpouts provided useful and objective data on the prevalence of single-day and consistent use. Considerably less expensive than alternatives, SmartSpouts enable an order of magnitude increase in how many POU-device sensors can be deployed.
Collapse
Affiliation(s)
- David D Meyer
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Courtney Hill
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - Kelly McCain
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - James A Smith
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - Pascal O Bessong
- University of Virginia, Charlottesville, Virginia 22904, United States
- University of Venda, Thohoyandou 0950, Limpopo, South Africa
| | | | - Natasha C Wright
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| |
Collapse
|
36
|
Barnes AN, Davaasuren A, Baasandavga U, Lantos PM, Gonchigoo B, Gray GC. Zoonotic enteric parasites in Mongolian people, animals, and the environment: Using One Health to address shared pathogens. PLoS Negl Trop Dis 2021; 15:e0009543. [PMID: 34237083 PMCID: PMC8266129 DOI: 10.1371/journal.pntd.0009543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/07/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cryptosporidium spp. and Giardia duodenalis are important zoonotic enteric pathogens of One Health concern for humans, animals, and the environment. For this study, we investigated parasite prevalence and risk factors among rural, peri-urban, and urban households and environments of Mongolia. METHODS This cross-sectional study implemented a household risk factor survey at 250 home sites along with sample collection from humans, animals, flies, and drinking water. Multiplex real-time PCR analysis was conducted to look for Cryptosporidium spp. and/or Giardia duodenalis within household samples. RESULTS Lab analysis found one or both zoonotic parasites at 20% of the participating households (51/250). Human samples had a parasite prevalence of 6.4% (27/419), domestic animals at 3.3% (19/570), pooled filth flies at 14.8% (17/115), and drinking water samples at 2% (5/250). Parasite presence at the household was significantly associated with a household's use of an improved drinking water source (OR 0.27; CI 0.12-0.61; p = < 0.01), having an indoor handwashing site (OR 0.41; CI 0.19-0.92; p = 0.03), domestic animal ownership (OR 2.40; CI 1.02-5.65; p = 0.05), and rural location (OR 0.50; CI 0.25-0.98; p = 0.04). Household use of an improved drinking water source remained significant in the multivariate model (OR 0.16; CI 0.04-0.68; p = 0.01). CONCLUSION In Mongolia, public and veterinary health are intertwined, particularly for rural herding households. Increased access to safe water, sanitation and hygiene infrastructure could help prevent further transmission of zoonotic enteric parasites. Public health interventions, policy and messaging should utilize a One Health framework employing joint leadership from local human and animal health sectors.
Collapse
Affiliation(s)
- Amber N. Barnes
- Institute of Veterinary Medicine, Ulaanbaatar, Mongolia
- School of Medicine, Duke University, Durham, North Carolina, United States of America
- Department of Public Health, University of North Florida, Jacksonville, Florida, United States of America
| | - Anu Davaasuren
- Institute of Veterinary Medicine, Ulaanbaatar, Mongolia
- National Center for Communicable Disease, Ulaanbaatar, Mongolia
| | - Uyanga Baasandavga
- Institute of Veterinary Medicine, Ulaanbaatar, Mongolia
- National Center for Zoonotic Disease, Ulaanbaatar, Mongolia
| | - Paul M. Lantos
- School of Medicine, Duke University, Durham, North Carolina, United States of America
| | | | - Gregory C. Gray
- School of Medicine, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Global Health Research Institute, Duke-Kunshan University, Kunshan, Jiangsu, China
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
| |
Collapse
|
37
|
Quattrochi JP, Coville A, Mvukiyehe E, Dohou CJ, Esu F, Cohen B, Bokasola YL, Croke K. Effects of a community-driven water, sanitation and hygiene intervention on water and sanitation infrastructure, access, behaviour, and governance: a cluster-randomised controlled trial in rural Democratic Republic of Congo. BMJ Glob Health 2021; 6:bmjgh-2021-005030. [PMID: 34001519 PMCID: PMC8130731 DOI: 10.1136/bmjgh-2021-005030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/27/2021] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Inadequate water and sanitation is a central challenge in global health. Since 2008, the Democratic Republic of Congo government has implemented a national programme, Healthy Villages and Schools (Villages et Ecoles Assainis (VEA), with support from UNICEF, financed by UK's Foreign, Commonwealth and Development Office. METHODS A cluster-level randomised controlled trial of VEA was implemented throughout 2019 across 332 rural villages, grouped into 50 treatment and 71 control clusters. Primary outcomes included time spent collecting water; quantity of water collected; prevalence of improved primary source of drinking water; and prevalence of improved primary defecation site. Secondary outcomes included child health, water governance, water satisfaction, handwashing practices, sanitation practices, financial cost of water, school attendance and water storage practices. All outcomes were self-reported. The primary analysis was on an intention-to-treat basis, using linear models. Outcomes were measured October-December 2019, median 5 months post-intervention. RESULTS The programme increased access to improved water sources by 33 percentage points (pp) (95% CI 22 to 45), to improved sanitation facilities by 26 pp (95% CI 14 to 37), and improved water governance by 1.3 SDs (95% CI 1.1 to 1.5), water satisfaction by 0.6 SD (95% CI 0.4 to 0.9), handwashing practices by 0.5 SD (95% CI 0.3 to 0.7) and sanitation practices by 0.3 SD (95% CI 0.1 to 0.4). There was no significant difference in financial cost of water, school attendance, child health or water storage practices. CONCLUSION VEA produced large increases in access to and satisfaction with water and sanitation services, in self-reported hygiene and sanitation behaviour, and in measures of water governance. TRIAL REGISTRATION NUMBER AEARCTR-0004648; American Economic Association RCT registry.
Collapse
Affiliation(s)
| | - Aidan Coville
- Development Impact Evaluation Department, World Bank Group, Washington, District of Columbia, USA
| | - Eric Mvukiyehe
- Development Impact Evaluation Department, World Bank Group, Washington, District of Columbia, USA
| | - Caleb Jeremie Dohou
- Development Impact Evaluation Department, The World Bank Group, Kinshasa, Democratic Republic of Congo
| | - Federica Esu
- Research, Assessment, and Monitoring Department, World Food Programme, Rome, Italy
| | - Byron Cohen
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Yannick Lokaya Bokasola
- Development Impact Evaluation Department, The World Bank Group, Kinshasa, Democratic Republic of Congo
| | - Kevin Croke
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
38
|
Sultana R, Luby SP, Gurley ES, Rimi NA, Swarna ST, Khan JAM, Nahar N, Ghosh PK, Howlader SR, Kabir H, Khan S, Jensen PKM. Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study. PLoS Negl Trop Dis 2021; 15:e0009439. [PMID: 34115764 PMCID: PMC8221788 DOI: 10.1371/journal.pntd.0009439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 06/23/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023] Open
Abstract
The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods. The illness cost borne by households, known as out-of-pocket expenditure was 74% of the total health expenditure in Bangladesh in 2017. Most of the studies in Bangladesh that estimated the cost of diarrheal illness collected data from hospital patients and mostly targeted under-five children. Information on economic burden of diarrhea borne by households of low-income urban communities who commonly had ≤ 2 US$ dollar income per capita per day still remained unknown. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 2015 to July 2016 to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 (2,147 BDT) and non-severe diarrhea was US$ 6.36 (499 BDT). A single diarrheal episode substantially affects financial capability of the low-income urban community: a severe episode can cost 4.35 days (17%) and a non-severe episode can cost 1 day (4%) of income of a households. Preventing diarrhea preserves health and supports financial livelihoods.
Collapse
Affiliation(s)
- Rebeca Sultana
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
- icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Stephen P. Luby
- Stanford University, Stanford, California, United States of America
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | - Nazmun Nahar
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
39
|
Besnier E, Thomson K, Stonkute D, Mohammad T, Akhter N, Todd A, Rom Jensen M, Kilvik A, Bambra C. Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low- and middle-income countries (LMICs): An umbrella review. PLoS One 2021; 16:e0251905. [PMID: 34111134 PMCID: PMC8191901 DOI: 10.1371/journal.pone.0251905] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 05/04/2021] [Indexed: 01/08/2023] Open
Abstract
Despite significant progress in the last few decades, infectious diseases remain a major threat to child health in low- and middle-income countries (LMICs)-particularly amongst more disadvantaged groups. It is imperative to understand the best available evidence concerning which public health interventions reduce morbidity, mortality and health inequalities in children aged under five years. To address this gap, we carried out an umbrella review (a systematic reviews of reviews) to identify evidence on the effects of public health interventions (promotion, protection, prevention) on morbidity, mortality and/or health inequalities due to infectious diseases amongst children in LMICs. Ten databases were searched for records published between 2014-2021 alongside a manual search of gray literature. Articles were quality-assessed using the Assessment of Multiple Systematic Reviews tool (AMSTAR 2). A narrative synthesis was conducted. We identified 60 systematic reviews synthesizing 453 individual primary studies. A majority of the reviews reported on preventive interventions (n = 48), with a minority on promotion (n = 17) and almost no reviews covering health protection interventions (n = 2). Effective interventions for improving child health across the whole population, as well as the most disadvantaged included communication, education and social mobilization for specific preventive services or tools, such as immunization or bed nets. For all other interventions, the effects were either unclear, unknown or detrimental, either at the overall population level or regarding health inequalities. We found few reviews reporting health inequalities information and the quality of the evidence base was generally low. Our umbrella review identified some prevention interventions that might be useful in reducing under five mortality from infectious diseases in LMICs, particularly amongst the most disadvantaged groups.
Collapse
Affiliation(s)
- Elodie Besnier
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Katie Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Donata Stonkute
- CHAIN, Department of Public Health and Nursing, NTNU, Trondheim, Norway
| | - Talal Mohammad
- CHAIN, Department of Public Health and Nursing, NTNU, Trondheim, Norway
| | - Nasima Akhter
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Magnus Rom Jensen
- Library Section for Humanities, Education and Social Sciences, NTNU, Trondheim, Norway
| | - Astrid Kilvik
- Medicine and Health Library, NTNU, Trondheim, Norway
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
40
|
Heylen C, Annan E, Monahan K, String G, Lantagne D. Modeling of Hydraulic Performance in Disks and Full-Scale Ceramic Water Filters. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:7702-7710. [PMID: 33983013 DOI: 10.1021/acs.est.1c01886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Ceramic filters for household water treatment can improve water quality and reduce diarrheal disease. Hydraulic performance is critical for quality control and user acceptability, and hydraulic models have previously been developed and tested with experimental full-scale filters. As filters are cumbersome, there is interest in using disks instead of filters in laboratory efficacy studies. To assess the validity of disk use, we collected experimental volume from three sets of full-scale frustum-shaped filters and matching disks with different burn-out material sieve sizes and firing temperatures. We compared the experimental and fitted data by calibrating hydraulic conductivities from filters and disks. Hydraulic conductivities increased with larger burn-out material and higher firing temperatures but were comparable between filters and disks (2.00-6.15 × 10-7m·s-1 and 2.69-6.32 × 10-7m·s-1, respectively). We found that previously described hydraulic models successfully predicted cumulative volumes for filters and disks with rRMSE ranging from 2.1 to 9.6% (filters) and 3.4 to 4.7% (disks). The error increased slightly (rRMSE: 5.0-15%) when predicting hydraulic parameters for filters from the hydraulic conductivity of disks. Our results validate a method to predict full-scale filter hydraulic performance from hydraulic conductivity of disks and can be used to simplify and increase testing capacity, resulting in higher quality, more acceptable filters that improve household drinking water quality.
Collapse
Affiliation(s)
- Camille Heylen
- Department of Civil and Environmental Engineering, Tufts University, 02155 Medford, Massachusetts, United States
| | - Ebenezer Annan
- Department of Civil and Environmental Engineering, Tufts University, 02155 Medford, Massachusetts, United States
- Department of Materials Science and Engineering, School of Engineering Sciences, CBAS, University of Ghana, 00233 Accra, Ghana
| | - Kyle Monahan
- Department of Civil and Environmental Engineering, Tufts University, 02155 Medford, Massachusetts, United States
| | - Gabrielle String
- Department of Civil and Environmental Engineering, Tufts University, 02155 Medford, Massachusetts, United States
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University, 02155 Medford, Massachusetts, United States
| |
Collapse
|
41
|
Gold-Watts A, Aamodt G, Gandhimathi S, Sudha R, Bastien S. Understanding Adolescents' Perceptions of Diarrhea: A Formative Research Study of a Visual Scale to Measure Self-Reported Diarrhea in Low-Resource Settings. Front Public Health 2021; 9:561367. [PMID: 34113594 PMCID: PMC8185169 DOI: 10.3389/fpubh.2021.561367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Although water, sanitation, and hygiene interventions are effective in reducing diarrhea, there are methodological issues regarding the research tools used to evaluate their health impact. Moreover, there is limited research on individuals' subjective interpretations of diarrheal illness which may introduce further limitations in relying on self-reported data. Therefore, we conducted a study that aims to understand adolescents' perceptions of diarrheal illness in rural Tamil Nadu, India. Next, we wish to explore the acceptability of the Bristol Stool Form Scale to assess self-reported diarrhea in water, sanitation, and hygiene interventions involving adolescent participants in low-resource settings. Materials and Methods: The study was conducted as part of the formative research phase in the cultural adaptation of Project SHINE, a school-based educational water, sanitation, and hygiene intervention in Thirumalaikodi, Tamil Nadu, India. A convergent parallel mixed-methods study design with a purposive sampling strategy was used. Qualitative data included 10 in-depth interviews with student participants aged 13–14. Quantitative data were collected through interviewer-administered face-to-face surveys (n = 14) and one-week stool diaries (n = 14). Each data set was analyzed separately and compiled during the interpretation of the findings. Results: Across all data sets, diarrhea was reported to be perceived as unhealthy and an irregular occurrence among participants. Participants also reported diarrheal-taboos, local methods to cure or control diarrhea, and discussed how diarrheal illness can lead to absenteeism or withdrawal from school and social activities. Moreover, participants were able to understand and answer questions about their stool using the Bristol Stool Form Scale, suggesting that is an acceptable tool. Discussion: Visual tools demonstrate promise in improving self-reported diarrheal illness among adolescents in low-resource settings in India. However, until we address diarrhea-related taboos it will be difficult to address methodological issues in the assessment and reporting of diarrheal illness among adolescents.
Collapse
Affiliation(s)
- Anise Gold-Watts
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - Geir Aamodt
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | | | - Rajamani Sudha
- Department of Obstetrics and Gynecology Nursing, Sri Narayani College and School of Nursing, Vellore, India
| | - Sheri Bastien
- Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
42
|
Heylen C, Oliveira Aguiar A, String G, Domini M, Goff N, Murray A, Asatekin A, Lantagne D. Laboratory Efficacy of Locally Available Backwashing Methods at Removing Fouling in Hollow-Fiber Membrane Filters Used for Household Water Treatment. MEMBRANES 2021; 11:375. [PMID: 34065587 PMCID: PMC8161404 DOI: 10.3390/membranes11050375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022]
Abstract
Hollow-fiber membrane filters (HFMFs) for household water treatment (HWT) can efficaciously remove disease-causing organisms in laboratory settings. However, lower effectiveness in use in low- and middle-income countries (LMICs) and humanitarian contexts (HCs) has been observed and attributed to membrane fouling and the associated cleaning. In LMICs/HCs, it is not possible to prevent and control fouling using commonly known methods (e.g., testing influent water, maintenance regimes), and the literature on fouling/cleaning of HFMFs distributed in LMICs is scarce. As such, controlled laboratory experiments were conducted to determine the efficacy of locally available (in LMICs/HCs) backwashing solutions at removing fouling using different influent waters and HFMF types. Four commonly distributed HFMFs were selected; fouling layers were developed by filtering three influent water compositions, representing LMIC/HC waters, for 10-days, and bleach, water, or vinegar backwashing solutions were used for daily backwashing. Filter performance indicators included: fiber mechanical properties (strain at break, break force), water quantity performance (flow), water quality performance (turbidity, E. coli), and imaging. The study found fouling developed rapidly and altered mechanical properties and water quantity indicators within 200 h of filtration. Fouling did not decrease water quality indicators. Backwashing improved the filter's mechanical properties and water quantity performance, but it did not fully recover the initial performance. Additionally, recovery differed between backwashing solutions, and no universal cleaning recommendation appropriate for HFMFs in LMICs/HCs was identified. Overall, fouling development and control depended on HFMF type, influent water quality, and backwashing solution type; thus, caution before distributing HFMFs for long-term use in LMICs/HCs is recommended.
Collapse
Affiliation(s)
- Camille Heylen
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA; (G.S.); (M.D.); (A.M.); (D.L.)
| | - Alice Oliveira Aguiar
- Department of Chemical and Biological Engineering, Tufts University, Medford, MA 02155, USA; (A.O.A.); (N.G.); (A.A.)
| | - Gabrielle String
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA; (G.S.); (M.D.); (A.M.); (D.L.)
| | - Marta Domini
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA; (G.S.); (M.D.); (A.M.); (D.L.)
| | - Nathaniel Goff
- Department of Chemical and Biological Engineering, Tufts University, Medford, MA 02155, USA; (A.O.A.); (N.G.); (A.A.)
| | - Anna Murray
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA; (G.S.); (M.D.); (A.M.); (D.L.)
| | - Ayse Asatekin
- Department of Chemical and Biological Engineering, Tufts University, Medford, MA 02155, USA; (A.O.A.); (N.G.); (A.A.)
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA; (G.S.); (M.D.); (A.M.); (D.L.)
| |
Collapse
|
43
|
Bauza V, Sclar GD, Bisoyi A, Majorin F, Ghugey A, Clasen T. Water, Sanitation, and Hygiene Practices and Challenges during the COVID-19 Pandemic: A Cross-Sectional Study in Rural Odisha, India. Am J Trop Med Hyg 2021; 104:2264-2274. [PMID: 33905349 PMCID: PMC8176476 DOI: 10.4269/ajtmh.21-0087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
Water, sanitation, and hygiene (WASH) practices emerged as a critical component to controlling and preventing the spread of the COVID-19 pandemic. We conducted 131 semistructured phone interviews with households in rural Odisha, India, to understand behavior changes made in WASH practices as a result of the pandemic and challenges that would prevent best practices. Interviews were conducted from May through July 2020 with 73 heads of household, 37 caregivers of children < 5 years old, and 21 members of village water and sanitation committees in villages with community-level piped water and high levels of latrine ownership. The majority of respondents (86%, N = 104) reported a change in their handwashing practice due to COVID-19, typically describing an increase in handwashing frequency, more thorough washing method, and/or use of soap. These improved handwashing practices remained in place a few months after the pandemic began and were often described as a new consistent practice after additional daily actions (such as returning home), suggesting new habit formation. Few participants (13%) reported barriers to handwashing. Some respondents also detailed improvements in other WASH behaviors, including village-level cleaning of water tanks and/or treatment of piped water (48% of villages), household water treatment and storage (17% of respondents), and household cleaning (41% of respondents). However, there was minimal change in latrine use and child feces management practices as a result of the pandemic. We provide detailed thematic summaries of qualitative responses to allow for richer insights into these WASH behavior changes during the pandemic. The results also highlight the importance of ensuring communities have adequate WASH infrastructure to enable the practice of safe behaviors and strengthen resilience during a large-scale health crisis.
Collapse
Affiliation(s)
- Valerie Bauza
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Gloria D. Sclar
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Psychology, University of Zürich, Zürich, Switzerland
| | | | - Fiona Majorin
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
44
|
Apanga PA, Weber AM, Darrow LA, Riddle MS, Tung WC, Liu Y, Garn JV. The interrelationship between water access, exclusive breastfeeding and diarrhea in children: a cross-sectional assessment across 19 African countries. J Glob Health 2021. [PMID: 33828842 PMCID: PMC8005312 DOI: 10.7189/jogh-11-04001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Access to an improved water supply and practicing exclusive breastfeeding are essential for improving maternal and child health outcomes. However, few studies have been equipped to assess the interdependencies between access to improved water, practicing exclusive breastfeeding, and child health. The primary aim of our study was to assess whether access to an improved water supply and water-fetching were associated with mothers’ practice of exclusive breastfeeding. Methods We analyzed data on 247 090 mothers with children 5 months old or less using Multiple Indicator Cluster Surveys from 19 African countries. Multivariable logistic regression was used to estimate the relationship between our exposures and exclusive breastfeeding practice, while meta-analytic methods were used to pool adjusted estimates across 19 countries. Results The prevalence of exclusive breastfeeding ranged from 22% in Nigeria to 70% in Malawi. Pooled results showed water-fetching was not associated with exclusive breastfeeding (adjusted prevalence odds ratios (aPOR) = 1.04, 95% confidence interval (CI) = 0.89, 1.21). Access to an improved water source was also not associated with exclusive breastfeeding (aPOR = 1.06, 95% CI = 0.94, 1.21). Across all countries many women were spending a significant amount of time water-fetching each day (mean time varied from 20 minutes in Ghana to 115 minutes in Mauritania). Exclusively breastfed children had 33% lower odds of diarrhea than those who were not exclusively breastfed (aPOR = 0.67, 95% CI = 0.56, 0.78). Conclusion Our study is the first to assess the relationship between access to improved water supply, water-fetching and exclusive breastfeeding. We found that access to water supply and time spent by mothers fetching water were not associated with exclusive breastfeeding practice, even though mothers spent significant time fetching water.
Collapse
Affiliation(s)
- Paschal A Apanga
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Ann M Weber
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Mark S Riddle
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Wei-Chen Tung
- The Valley Foundation of School of Nursing, San Jose State University, San Jose, California, USA
| | - Yan Liu
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Joshua V Garn
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| |
Collapse
|
45
|
Apanga PA, Weber AM, Darrow LA, Riddle MS, Tung WC, Liu Y, Garn JV. The interrelationship between water access, exclusive breastfeeding and diarrhea in children: a cross-sectional assessment across 19 African countries. J Glob Health 2021; 11:04001. [PMID: 33828842 PMCID: PMC8005312 DOI: 10.7189/jogh.11.04001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Access to an improved water supply and practicing exclusive breastfeeding are essential for improving maternal and child health outcomes. However, few studies have been equipped to assess the interdependencies between access to improved water, practicing exclusive breastfeeding, and child health. The primary aim of our study was to assess whether access to an improved water supply and water-fetching were associated with mothers' practice of exclusive breastfeeding. METHODS We analyzed data on 247 090 mothers with children 5 months old or less using Multiple Indicator Cluster Surveys from 19 African countries. Multivariable logistic regression was used to estimate the relationship between our exposures and exclusive breastfeeding practice, while meta-analytic methods were used to pool adjusted estimates across 19 countries. RESULTS The prevalence of exclusive breastfeeding ranged from 22% in Nigeria to 70% in Malawi. Pooled results showed water-fetching was not associated with exclusive breastfeeding (adjusted prevalence odds ratios (aPOR) = 1.04, 95% confidence interval (CI) = 0.89, 1.21). Access to an improved water source was also not associated with exclusive breastfeeding (aPOR = 1.06, 95% CI = 0.94, 1.21). Across all countries many women were spending a significant amount of time water-fetching each day (mean time varied from 20 minutes in Ghana to 115 minutes in Mauritania). Exclusively breastfed children had 33% lower odds of diarrhea than those who were not exclusively breastfed (aPOR = 0.67, 95% CI = 0.56, 0.78). CONCLUSION Our study is the first to assess the relationship between access to improved water supply, water-fetching and exclusive breastfeeding. We found that access to water supply and time spent by mothers fetching water were not associated with exclusive breastfeeding practice, even though mothers spent significant time fetching water.
Collapse
Affiliation(s)
- Paschal A Apanga
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Ann M Weber
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Mark S Riddle
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Wei-Chen Tung
- The Valley Foundation of School of Nursing, San Jose State University, San Jose, California, USA
| | - Yan Liu
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| | - Joshua V Garn
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
| |
Collapse
|
46
|
Lantagne D, Lehmann L, Yates T, Gallandat K, Sikder M, Domini M, String G. Lessons learned from conducting six multi-country mixed-methods effectiveness research studies on water, sanitation, and hygiene (WASH) interventions in humanitarian response. BMC Public Health 2021; 21:560. [PMID: 33752646 PMCID: PMC7983375 DOI: 10.1186/s12889-021-10597-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 03/09/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Provision of safe water, sanitation, and hygiene (WASH) to affected populations in humanitarian emergencies is necessary for dignity and communicable disease control. Additional evidence on WASH interventions is needed in humanitarian settings. Between 2008 and 2019, we completed six multi-country, mixed-methods effectiveness studies in humanitarian response on six different WASH interventions. In each evaluation, we conducted: key informant interviews; water point observations and water quality testing; household surveys with recipients, including survey and water quality testing; focus group discussions; and/or, secondary data analysis. The research questions were: "What is the effectiveness of [intervention] in reducing the risk of diarrhea/cholera transmission; and, what programmatic factors lead to higher effectiveness?" DISCUSSION In all six multi-country, mixed-methods evaluations, policy-relevant outcomes were obtained. We found, in our individual research results, that: interventions could reduce the risk of disease in humanitarian contexts; this reduction of risk did not always occur, as there were large ranges in effectiveness; and, implementation factors were crucial to intervention effectiveness. When collaboratively reviewing our research process across evaluations, we found strategies for successfully conducting this research included: 1) working with partners to identify and evaluate programs; 2) rapidly obtaining approvals to deploy; and, 3) conducting research methodologies consistently. Personal connections, in-person communication, trust, and experience working together were key factors for success in identifying partners for evaluation. Successes in evaluation deployment occurred with flexibility, patience, commitment of adequate time, and understanding of processes; although we note access and security concerns in insecure contexts precluded deployment. Consistent and robust protocols, flexibility, and a consistent researcher on the ground in each context allowed for methodological consistency and high-quality results. CONCLUSIONS In conclusion, we have found multi-country, mixed-methods results to be one crucial piece of the WASH evidence base in humanitarian contexts. This is particularly because evaluations of reductions in risk from real-world programming are policy-relevant, and are directly used to improve programming. In future, we need to flexibly work with donors, agencies, institutions, responders, local governments, local responders, and beneficiaries to design safe and ethical research protocols to answer questions related to WASH interventions effectiveness in humanitarian response, and, improve WASH programming.
Collapse
Affiliation(s)
| | - Lilian Lehmann
- Innovations for Poverty Action, New Haven, CT, USA
- IDinsight, Manila, Philippines
| | - Travis Yates
- Tufts University School of Engineering, Medford, MA, USA
| | - Karin Gallandat
- Tufts University School of Engineering, Medford, MA, USA
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mustafa Sikder
- Tufts University School of Engineering, Medford, MA, USA
- Johns Hopkins University, Center for Humanitarian Health, Baltimore, MD, USA
| | - Marta Domini
- Tufts University School of Engineering, Medford, MA, USA
- Brescia University, Brescia, Italy
| | | |
Collapse
|
47
|
Sharma Waddington H, Cairncross S. PROTOCOL: Water, sanitation and hygiene for reducing childhood mortality in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1135. [PMID: 37050969 PMCID: PMC8356349 DOI: 10.1002/cl2.1135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Respiratory tract infections and diarrhoea are the two biggest killers of children in low income contexts. They are closely related to access to, and use of improved water, sanitation and hygiene (WASH). However, there is no high quality systematic review that quantifies the effect of WASH improvements on childhood mortality. Existing systematic reviews of WASH improvements measure effects on morbidity, under the (often implicit) assumption that morbidity is closely correlated with mortality. This is at least partly because the impact evaluations on which they are based are only designed to detect changes in morbidity with statistical precision, whereas mortality is a relatively rare outcome. The proposed review will address this evidence synthesis gap, using the greater statistical power of meta-analysis to pool findings across studies.
Collapse
Affiliation(s)
- Hugh Sharma Waddington
- London School of Hygiene and Tropical MedicineLondon International Development CentreLondonUK
| | | |
Collapse
|
48
|
Sikder M, Naumova EN, Ogudipe AO, Gomez M, Lantagne D. Fecal Indicator Bacteria Data to Characterize Drinking Water Quality in Low-Resource Settings: Summary of Current Practices and Recommendations for Improving Validity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052353. [PMID: 33670869 PMCID: PMC7957662 DOI: 10.3390/ijerph18052353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 11/16/2022]
Abstract
Fecal indicator bacteria (FIB) values are widely used to assess microbial contamination in drinking water and to advance the modeling of infectious disease risks. The membrane filtration (MF) testing technique for FIB is widely adapted for use in low- and middle-income countries (LMICs). We conducted a systematic literature review on the use of MF-based FIB data in LMICs and summarized statistical methods from 172 articles. We then applied the commonly used statistical methods from the review on publicly available datasets to illustrate how data analysis methods affect FIB results and interpretation. Our findings indicate that standard methods for processing samples are not widely reported, the selection of statistical tests is rarely justified, and, depending on the application, statistical methods can change risk perception and present misleading results. These results raise concerns about the validity of FIB data collection, analysis, and presentation in LMICs. To improve evidence quality, we propose a FIB data reporting checklist to use as a reminder for researchers and practitioners.
Collapse
Affiliation(s)
- Mustafa Sikder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA 02155, USA; (E.N.N.); (A.O.O.); (M.G.); (D.L.)
- Correspondence:
| | - Elena N. Naumova
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA 02155, USA; (E.N.N.); (A.O.O.); (M.G.); (D.L.)
- Division of Nutrition Epidemiology and Data Science, Friedman School of Nutrition Science and Policy, Boston, MA 02111, USA
| | - Anthonia O. Ogudipe
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA 02155, USA; (E.N.N.); (A.O.O.); (M.G.); (D.L.)
| | - Mateo Gomez
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA 02155, USA; (E.N.N.); (A.O.O.); (M.G.); (D.L.)
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA 02155, USA; (E.N.N.); (A.O.O.); (M.G.); (D.L.)
| |
Collapse
|
49
|
Molecular Epidemiology of Human Cryptosporidiosis in Low- and Middle-Income Countries. Clin Microbiol Rev 2021; 34:34/2/e00087-19. [PMID: 33627442 DOI: 10.1128/cmr.00087-19] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Cryptosporidiosis is one of the most important causes of moderate to severe diarrhea and diarrhea-related mortality in children under 2 years of age in low- and middle-income countries. In recent decades, genotyping and subtyping tools have been used in epidemiological studies of human cryptosporidiosis. Results of these studies suggest that higher genetic diversity of Cryptosporidium spp. is present in humans in these countries at both species and subtype levels and that anthroponotic transmission plays a major role in human cryptosporidiosis. Cryptosporidium hominis is the most common Cryptosporidium species in humans in almost all the low- and middle-income countries examined, with five subtype families (namely, Ia, Ib, Id, Ie, and If) being commonly found in most regions. In addition, most Cryptosporidium parvum infections in these areas are caused by the anthroponotic IIc subtype family rather than the zoonotic IIa subtype family. There is geographic segregation in Cryptosporidium hominis subtypes, as revealed by multilocus subtyping. Concurrent and sequential infections with different Cryptosporidium species and subtypes are common, as immunity against reinfection and cross protection against different Cryptosporidium species are partial. Differences in clinical presentations have been observed among Cryptosporidium species and C. hominis subtypes. These observations suggest that WASH (water, sanitation, and hygiene)-based interventions should be implemented to prevent and control human cryptosporidiosis in low- and middle-income countries.
Collapse
|
50
|
Bountogo M, Ouattara M, Sié A, Compaoré G, Dah C, Boudo V, Zakane A, Lebas E, Brogdon JM, Godwin WW, Lin Y, Arnold BF, Oldenburg CE. Access to Improved Sanitation and Nutritional Status among Preschool Children in Nouna District, Burkina Faso. Am J Trop Med Hyg 2021; 104:1540-1545. [PMID: 33556039 PMCID: PMC8045633 DOI: 10.4269/ajtmh.20-0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/16/2020] [Indexed: 11/07/2022] Open
Abstract
Access to improved sanitation and hygiene may improve child nutritional status by reducing exposure to enteric pathogens. We evaluated this relationship as part of the Community Health with Azithromycin Trial, a community-randomized trial of azithromycin versus placebo for the prevention of child mortality in rural Burkina Faso. Before the baseline study visit, a door-to-door household survey was conducted for all households in the study area. During the baseline study census, which occurred approximately 9 months after the household survey, a mid-upper arm circumference (MUAC) measurement was obtained from each child. We evaluated the relationship between household improved latrine use compared with unimproved latrines or open defecation and MUAC in children aged 6-59 months. Among 32,172 children with household survey data and MUAC measurements, 931 (2.9%) had an MUAC less than 12.5 cm and were classified as having moderate acute malnutrition (MAM). The odds of MAM were higher in children living in households with an unimproved latrine than those with an improved latrine (adjusted odds ratio: 1.60; 95% CI: 1.11-2.31). Children in households with unimproved latrines and households that practiced open defection had approximate 0.15 cm reduced MUAC compared with those in households with an improved latrine. There was a small, but statistically significant, association between improved latrine and nutritional status in preschool children as measured by MUAC.
Collapse
Affiliation(s)
| | | | - Ali Sié
- 1Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Clarisse Dah
- 1Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Valentin Boudo
- 1Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Elodie Lebas
- 2Francis I Proctor Foundation, University of California, San Francisco, California
| | - Jessica M Brogdon
- 2Francis I Proctor Foundation, University of California, San Francisco, California
| | - William W Godwin
- 2Francis I Proctor Foundation, University of California, San Francisco, California
| | - Ying Lin
- 2Francis I Proctor Foundation, University of California, San Francisco, California
| | - Benjamin F Arnold
- 2Francis I Proctor Foundation, University of California, San Francisco, California.,3Department of Ophthalmology, University of California, San Francisco, California
| | - Catherine E Oldenburg
- 2Francis I Proctor Foundation, University of California, San Francisco, California.,3Department of Ophthalmology, University of California, San Francisco, California.,4Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | | |
Collapse
|