1
|
Betera S, Wispriyono B, Nunu WN. Exploring the water, sanitation and hygiene status and health outcomes in Zimbabwe: a scoping review protocol. BMJ Open 2024; 14:e082224. [PMID: 39160105 PMCID: PMC11337704 DOI: 10.1136/bmjopen-2023-082224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 07/31/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The sixth United Nations Sustainable Development Goal emphasises universal access to clean water, sanitation and hygiene (WASH) to ensure human well-being as a fundamental human right for sustainable development. In Zimbabwe, WASH reforms began more than a century ago from the preindependence to postindependence era. However, countries face pressing challenges in improving their related health outcomes. Therefore, this scoping review aims to explore WASH status and how it influences health outcomes in Zimbabwe. METHODS AND ANALYSIS The leading databases to be searched for relevant sources published in English with an unrestricted search back until May 2024 include PubMed, EBSCO, SAGE, SpringerLink, Cochrane Library, ScienceDirect, Scopus, Web of Science and African Journals Online. A search string was developed for retrieving literature, and reports from key stakeholders in the WASH sector will be included in this study as grey literature. The study will employ a two-step screening process for identifying relevant literature incorporating Cohen's kappa coefficient statistics to estimate the inter-rater reliability between two independent reviewers using Mendeley and Rayyan software. The Strengthening the Reporting of Observational Studies in Epidemiology checklist for observational studies and the Consolidated Standards of Reporting Trials checklist for randomised controlled trials will be used for the quality checks. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will guide this study in terms of data collection, extraction and analysis from relevant literature. Data charting was used to present and interpret the findings. The entire process is scheduled to commence in June 2024, with the manuscript anticipated to be submitted to a journal in October 2024. ETHICS AND DISSEMINATION This review will use only published data; therefore, no ethical clearance is required. The findings will be disseminated to relevant stakeholders through peer-reviewed journals, meetings, conferences, seminars and forums.
Collapse
Affiliation(s)
- Same Betera
- Department of Environmental Health, Universitas Indonesia, Kota Depok, Jawa Barat, Indonesia
| | - Bambang Wispriyono
- Department of Environmental Health, Universitas Indonesia, Kota Depok, Jawa Barat, Indonesia
| | - Wilfred Njabulo Nunu
- Department of Environmental Health, University of Botswana, Gaborone, Botswana
- Department of Public Health, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
2
|
Cohen A, Rasheduzzaman M, O'Connell B, Brown T, Taniuchi M, Krometis LA, Hubbard A, Scheuerman P, Edwards M, Darling A, Pennala B, Price S, Lytton B, Wettstone E, Pholwat S, Ward H, Hallinger DR, Simmons SO, Griffin SM, Kobylanski J, Egorov AI, Wade TJ. Drinking water sources, quality, and associated health outcomes in Appalachian Virginia: A risk characterization study in two counties. Int J Hyg Environ Health 2024; 260:114390. [PMID: 38772087 DOI: 10.1016/j.ijheh.2024.114390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES In the US, violations of drinking water regulations are highest in lower-income rural areas overall, and particularly in Central Appalachia. However, data on drinking water use, quality, and associated health outcomes in rural Appalachia are limited. We sought to assess public and private drinking water sources and associated risk factors for waterborne pathogen exposures for individuals living in rural regions of Appalachian Virginia. METHODS We administered surveys and collected tap water, bottled water, and saliva samples in lower-income households in two adjacent rural counties in southwest Virginia (bordering Kentucky and Tennessee). Water samples were tested for pH, temperature, conductivity, total coliforms, E. coli, free chlorine, nitrate, fluoride, heavy metals, and specific pathogen targets. Saliva samples were analyzed for antibody responses to potentially waterborne infections. We also shared water analysis results with households. RESULTS We enrolled 33 households (83 individuals), 82% (n = 27) with utility-supplied water and 18% with private wells (n = 3) or springs (n = 3). 58% (n = 19) reported household incomes of <$20,000/year. Total coliforms were detected in water samples from 33% (n = 11) of homes, E. coli in 12%, all with wells or springs (n = 4), and Aeromonas, Campylobacter, and Enterobacter in 9%, all spring water (n = 3). Diarrhea was reported for 10% of individuals (n = 8), but was not associated with E. coli detection. 34% (n = 15) of saliva samples had detectable antibody responses for Cryptosporidium spp., C. jejuni, and Hepatitis E. After controlling for covariates and clustering, individuals in households with septic systems and straight pipes had significantly higher likelihoods of antibody detection (risk ratios = 3.28, 95%CI = 1.01-10.65). CONCLUSIONS To our knowledge, this is the first study to collect and analyze drinking water samples, saliva samples, and reported health outcome data from low-income households in Central Appalachia. Our findings indicate that utility-supplied water in this region was generally safe, and individuals in low-income households without utility-supplied water or sewerage have higher exposures to waterborne pathogens.
Collapse
Affiliation(s)
- Alasdair Cohen
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA; Department of Civil & Environmental Engineering, Virginia Tech, Blacksburg, VA, USA.
| | - Md Rasheduzzaman
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Bethesda O'Connell
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Teresa Brown
- Department of Natural Sciences, University of Virginia's College at Wise, Wise, VA, USA
| | - Mami Taniuchi
- Department of Civil and Environmental Engineering, University of Virginia, Charlottesville, VA, USA; Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA; Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - Leigh-Anne Krometis
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Alan Hubbard
- Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Phillip Scheuerman
- Department of Environmental and Occupational Health and Safety Sciences, East Tennessee State University, Johnson City, TN, USA
| | - Marc Edwards
- Department of Civil & Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Amanda Darling
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA; Department of Civil & Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Blaine Pennala
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Sarah Price
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Breanna Lytton
- Department of Population Health Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Erin Wettstone
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Suporn Pholwat
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | - Daniel R Hallinger
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Steven O Simmons
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Shannon M Griffin
- Office of Research and Development, US Environmental Protection Agency, Cincinnati, OH, USA
| | - Jason Kobylanski
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Andrey I Egorov
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Timothy J Wade
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| |
Collapse
|
3
|
Wolken M, Wang M, Schedler J, Campos RH, Ensor K, Hopkins L, Treangen T, Stadler LB. PreK-12 school and citywide wastewater monitoring of the enteric viruses astrovirus, rotavirus, and sapovirus. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 931:172683. [PMID: 38663617 DOI: 10.1016/j.scitotenv.2024.172683] [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: 01/22/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
Wastewater monitoring is an efficient and effective way to surveil for various pathogens in communities. This is especially beneficial in areas of high transmission, such as preK-12 schools, where infections may otherwise go unreported. In this work, we apply wastewater disease surveillance using school and community wastewater from across Houston, Texas to monitor three major enteric viruses: astrovirus, sapovirus genogroup GI, and group A rotavirus. We present the results of a 10-week study that included the analysis of 164 wastewater samples for astrovirus, rotavirus, and sapovirus in 10 preK-12 schools, 6 wastewater treatment plants, and 2 lift stations using newly designed RT-ddPCR assays. We show that the RT-ddPCR assays were able to detect astrovirus, rotavirus, and sapovirus in school, lift station, and wastewater treatment plant (WWTP) wastewater, and that a positive detection of a virus in a school sample was paired with a positive detection of the same virus at a downstream lift station or wastewater treatment plant over 97 % of the time. Additionally, we show how wastewater detections of rotavirus in schools and WWTPs were significantly associated with citywide viral intestinal infections. School wastewater can play a role in the monitoring of enteric viruses and in the detection of outbreaks, potentially allowing public health officials to quickly implement mitigation strategies to prevent viral spread into surrounding communities.
Collapse
Affiliation(s)
- Madeline Wolken
- Department of Civil and Environmental Engineering, Rice University, 6100 Main Street MS-519, Houston, TX, United States of America
| | - Michael Wang
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX, United States of America
| | - Julia Schedler
- Department of Statistics, Rice University, 6100 Main Street MS 138, Houston, TX, United States of America
| | - Roberto H Campos
- Department of Civil and Environmental Engineering, Rice University, 6100 Main Street MS-519, Houston, TX, United States of America
| | - Katherine Ensor
- Department of Statistics, Rice University, 6100 Main Street MS 138, Houston, TX, United States of America
| | - Loren Hopkins
- Department of Statistics, Rice University, 6100 Main Street MS 138, Houston, TX, United States of America; Houston Health Department, 8000 N. Stadium Dr., Houston, TX, United States of America
| | - Todd Treangen
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX, United States of America; Department of Computer Science, Rice University, 6100 Main Street, Houston, TX, United States of America
| | - Lauren B Stadler
- Department of Civil and Environmental Engineering, Rice University, 6100 Main Street MS-519, Houston, TX, United States of America.
| |
Collapse
|
4
|
Mertens A, Arnold BF, Benjamin-Chung J, Boehm AB, Brown J, Capone D, Clasen T, Fuhrmeister ER, Grembi JA, Holcomb D, Knee J, Kwong LH, Lin A, Luby SP, Nala R, Nelson K, Njenga SM, Null C, Pickering AJ, Rahman M, Reese HE, Steinbaum L, Stewart JR, Thilakaratne R, Cumming O, Colford JM, Ercumen A. Is detection of enteropathogens and human or animal faecal markers in the environment associated with subsequent child enteric infections and growth: an individual participant data meta-analysis. Lancet Glob Health 2024; 12:e433-e444. [PMID: 38365415 PMCID: PMC10882208 DOI: 10.1016/s2214-109x(23)00563-6] [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: 01/06/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Quantifying contributions of environmental faecal contamination to child diarrhoea and growth faltering can illuminate causal mechanisms behind modest health benefits in recent water, sanitation, and hygiene (WASH) trials. We aimed to assess associations between environmental detection of enteropathogens and human or animal microbial source tracking markers (MSTM) and subsequent child health outcomes. METHODS In this individual participant data meta-analysis we searched we searched PubMed, Embase, CAB Direct Global Health, Agricultural and Environmental Science Database, Web of Science, and Scopus for WASH intervention studies with a prospective design and concurrent control that measured enteropathogens or MSTM in environmental samples, or both, and subsequently measured enteric infections, diarrhoea, or height-for-age Z-scores (HAZ) in children younger than 5 years. We excluded studies that only measured faecal indicator bacteria. The initial search was done on Jan 19, 2021, and updated on March 22, 2023. One reviewer (AM) screened abstracts, and two independent reviewers (AM and RT) examined the full texts of short-listed articles. All included studies include at least one author that also contributed as an author to the present Article. Our primary outcomes were the 7-day prevalence of caregiver-reported diarrhoea and HAZ in children. For specific enteropathogens in the environment, primary outcomes also included subsequent child infection with the same pathogen ascertained by stool testing. We estimated associations using covariate-adjusted regressions and pooled estimates across studies. FINDINGS Data from nine published reports from five interventions studies, which included 8603 children (4302 girls and 4301 boys), were included in the meta-analysis. Environmental pathogen detection was associated with increased infection prevalence with the same pathogen and lower HAZ (ΔHAZ -0·09 [95% CI -0·17 to -0·01]) but not diarrhoea (prevalence ratio 1·22 [95% CI 0·95 to 1·58]), except during wet seasons. Detection of MSTM was not associated with diarrhoea (no pooled estimate) or HAZ (ΔHAZ -0·01 [-0·13 to 0·11] for human markers and ΔHAZ -0·02 [-0·24 to 0·21] for animal markers). Soil, children's hands, and stored drinking water were major transmission pathways. INTERPRETATION Our findings support a causal chain from pathogens in the environment to infection to growth faltering, indicating that the lack of WASH intervention effects on child growth might stem from insufficient reductions in environmental pathogen prevalence. Studies measuring enteropathogens in the environment should subsequently measure the same pathogens in stool to further examine theories of change between WASH, faecal contamination, and health. Given that environmental pathogen detection was predictive of infection, programmes targeting specific pathogens (eg, vaccinations and elimination efforts) can environmentally monitor the pathogens of interest for population-level surveillance instead of collecting individual biospecimens. FUNDING The Bill & Melinda Gates Foundation and the UK Foreign and Commonwealth Development Office.
Collapse
Affiliation(s)
- Andrew Mertens
- Division of Epidemiology, University of California, Berkeley, CA, USA; Division of Biostatistics, University of California, Berkeley, CA, USA.
| | - Benjamin F Arnold
- Francis I Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Alexandria B Boehm
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Joe Brown
- Department of Environmental Science and Engineering, University of North Carolina, Gillings School of Global Public Health, Michael Hooker Research Center, Chapel Hill, NC, USA
| | - Drew Capone
- Department of Environmental and Occupational Health, Indiana University, Bloomington, IN, USA
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Erica R Fuhrmeister
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | | | - David Holcomb
- Department of Environmental Science and Engineering, University of North Carolina, Gillings School of Global Public Health, Michael Hooker Research Center, Chapel Hill, NC, USA
| | - Jackie Knee
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - Laura H Kwong
- Division of Environmental Health Sciences, University of California, Berkeley, CA, USA
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Rassul Nala
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Kara Nelson
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | | | | | - Amy J Pickering
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, Dhaka, Bangladesh
| | - Heather E Reese
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren Steinbaum
- California Department of Toxic Substances Control, Sacramento, CA, USA
| | - Jill R Stewart
- Department of Environmental Science and Engineering, University of North Carolina, Gillings School of Global Public Health, Michael Hooker Research Center, Chapel Hill, NC, USA
| | | | - Oliver Cumming
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - John M Colford
- Division of Epidemiology, University of California, Berkeley, CA, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
| |
Collapse
|
5
|
Dominguez-Salas P, Waddington HS, Grace D, Bosire C, Moodley A, Kulkarni B, Dasi T, Banjara SK, Kumar RN, Fahmida U, Htet MK, Sudibya ARP, Faye B, Tine RC, Heffernan C, Saxena D, Dreibelbis R, Häsler B. Understanding the role of household hygiene practices and foodborne disease risks in child stunting: a UKRI GCRF Action Against Stunting Hub protocol paper. BMJ Paediatr Open 2024; 8:e001695. [PMID: 38417924 PMCID: PMC10900323 DOI: 10.1136/bmjpo-2022-001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/20/2023] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Environmental hygiene and food safety are important determinants of child stunting. This research aims to explore the relationship between child stunting and household hygiene practices and behaviours, including the availability of water, sanitation and hygiene (WASH) facilities; the use of safe food and good quality drinking water (especially when used for complementary feeding); hygienic practices in food transport, storage and preparation and the control of cross-contamination from animals, their produce and waste. METHODS AND ANALYSIS This study is part of a wider observational study which aims to investigate the interdisciplinary factors contributing to child stunting using a 'whole child' paradigm. The observational study recruits women during pregnancy in Hyderabad, India, Lombok, Indonesia and Kaffrine, Senegal, and dyads (ie, 500 mother-infant pairs per country) are followed longitudinally up to 24 months after birth. Within the interdisciplinary niche, the study here has developed tools to investigate the potential exposure pathways to environmental pathogen contamination of foods and water. Holistic WASH and food safety data collection tools have been developed to explore exposure pathways at the household level, including: (1) survey questionnaires; (2) spot-checks; (3) biological sampling of drinking water, food and domestic surfaces and (4) direct observation. An integrated analytical approach will be used to triangulate the evidence in order to examine the relationships between child stunting, WASH and food safety behaviours. ETHICS AND DISSEMINATION Ethical approval of the study was granted by the ethics committee of the LSHTM, RVC, ILRI, ICMR, IIPHG, SEAMEO-RECFON, University of Cheikh Anta Diop. Findings of the study will be disseminated through publication in peer-reviewed journals, relevant international conferences, public engagement events, and policy-maker and stakeholder events.
Collapse
Affiliation(s)
- Paula Dominguez-Salas
- National Resources Institute, University of Greenwich, London, UK
- Policies, Institutions and Livelihoods Programme, International Livestock Research Institute (ILRI), Nairobi, Kenya, Nairobi, Kenya
| | - Hugh Sharma Waddington
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Delia Grace
- National Resources Institute, University of Greenwich, London, UK
- Animal and Human Health Programme, International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Caroline Bosire
- Animal and Human Health Programme, International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Arshnee Moodley
- CGIAR Antimicrobial Resistance Hub, International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Bharati Kulkarni
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, Telangana, India
| | - Teena Dasi
- National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, Telangana, India
| | | | | | - Umi Fahmida
- Southeast Asian Ministry of Education Organisation Regional Centre for Food and Nutrition (SEAMEO RECFON), East Jakarta, Indonesia
| | - Min Kyaw Htet
- Southeast Asian Ministry of Education Organisation Regional Centre for Food and Nutrition (SEAMEO RECFON), East Jakarta, Indonesia
| | - Arienta R P Sudibya
- Southeast Asian Ministry of Education Organisation Regional Centre for Food and Nutrition (SEAMEO RECFON), East Jakarta, Indonesia
| | - Babacar Faye
- Department of Parasitology, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
| | - Roger C Tine
- Department of Parasitology-Mycology, University of Cheikh Anta DIOP, Dakar, Senegal
| | - Claire Heffernan
- Department of Pathobiology and Population Sciences, University of London, London, UK
- London International Development Centre, London, UK
| | - Deepak Saxena
- Public Health Foundation, Indian Institute of Public Health Gandhinagar (IIPHG), New Delhi, Delhi, India
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - B Häsler
- Department of Pathobiology and Population Sciences, Royal Veterinary College (RVC), Hatfield, UK
| |
Collapse
|
6
|
Holcomb DA, Monteiro V, Capone D, António V, Chiluvane M, Cumbane V, Ismael N, Knee J, Kowalsky E, Lai A, Linden Y, Mataveia E, Nala R, Rao G, Ribeiro J, Cumming O, Viegas E, Brown J. Long-term impacts of an urban sanitation intervention on enteric pathogens in children in Maputo city, Mozambique: study protocol for a cross-sectional follow-up to the Maputo Sanitation (MapSan) trial 5 years postintervention. BMJ Open 2023; 13:e067941. [PMID: 37290945 PMCID: PMC10254709 DOI: 10.1136/bmjopen-2022-067941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION We previously assessed the effect of an onsite sanitation intervention in informal neighbourhoods of urban Maputo, Mozambique on enteric pathogen detection in children after 2 years of follow-up (Maputo Sanitation (MapSan) trial, ClinicalTrials.gov: NCT02362932). We found significant reductions in Shigella and Trichuris prevalence but only among children born after the intervention was delivered. In this study, we assess the health impacts of the sanitation intervention after 5 years among children born into study households postintervention. METHODS AND ANALYSIS We are conducting a cross-sectional household study of enteric pathogen detection in child stool and the environment at compounds (household clusters sharing sanitation and outdoor living space) that received the pour-flush toilet and septic tank intervention at least 5 years prior or meet the original criteria for trial control sites. We are enrolling at least 400 children (ages 29 days to 60 months) in each treatment arm. Our primary outcome is the prevalence of 22 bacterial, protozoan, and soil transmitted helminth enteric pathogens in child stool using the pooled prevalence ratio across the outcome set to assess the overall intervention effect. Secondary outcomes include the individual pathogen detection prevalence and gene copy density of 27 enteric pathogens (including viruses); mean height-for-age, weight-for-age, and weight-for-height z-scores; prevalence of stunting, underweight, and wasting; and the 7-day period prevalence of caregiver-reported diarrhoea. All analyses are adjusted for prespecified covariates and examined for effect measure modification by age. Environmental samples from study households and the public domain are assessed for pathogens and faecal indicators to explore environmental exposures and monitor disease transmission. ETHICS AND DISSEMINATION Study protocols have been reviewed and approved by human subjects review boards at the Ministry of Health, Republic of Mozambique and the University of North Carolina at Chapel Hill. Deidentified study data will be deposited at https://osf.io/e7pvk/. TRIAL REGISTRATION NUMBER ISRCTN86084138.
Collapse
Affiliation(s)
- David A Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Vanessa Monteiro
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Drew Capone
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Virgílio António
- Division of Biotechnology and Genetics, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Márcia Chiluvane
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Victória Cumbane
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Nália Ismael
- Division of Biotechnology and Genetics, Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Jackie Knee
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Erin Kowalsky
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amanda Lai
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yarrow Linden
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elly Mataveia
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Rassul Nala
- Division of Parasitology, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Gouthami Rao
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jorge Ribeiro
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Edna Viegas
- Centro de Investigação e Treino em Saúde da Polana Caniço, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
7
|
Gunjyal N, Singh G, Ojha CSP. Elevated levels of anthropogenic antibiotic resistance gene marker, sul1, linked with extreme fecal contamination and poor water quality in wastewater-receiving ponds. JOURNAL OF ENVIRONMENTAL QUALITY 2023; 52:652-664. [PMID: 36716263 DOI: 10.1002/jeq2.20453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/12/2023] [Indexed: 05/06/2023]
Abstract
In several low- and middle-income countries, such as India, the rapid construction of toilets to combat open defecation has not been matched with adequate wastewater treatment, resulting in extreme fecal contamination of the receiving environments. The sewage-receiving surface water bodies, typically close to the residences, are a potential hotspot for disease transmission and antibiotic resistance. Water, soil, and sediment samples from seven wastewater-receiving ponds (WRPs) were analyzed for water quality, chlorophyll-a, fecal contamination (yccT for Escherichia coli), 16S rRNA gene copies, and anthropogenic antibiotic resistance gene markers-sul1 and intI1. These WRPs were contrasted with two ponds that did not directly receive sewage. The water quality in the WRPs was comparable to raw sewage (BOD: 210-380 mg/L; COD: 350-630 mg/L; total-N: 100-190 mg/L; and total-P: 6-21 mg/L), and the relative levels of the DNA marker of E. coli were very high (yccT: 0.1% to ∼100% of total bacterial count) indicating extreme fecal contamination. The relative levels of sul1 and intI1 were 1-3 orders of magnitude higher in WRPs (sul1: 0.32%-10% of total bacterial count; and intI1: 0.2%-5% of total bacterial count) compared to the ponds that did not receive sewage directly. The relative levels of sul1 correlated with the DNA marker for the fecal indicator, E. coli (p-value < 0.05; r = 0.50; Spearman's rank correlation), and poor water quality.
Collapse
Affiliation(s)
- Neelam Gunjyal
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Gargi Singh
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | | |
Collapse
|
8
|
Eifan S, Maniah K, Nour I, Hanif A, Yassin MT, Al-Ashkar I, Abid I. Pepper Mild Mottle Virus as a Potential Indicator of Fecal Contamination in Influents of Wastewater Treatment Plants in Riyadh, Saudi Arabia. Microorganisms 2023; 11:microorganisms11041038. [PMID: 37110461 PMCID: PMC10144068 DOI: 10.3390/microorganisms11041038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Several indicators of fecal pollution in water resources are continuously monitored for their reliability and, of particular interest, their correlation to human enteric viruses-not justified by traditional bacterial indicators. Pepper mild mottle virus (PMMoV) has recently been proposed as a successful viral surrogate of human waterborne viruses; however, in Saudi Arabia there are no available data in terms of its prevalence and concentration in water bodies. The concentration of PMMoV in three different wastewater treatment plants (King Saud University (KSU), Manfoha (MN), and Embassy (EMB) wastewater treatment plants (WWTP)) was measured using qRT-PCR during a one-year period and compared to the human adenovirus (HAdV), which is highly persistent and considered an indicator for viral-mediated fecal contamination. PMMoV was found in ~94% of the entire wastewater samples (91.6-100%), with concentrations ranging from 62 to 3.5 × 107 genome copies/l (GC/l). However, HAdV was detected in 75% of raw water samples (~67-83%). The HAdV concentration ranged between 1.29 × 103 GC/L and 1.26 × 107 GC/L. Higher positive correlation between PMMoV and HAdV concentrations was detected at MN-WWTP (r = 0.6148) than at EMB-WWTP (r = 0.207). Despite the lack of PMMoV and HAdV seasonality, a higher positive correlation (r = 0.918) of PMMoV to HAdV was recorded at KSU-WWTP in comparison to EMB-WWTP (r = 0.6401) around the different seasons. Furthermore, meteorological factors showed no significant influence on PMMoV concentrations (p > 0.05), thus supporting the use of PMMoV as a possible fecal indicator of wastewater contamination and associated public health issues, particularly at MN-WWTP. However, a continuous monitoring of the PMMoV distribution pattern and concentration in other aquatic environments, as well as its correlation to other significant human enteric viruses, is essential for ensuring its reliability and reproducibility as a fecal pollution indicator.
Collapse
Affiliation(s)
- Saleh Eifan
- Botany and Microbiology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Khalid Maniah
- Botany and Microbiology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Islam Nour
- Botany and Microbiology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Atif Hanif
- Botany and Microbiology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohamed Taha Yassin
- Botany and Microbiology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ibrahim Al-Ashkar
- Department of Plant Production, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Islem Abid
- Botany and Microbiology Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| |
Collapse
|
9
|
Hussein ND, Hassan JW, Osman M, El-Omari K, Kharroubi SA, Toufeili I, Kassem II. Assessment of the Microbiological Acceptability of White Cheese (Akkawi) in Lebanon and the Antimicrobial Resistance Profiles of Associated Escherichia coli. Antibiotics (Basel) 2023; 12:antibiotics12030610. [PMID: 36978477 PMCID: PMC10044863 DOI: 10.3390/antibiotics12030610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Dairy foods are a staple in Lebanon, a low- and middle-income country that has been experiencing serious challenges to food safety and antimicrobial stewardship among other issues. The microbiological acceptability of dairy products has been of increasing concern. This is partially due to the failing economy and prolonged power outages that affect the quality of raw material and disrupt the dairy cold chain, respectively. Therefore, we assessed the microbiological acceptability of Akkawi, a popular white-brined cheese in Lebanon. For this purpose, we quantified the densities of Escherichia coli (a fecal indicator) and Staphylococcus aureus in cheeses collected from Lebanese retail stores. Additionally, we evaluated the antibiotic resistance profiles of the E. coli isolated from the cheese. E. coli and S. aureus were detected in 40 (80%) and 16 (32%) of the 50 cheese samples, respectively. Notably, 40 (80%) and 16 (32%) of the samples exceeded the maximum permissible limit of E. coli and S. aureus, respectively. A high percentage of the 118 E. coli isolated from the cheeses showed resistance to clinically and agriculturally important antibiotics, while 89 (75%) isolates were classified as multidrug-resistant (MDR). Given that Akkawi can be consumed without cooking, our findings highlight serious food safety and antimicrobial resistance problems that require immediate interventions.
Collapse
Affiliation(s)
- Nasri Daher Hussein
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon
| | - Jouman W. Hassan
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223, USA
| | - Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY 14853, USA
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Khaled El-Omari
- Quality Control Center Laboratories at the Chamber of Commerce, Industry & Agriculture of Tripoli & North Lebanon, Tripoli 1300, Lebanon
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli 1300, Lebanon
| | - Samer A. Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon
| | - Imad Toufeili
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut (AUB), Beirut 1107 2020, Lebanon
| | - Issmat I. Kassem
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, 1109 Experiment Street, Griffin, GA 30223, USA
- Correspondence:
| |
Collapse
|
10
|
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
|
11
|
Lv B, Zhu G, Tian W, Guo C, Lu X, Han Y, An T, Cui Y, Jiang T. The prevalence of potential pathogens in ballast water and sediments of oceangoing vessels and implications for management. ENVIRONMENTAL RESEARCH 2023; 218:114990. [PMID: 36463990 DOI: 10.1016/j.envres.2022.114990] [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: 09/02/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Ballast water and sediments can serve as prominent vectors for the widespread dispersal of pathogens between geographically distant areas. However, information regarding the diversity and distribution of the bacterial pathogens in ballast water and sediments is highly limited. In this study, using high-throughput sequencing and quantitative PCR, we investigated the composition and abundance of potential pathogens, and their associations with indicator microorganisms. We accordingly detected 48 potential bacterial pathogens in the assessed ballast water and sediments, among which there were significant differences in the compositions and abundances of pathogenic bacterial communities characterizing ballast water and sediments. Rhodococcus erythropolis, Bacteroides vulgatus, and Vibrio campbellii were identified as predominant pathogens in ballast water, whereas Pseudomonas stutzeri, Mycobacterium paragordonae, and Bacillus anthracis predominated in ballast sediments. Bacteroidetes, Vibrio alginolyticus, Vibrio parahaemolyticus, and Escherichia coli were generally detected with median values of 8.54 × 103-1.22 × 107 gene copies (GC)/100 mL and 1.16 × 107-3.97 × 109 GC/100 g in ballast water and sediments, respectively. Notably, the concentrations of Shigella sp., Staphylococcus aureus, and V. alginolyticus were significantly higher in ballast sediments than in the water. In addition, our findings tend to confirm that the indicator species specified by the International Maritime Organization (IMO) might underestimate the pathogen risk in the ballast water and sediments, as these bacteria were unable to predict some potential pathogens assessed in this study. In summary, this study provides a comprehensive insight into the spectrum of the potential pathogens that transferred by ship ballast tanks and emphasizes the need for the implementation of IMO convention on ballast sediment management.
Collapse
Affiliation(s)
- Baoyi Lv
- International Joint Research Center for Persistent Toxic Substances (IJRC-PTS), College of Ocean Science and Engineering, Shanghai Maritime University, Shanghai, 201306, China.
| | - Guorong Zhu
- International Joint Research Center for Persistent Toxic Substances (IJRC-PTS), College of Ocean Science and Engineering, Shanghai Maritime University, Shanghai, 201306, China
| | - Wen Tian
- Jiangyin Customs, Jiangyin, 214400, China
| | - Chong Guo
- Maritime Safety Bureau of Yangshan Port, Shanghai, 201306, China
| | - Xiaolan Lu
- International Joint Research Center for Persistent Toxic Substances (IJRC-PTS), College of Ocean Science and Engineering, Shanghai Maritime University, Shanghai, 201306, China
| | - Yangchun Han
- Maritime Safety Bureau of Yangshan Port, Shanghai, 201306, China
| | - Tingxuan An
- International Joint Research Center for Persistent Toxic Substances (IJRC-PTS), College of Ocean Science and Engineering, Shanghai Maritime University, Shanghai, 201306, China
| | - Yuxue Cui
- Shanghai Engineering Research Center of Biotransformation of Organic Solid Waste, School of Ecology and Environmental Sciences, East China Normal University, Shanghai, 200241, China
| | - Ting Jiang
- International Joint Research Center for Persistent Toxic Substances (IJRC-PTS), College of Ocean Science and Engineering, Shanghai Maritime University, Shanghai, 201306, China
| |
Collapse
|
12
|
Capone D, Adriano Z, Cumming O, Irish SR, Knee J, Nala R, Brown J. Urban Onsite Sanitation Upgrades and Synanthropic Flies in Maputo, Mozambique: Effects on Enteric Pathogen Infection Risks. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:549-560. [PMID: 36516327 PMCID: PMC9835884 DOI: 10.1021/acs.est.2c06864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Synanthropic filth flies transport enteric pathogens from feces to food, which upon consumption poses an infection risk. We evaluated the effect of an onsite sanitation intervention─including fly control measures─in Maputo, Mozambique, on the risk of infection from consuming fly-contaminated food. After enumerating flies at intervention and control sites, we cultured fecal indicator bacteria, quantified gene copies for 22 enteric pathogens via reverse transcription quantitative polymerase chain reaction (RT-qPCR), and developed quantitative microbial risk assessment (QMRA) models to estimate annual risks of infection attributable to fly-contaminated foods. We found that the intervention reduced fly counts at latrine entrances by 69% (aRR = 0.31, [0.13, 0.75]) but not at food preparation areas (aRR = 0.92, [0.33, 2.6]). Half of (23/46) of individual flies were positive for culturable Escherichia coli, and we detected ≥1 pathogen gene from 45% (79/176) of flies, including enteropathogenic E. coli (37/176), adenovirus (25/176), Giardia spp. (13/176), and Trichuris trichiura (12/176). We detected ≥1 pathogen gene from half the flies caught in control (54%, 30/56) and intervention compounds (50%, 17/34) at baseline, which decreased 12 months post-intervention to 43% (23/53) at control compounds and 27% (9/33) for intervention compounds. These data indicate flies as a potentially important mechanical vector for enteric pathogen transmission in this setting. The intervention may have reduced the risk of fly-mediated enteric infection for some pathogens, but infrequent detection resulted in wide confidence intervals; we observed no apparent difference in infection risk between groups in a pooled estimate of all pathogens assessed (aRR = 0.84, [0.61, 1.2]). The infection risks posed by flies suggest that the design of sanitation systems and service delivery should include fly control measures to prevent enteric pathogen transmission.
Collapse
Affiliation(s)
- Drew Capone
- Department
of Environmental and Occupational Health, School of Public Health, Indiana University, 2719 E 10th St, Bloomington, Indiana47401, United States
| | - Zaida Adriano
- WE
Consult ltd, 177 Rua
Tomas Ribeiro, Maputo1102, Mozambique
| | - Oliver Cumming
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, LondonWC1E 7HT, United
Kingdom
| | - Seth R. Irish
- Epidemiology
and Public Health Department, Swiss Tropical
and Public Health Institute, Kreuzstrasse 2, Allschwil4123, Switzerland
| | - Jackie Knee
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, LondonWC1E 7HT, United
Kingdom
| | - Rassul Nala
- Ministério
da Saúde, Instituto Nacional de Saúde
Maputo, Maputo1102, Mozambique
| | - Joe Brown
- Department
of Environmental Sciences and Engineering, Gillings School of Public
Health, University of North Carolina at
Chapel Hill, Chapel
Hill, North Carolina27599, United States
| |
Collapse
|
13
|
Brouwer AF, Eisenberg MC, Bakker KM, Boerger SN, Zahid MH, Freeman MC, Eisenberg JNS. Leveraging infectious disease models to interpret randomized controlled trials: Controlling enteric pathogen transmission through water, sanitation, and hygiene interventions. PLoS Comput Biol 2022; 18:e1010748. [DOI: 10.1371/journal.pcbi.1010748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 12/15/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Randomized controlled trials (RCTs) evaluate hypotheses in specific contexts and are often considered the gold standard of evidence for infectious disease interventions, but their results cannot immediately generalize to other contexts (e.g., different populations, interventions, or disease burdens). Mechanistic models are one approach to generalizing findings between contexts, but infectious disease transmission models (IDTMs) are not immediately suited for analyzing RCTs, since they often rely on time-series surveillance data. We developed an IDTM framework to explain relative risk outcomes of an infectious disease RCT and applied it to a water, sanitation, and hygiene (WASH) RCT. This model can generalize the RCT results to other contexts and conditions. We developed this compartmental IDTM framework to account for key WASH RCT factors: i) transmission across multiple environmental pathways, ii) multiple interventions applied individually and in combination, iii) adherence to interventions or preexisting conditions, and iv) the impact of individuals not enrolled in the study. We employed a hybrid sampling and estimation framework to obtain posterior estimates of mechanistic parameter sets consistent with empirical outcomes. We illustrated our model using WASH Benefits Bangladesh RCT data (n = 17,187). Our model reproduced reported diarrheal prevalence in this RCT. The baseline estimate of the basic reproduction number R 0 for the control arm (1.10, 95% CrI: 1.07, 1.16) corresponded to an endemic prevalence of 9.5% (95% CrI: 7.4, 13.7%) in the absence of interventions or preexisting WASH conditions. No single pathway was likely able to sustain transmission: pathway-specific R 0 s for water, fomites, and all other pathways were 0.42 (95% CrI: 0.03, 0.97), 0.20 (95% CrI: 0.02, 0.59), and 0.48 (95% CrI: 0.02, 0.94), respectively. An IDTM approach to evaluating RCTs can complement RCT analysis by providing a rigorous framework for generating data-driven hypotheses that explain trial findings, particularly unexpected null results, opening up existing data to deeper epidemiological understanding.
Collapse
|
14
|
Lowe J, Ercumen A, Prottas C, Harris AR. Exploring the determinants and indicators of poultry feces management behaviors in rural Western Uganda. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 834:155202. [PMID: 35421491 DOI: 10.1016/j.scitotenv.2022.155202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
Animal ownership has reported financial and nutritional benefits but has also been associated with enteric and respiratory infections, and inadequate sanitation and hygiene can lead to children touching and ingesting animal fecal matter. We identified key indicators for poultry feces management and investigated their social determinants using data from a baseline survey of a randomized-controlled trial of a poultry management training program in rural Western Uganda. The baseline survey was conducted in the Masindi and Kiryandongo districts of Uganda in September 2019, and data collected from 609 households were used. We evaluated indicators for poultry feces management behaviors using scale development methods, including descriptive statistics, bivariate correlation analyses, and Factor Analysis of Mixed Data. We also investigated social determinants of key poultry feces management behaviors using logistic and multinomial logistic regression models. A significant increase in odds of having free-roaming poultry was found for each additional poultry owned (OR = 1.18, P < 0.001). The odds of a household having an observed enclosure for poultry increased by 5% with each incremental poultry owned (OR = 1.05, P < 0.001), and by 4% with increasing wealth with each additional point on the poverty probability index score (OR = 1.04, P < 0.001). Our results also suggest enclosures are intermittently used and constructing them without further intervention likely will not be sufficient for effectively managing animal fecal contamination. We recommend that future studies on animal feces management measure indicators for corralling and feces disposal practices and evaluate their relationship to enteric pathogen exposure and health outcomes. Insights from this work can inform the development of robust indicators of poultry feces management behaviors that can be used for monitoring and evaluation purposes.
Collapse
Affiliation(s)
- Jeremy Lowe
- Department of Civil, Construction, and Environmental Engineering, NC State University, Raleigh, NC, United States.
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, NC State University, Raleigh, NC, United States.
| | | | - Angela R Harris
- Department of Civil, Construction, and Environmental Engineering, NC State University, Raleigh, NC, United States.
| |
Collapse
|
15
|
Contreras JD, Islam M, Mertens A, Pickering AJ, Kwong LH, Arnold BF, Benjamin-Chung J, Hubbard AE, Alam M, Sen D, Islam S, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Influence of community-level sanitation coverage and population density on environmental fecal contamination and child health in a longitudinal cohort in rural Bangladesh. Int J Hyg Environ Health 2022; 245:114031. [PMID: 36058111 PMCID: PMC9489923 DOI: 10.1016/j.ijheh.2022.114031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/15/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Household-level sanitation interventions have had limited effects on child health or environmental contamination, potentially due to low community coverage. Higher community-level coverage with safely managed sanitation can reduce opportunities for disease transmission. METHODS We estimated associations between community sanitation coverage, environmental fecal contamination, and child health among 360 compounds in the control arm of the WASH Benefits trial in rural Bangladesh (NCT01590095). In each compound, we enumerated E. coli in environmental samples and recorded the 7-day prevalence of caregiver-reported diarrheal disease and acute respiratory infections (ARI) in children under five. We observed indicators of latrine access and quality among all neighboring compounds within 100 m of study compounds. We defined community coverage as the proportion of neighboring compounds with (1) at least one latrine, and (2) exclusively hygienic latrines (improved facility observed to safely contain feces), within both 50 m and 100 m of study compounds. We assessed effect modification by population density and season. RESULTS Adjusted for confounders, study compounds surrounded by 100% coverage of at least one latrine per compound within 50 m had slightly lower log10E. coli counts in stored water (Δlog = -0.13, 95% CI -0.26, -0.01), child hand rinses (Δlog = -0.13, 95% CI -0.24, -0.02), and caregiver hand rinses (Δlog = -0.16, 95% CI -0.29, -0.03) and marginally lower prevalence of diarrheal disease (prevalence ratio [PR] = 0.82, 95% CI 0.64, 1.04) and ARI (PR = 0.84, 95% CI 0.69, 1.03) compared to compounds surrounded by <100% coverage. Effects were similar but less pronounced at 100 m. At higher population densities, community latrine coverage was associated with larger reductions in E. coli on child and caregiver hands and prevalence of diarrheal disease. Coverage with exclusively hygienic latrines was not associated with any outcome. CONCLUSION Higher community sanitation coverage was associated with reduced fecal contamination and improved child health, with stronger effects at highly local scales (50m) and at high population densities. Our findings indicate that the relationship between community sanitation coverage, environmental contamination, and child health varies by definition of coverage, distance, and population density. This work highlights significant uncertainty around how to best measure sanitation coverage and the expected health effects of increasing sanitation coverage using a specific metric. Better understanding of community-level sanitation access is needed to inform policy for implementing sanitation systems that effectively protect community health.
Collapse
Affiliation(s)
- Jesse D Contreras
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, 27695, United States
| | - Mahfuza Islam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Laura H Kwong
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, 94158, United States
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, 94304, United States
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Mahfuja Alam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Debashis Sen
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Sharmin Islam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, 94305, United States
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, 27695, United States.
| |
Collapse
|
16
|
Bottled and Well Water Quality in a Small Central Appalachian Community: Household-Level Analysis of Enteric Pathogens, Inorganic Chemicals, and Health Outcomes in Rural Southwest Virginia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148610. [PMID: 35886462 PMCID: PMC9319903 DOI: 10.3390/ijerph19148610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023]
Abstract
Consumption of unsafe drinking water is associated with a substantial burden of disease globally. In the US, ~1.8 million people in rural areas lack reliable access to safe drinking water. Our objective was to characterize and assess household-level water sources, water quality, and associated health outcomes in Central Appalachia. We collected survey data and water samples (tap, source, and bottled water) from consenting households in a small rural community without utility-supplied water in southwest Virginia. Water samples were analyzed for physicochemical parameters, total coliforms, E. coli, nitrate, sulfate, metals (e.g., arsenic, cadmium, lead), and 30+ enteric pathogens. Among the 69% (n = 9) of households that participated, all had piped well water, though 67% (n = 6) used bottled water as their primary drinking water source. Total coliforms were detected in water samples from 44.4% (n = 4) of homes, E. coli in one home, and enteric pathogens (Aeromonas, Campylobacter, Enterobacter) in 33% (n = 3) of homes. Tap water samples from 11% (n = 1) of homes exceeded the EPA MCL for nitrate, and 33% (n = 3) exceeded the EPA SMCL for iron. Among the 19 individuals residing in study households, reported diarrhea was 25% more likely in homes with measured E. coli and/or specific pathogens (risk ratio = 1.25, cluster-robust standard error = 1.64, p = 0.865). Although our sample size was small, our findings suggest that a considerable number of lower-income residents without utility-supplied water in rural areas of southwest Virginia may be exposed to microbiological and/or chemical contaminants in their water, and many, if not most, rely on bottled water as their primary source of drinking water.
Collapse
|
17
|
Gizaw Z, Yalew AW, Bitew BD, Lee J, Bisesi M. Effects of local handwashing agents on microbial contamination of the hands in a rural setting in Northwest Ethiopia: a cluster randomised controlled trial. BMJ Open 2022; 12:e056411. [PMID: 35568490 PMCID: PMC9109095 DOI: 10.1136/bmjopen-2021-056411] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 04/26/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of handwashing with water and wood ash in reducing faecal contamination of the hands. DESIGN A cluster randomised controlled trial was employed with two arms: handwashing with water and wood ash versus handwashing with water alone. SETTING Rural households of East Dembiya District, Central Gondar Zone, Amhara National Regional State, Ethiopia. PARTICIPANTS 440 mothers and caregivers of children younger than 5 years assigned (1:1, 220 in each group) in clusters, with buffer zones between each cluster. INTERVENTION Health education on effective handwashing was given to the intervention and control groups. Participants in the intervention group used wood ash of the same quantity (ie, one closed palm). OUTCOME MEASURES The primary outcome was microbial contamination of the hands, measured by means of Escherichia coli counts before and after handwashing. RESULTS At baseline, 75.9% and 67.7% of the participants in the intervention and control groups, respectively, had dirt on their fingernails, and the hands of all participants in both groups were contaminated with E. coli. The mean E. coli counts recovered at baseline were 3.07 log10 colony forming unit (CFU)/swab in the intervention group and 3.03 log10 CFU/swab in the control group, while at endline it was 1.4 log10 CFU/swab in the intervention group and 3.02 log10 CFU/swab in the control group. The mean E.coli counts was reduced by 1.65 log10 due to the intervention (difference-in-differences: β= -1.65, 95% CI= -1.84 to -1.46). CONCLUSION Two-thirds of the swab samples tested positive for E. coli after handwashing with water and wood ash, which indicates wood ash is not very effective in terms of completely removing micro-organisms on the hands. However, wood ash was significantly better than water alone in reducing the concentration of faecal coliform organisms on the hands. Local health authorities should primarily promote handwashing with soap. However, in the absence of soap, use of wood ash over water alone might be appropriate. TRIAL REGISTRATION NUMBER PACTR202011855730652.
Collapse
Affiliation(s)
- Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, University of Gondar, Gondar, Ethiopia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Global One Health Initiative (GOHi), the Ohio State University, Columbus, Ohio, USA
| | | | - Bikes Destaw Bitew
- Department of Environmental and Occupational Health and Safety, University of Gondar, Gondar, Ethiopia
| | - Jiyoung Lee
- Division of Environmental Health Sciences, The Ohio State University, Columbus, Ohio, USA
- Department of Food Science and Technology, The Ohio State University, Columbus, Ohio, USA
| | - Michael Bisesi
- Division of Environmental Health Sciences, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
18
|
Gizaw Z, Yalew AW, Bitew BD, Lee J, Bisesi M. Development and validation of questionnaire to assess exposure of children to enteric infections in the rural northwest Ethiopia. Sci Rep 2022; 12:6740. [PMID: 35468977 PMCID: PMC9039032 DOI: 10.1038/s41598-022-10811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/12/2022] [Indexed: 11/09/2022] Open
Abstract
In areas where children have multiple environmental exposures to enteric pathogens, identifying the sources of exposure by measuring external and internal exposures to enteric pathogens and complementing by questionnaire and observational checklist to capture behaviors resulting risk of exposure is critical. Accordingly, this study was conducted to design valid and reliable questionnaire to assess behaviors and environmental conditions resulting exposure to enteric pathogens in the rural northwest Ethiopia. We began with a thorough exploration of relevant literature to understand the theoretical framework on the research objectives to identify variables to highlight what the questionnaire is measuring. We then generated items in each domain that can effectively address the study objectives and we refined and organized the items in a suitable format. Then after, we conducted face and content validity by involving experts on the research subject. After pre-testing a pre-final version of the instrument generated in the content validity study, we conducted a pilot study in 150 randomly selected rural households to test the internal consistency reliability. We used content validity ratio (CVR), item-level content validity index (I-CVIs), scale-level content validity index (S-CVI/UA), and modified kappa statistics to measure content validity of items. Moreover, we used agreement and consistency indices (i.e., Cronbach's alpha) to assess the internal consistency of items. The content validity test result showed that the value of CVR was 0.95, I-CVIs was 0.97, and modified kappa was 0.97 for the whole items, indicating all the items are appropriate. The scale-level content validity index (S-CVI/UA) was 0.95 for the whole items indicating the agreement among judges to each items is higher. The internal consistency reliability test result indicated that Cronbach's alpha for the pre-final version of the pre-final tool was 0.85, indicating the strong reliability of the tool. The final version of the questionnaire was, therefore, prepared with 8 dimensions and 80 items. In this study, we designed valid and reliable questionnaire to assess behaviors and environmental conditions that result high risk of exposure to enteric infections in rural settings. The questionnaire can be used as a tool in the rural settings of developing countries with some amendments to account local contexts. However, this questionnaire alone does not measure exposure of children to enteric infections. It only complements external and internal exposure assessments.
Collapse
Affiliation(s)
- Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Addis Continental Institute of Public Health, Addis Ababa, Ethiopia. .,Global One Health Initiative (GOHi), the Ohio State University, Columbus, OH, USA.
| | | | - Bikes Destaw Bitew
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jiyoung Lee
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA.,Department of Food Science and Technology, The Ohio State University, Columbus, OH, USA
| | - Michael Bisesi
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH, 43210, USA
| |
Collapse
|
19
|
Sosa-Moreno A, Lee GO, Van Engen A, Sun K, Uruchima J, Kwong LH, Ludwig-Borycz E, Caruso BA, Cevallos W, Levy K, Eisenberg JNS. Characterizing Behaviors Associated with Enteric Pathogen Exposure among Infants in Rural Ecuador through Structured Observations. Am J Trop Med Hyg 2022; 106:tpmd211099. [PMID: 35405653 PMCID: PMC9209906 DOI: 10.4269/ajtmh.21-1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/31/2022] [Indexed: 11/07/2022] Open
Abstract
The relative importance of environmental pathways that results in enteropathogen transmission may vary by context. However, measurement of contact events between individuals and the environment remains a challenge, especially for infants and young children who may use their mouth and hands to explore their environment. Using a mixed-method approach, we combined 1) semistructured observations to characterize key behaviors associated with enteric pathogen exposure and 2) structured observations using Livetrak, a customized software application, to quantify the frequency and duration of contacts events among infants in rural Ecuador. After developing and iteratively piloting the structured observation instrument, we loaded the final list of prompts onto a LiveTrak pallet to assess environmental exposures of 6-month infants (N = 19) enrolled in a prospective cohort study of diarrheal disease. Here we provide a detailed account of the lessons learned. For example, in our field site, 1) most mothers reported washing their hands after diaper changes (14/18, 77.8%); however only a third (4/11, 36.4%) were observed washing their hands; 2) the observers noted that animal ownership differed from observed animal exposure because animals owned by neighboring households were reported during the observation; and 3) using Livetrak, we found that infants frequently mouthed their hands (median = 1.9 episodes/hour, median duration: 1.6 min) and mouthed surroundings objects (1.8 episodes/hour, 1.9 min). Structured observations that track events in real time, can complement environmental sampling, quantitative survey data and qualitative interviews. Customizing these observations enabled us to quantify enteric exposures most relevant to our rural Ecuadorian context.
Collapse
Affiliation(s)
| | - Gwenyth O. Lee
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Amanda Van Engen
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Kelly Sun
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jessica Uruchima
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Laura H. Kwong
- School of Public Health, University of California Berkeley, Berkeley, California
| | | | - Bethany A. Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington
| | | |
Collapse
|
20
|
Chua PLC, Ng CFS, Tobias A, Seposo XT, Hashizume M. Associations between ambient temperature and enteric infections by pathogen: a systematic review and meta-analysis. Lancet Planet Health 2022; 6:e202-e218. [PMID: 35278387 DOI: 10.1016/s2542-5196(22)00003-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Numerous studies have quantified the associations between ambient temperature and enteric infections, particularly all-cause enteric infections. However, the temperature sensitivity of enteric infections might be pathogen dependent. Here, we sought to identify pathogen-specific associations between ambient temperature and enteric infections. METHODS We did a systematic review and meta-analysis by searching PubMed, Web of Science, and Scopus for peer-reviewed research articles published from Jan 1, 2000, to Dec 31, 2019, and also hand searched reference lists of included articles and excluded reviews. We included studies that quantified the effects of ambient temperature increases on common pathogen-specific enteric infections in humans. We excluded studies that expressed ambient temperature as a categorical or diurnal range, or in a standardised format. Two authors screened the search results, one author extracted data from eligible studies, and four authors verified the data. We obtained the overall risks by pooling the relative risks of enteric infection by pathogen for each 1°C temperature rise using random-effects modelling and robust variance estimation for the correlated effect estimates. Between-study heterogeneity was measured using I2, τ2, and Q-statistic. Publication bias was determined using funnel plot asymmetry and the trim-and-fill method. Differences among pathogen-specific pooled estimates were determined using subgroup analysis of taxa-specific meta-analysis. The study protocol was not registered but followed the PRISMA guidelines. FINDINGS We identified 2981 articles via database searches and 57 articles from scanning reference lists of excluded reviews and included articles, of which 40 were eligible for pathogen-specific meta-analyses. The overall increased risks of incidence per 1°C temperature rise, expressed as relative risks, were 1·05 (95% CI 1·04-1·07; I2 97%) for salmonellosis, 1·07 (1·04-1·10; I2 99%) for shigellosis, 1·02 (1·01-1·04; I2 98%) for campylobacteriosis, 1·05 (1·04-1·07; I2 36%) for cholera, 1·04 (1·01-1·07; I2 98%) for Escherichia coli enteritis, and 1·15 (1·07-1·24; I2 0%) for typhoid. Reduced risks per 1°C temperature increase were 0·96 (95% CI 0·90-1·02; I2 97%) for rotaviral enteritis and 0·89 (0·81-0·99; I2 96%) for noroviral enteritis. There was evidence of between-pathogen differences in risk for bacterial infections but not for viral infections. INTERPRETATION Temperature sensitivity of enteric infections can vary according to the enteropathogen causing the infection, particularly for bacteria. Thus, we encourage a pathogen-specific health adaptation approach, such as vaccination, given the possibility of increasingly warm temperatures in the future. FUNDING Japan Society for the Promotion of Science (Kakenhi) Grant-in-Aid for Scientific Research.
Collapse
Affiliation(s)
- Paul L C Chua
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Aurelio Tobias
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
| | - Xerxes T Seposo
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
21
|
Gizaw Z, Yalew AW, Bitew BD, Lee J, Bisesi M. Fecal indicator bacteria along multiple environmental exposure pathways (water, food, and soil) and intestinal parasites among children in the rural northwest Ethiopia. BMC Gastroenterol 2022; 22:84. [PMID: 35220951 PMCID: PMC8882269 DOI: 10.1186/s12876-022-02174-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Children in low-resource settings are exposed to multiple risk factors for enteropathogens. However, the probability of exposures may be different across exposure pathways. Accordingly, this study was conducted to assess environmental exposures of children to intestinal parasites in the east Dembiya district of Ethiopia. METHODS A cross-sectional study was conducted for 372 households with children aged 24-59 months. The potential for external exposure of children to intestinal parasites was assessed by determining the presence of fecal indicator organism (Escherichia coli (E. coli)) in drinking water at point of use, ready-to-eat foods, and courtyard soil from children's outdoor play areas. For internal exposure assessment, ova of parasites in stool samples was detected using wet mount and Kato-Katz techniques to estimate exposure to intestinal parasites. The external and internal exposure assessments were also complemented using questionnaire and spot-check observations to assess behaviors that result in high risk of exposure. Individual and community-level predictors of intestinal parasites were identified using a multilevel logistic regression model. Statistically significant variables were identified on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05. RESULTS Ova of one or more intestinal parasites was detected among 178 (47.8%) (95% CI 42.8, 52.6%) of the children. The most common intestinal parasites were A. lumbricoides (20.7%) and S. mansoni (19.1%). Furthermore, E. coli was detected in 69.1% of drinking water samples at point of use, 67.5% of ready-to-eat food samples, and 83.1% of courtyard soil samples from children's outdoor play areas. Exposure of children to intestinal parasites among children in the studied region was associated with poor hand hygiene of mothers (AOR 1.98, 95% CI (1.07, 3.66), poor hand hygiene of children (AOR 3.20, 95% CI (1.77, 5.77), mouthing of soil contaminated materials (AOR 2.31, 95% CI (1.26, 4.24), open defecation practices (AOR 2.22, 95% CI (1.20, 4.10), limited access to water (AOR 2.38, 95% CI (1.13, 5.01), water contamination (AOR 2.51, 95% CI (1.31, 4.80), food contamination (AOR 3.21, 95% CI (1.69, 6.09), and soil contamination (AOR 2.56, 95% CI (1.34, 4.90). CONCLUSION An extensive E. coli contamination of water, foods, and courtyard soil was found in the studied region and the potential sources of contamination were open defecation practices, unhygienic disposal of wastes, poor animal husbandry and keeping practices, and poor water and food safety measures at household level. Moreover, fecal contamination of water, foods, and soil linked to exposure of children to intestinal parasites in the studied region. Thus, it is critical to implement individual-level interventions (such as latrine utilization, hand hygiene promotion, food safety, home-based water treatment, and containment of domestic animals), plus community-level interventions (such as protecting water sources from contamination, source-based water treatment, and community-driven sanitation).
Collapse
Affiliation(s)
- Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Global One Health Initiative (GOHi), The Ohio State University, Columbus, OH USA
| | | | - Bikes Destaw Bitew
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jiyoung Lee
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210 USA
- Department of Food Science and Technology, The Ohio State University, Columbus, OH USA
| | - Michael Bisesi
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210 USA
| |
Collapse
|
22
|
Lambrecht NJ, Wilson ML, Bridges D, Eisenberg JNS, Adu B, Baylin A, Folson G, Jones AD. Ruminant-Related Risk Factors are Associated with Shiga Toxin-Producing Escherichia coli Infection in Children in Southern Ghana. Am J Trop Med Hyg 2022; 106:513-522. [PMID: 34844207 PMCID: PMC8832919 DOI: 10.4269/ajtmh.21-0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023] Open
Abstract
Livestock can provide benefits to low-income households, yet may expose children to zoonotic enteropathogens that cause illness and negative long-term health outcomes. The aim of this cross-sectional study was to determine whether livestock-related risk factors, including animal ownership, exposure to animal feces, and consumption of animal-source foods, were associated with bacterial zoonotic enteropathogen infections in children 6-59 months old in Greater Accra, Ghana. Stool samples from 259 children and 156 household chickens were analyzed for atypical enteropathogenic Escherichia coli (aEPEC), Campylobacter jejuni/coli (C. jejuni/coli), Salmonella, and Shiga toxin-producing Escherichia coli (STEC) using quantitative polymerase chain reaction (qPCR). aEPEC, C. jejuni/coli, STEC, and Salmonella were detected in 45.6%, 11.6%, 4.3%, and 0.8% of children's stool samples, respectively. In adjusted logistic regression models, household ownership of goats or sheep was associated with STEC detection in children (odds ratio [95% confidence interval]: 4.30 [1.32, 14.08]), as were positive detection of STEC in chicken feces (7.85 [2.54, 24.30]) and frequent consumption of fresh cow's milk (3.03 [1.75, 5.24]). No livestock-related risk factors were associated with aEPEC or C. jejuni/coli infection in children. Our findings suggest that ruminant ownership in southern Ghana may expose children to STEC through household fecal contamination and foodborne routes. The lack of association between livestock risk factors and the more commonly detected pathogens, aEPEC and C. jejuni/coli, warrants further research, particularly to help explain how animal-keeping and sanitation practices affect transmission of fecal pathogens that were highly prevalent in chicken feces.
Collapse
Affiliation(s)
- Nathalie J. Lambrecht
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan;,Address correspondence to Nathalie J. Lambrecht, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany. E-mail:
| | - Mark L. Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Dave Bridges
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Joseph N. S. Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bright Adu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Ana Baylin
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan;,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Gloria Folson
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
23
|
Hunter CL, Shields GS. Mediators of the associations between family income during adolescence and adult long-term memory and working memory. COGNITIVE DEVELOPMENT 2022. [DOI: 10.1016/j.cogdev.2021.101140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Liao Y, Hong X, Wu A, Jiang Y, Liang Y, Gao J, Xue L, Kou X. Global prevalence of norovirus in cases of acute gastroenteritis from 1997 to 2021: An updated systematic review and meta-analysis. Microb Pathog 2021; 161:105259. [PMID: 34687838 DOI: 10.1016/j.micpath.2021.105259] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The worldwide response towards the acute gastroenteritis epidemic was well known, but the absence of an updated systematic review of global norovirus epidemiology in cases of gastroenteritis existed. We aimed to conduct and update a systematic review and meta-analysis of studies assessing norovirus prevalence among gastroenteritis patients worldwide. METHODS Four databases (PubMed, EMBASE, Cochrane Library, and Web of Science) were searched for epidemiological papers from 2014 to 2021 which applied the PCR method to access the prevalence of norovirus in acute gastroenteritis patients more than a full year. Statistical analysis was conducted using R-4.0.0 software. RESULTS A total of 405 records with 842, 926 cases were included. The pooled prevalence of norovirus was 16% (95%CI 15, 17). Children under 5 years old were at a higher risk with norovirus. A higher prevalence was seen in South America (22%, 95% CI 18, 27), while other continents showed a similar result with the overall prevalence of norovirus. No association was found between national income level and norovirus prevalence. A gradient of decreasing prevalence was noticed from community (20%, 95% CI 16, 24) to outpatients (18%, 95% CI 16, 20) to hospital setting (included both in- and outpatients, 17%, 95% CI 16, 19) to inpatients (15%, 95% CI 13, 17). CONCLUSION Norovirus were associated with 16% acute gastroenteritis globally. To fully understand the prevalence of norovirus worldwide, the continual surveillance of norovirus epidemics was required.
Collapse
Affiliation(s)
- Yingyin Liao
- KingMed School of Laboratory Medicine of Guangzhou Medical University, Guangzhou, China
| | - Xiaojing Hong
- KingMed School of Laboratory Medicine of Guangzhou Medical University, Guangzhou, China
| | - Aiwu Wu
- KingMed School of Laboratory Medicine of Guangzhou Medical University, Guangzhou, China
| | - Yueting Jiang
- Department of Laboratory Medicine, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanhui Liang
- Hubei Key Laboratory of Edible Wild Plants Conservation and Utilization, Hubei Normal University, Huangshi, China
| | - Junshan Gao
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, China
| | - Liang Xue
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Guangdong Institute of Microbiology, Guangdong Academy of Sciences, China.
| | - Xiaoxia Kou
- KingMed School of Laboratory Medicine of Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
25
|
Holcomb DA, Knee J, Capone D, Sumner T, Adriano Z, Nalá R, Cumming O, Brown J, Stewart JR. Impacts of an Urban Sanitation Intervention on Fecal Indicators and the Prevalence of Human Fecal Contamination in Mozambique. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:11667-11679. [PMID: 34382777 PMCID: PMC8429117 DOI: 10.1021/acs.est.1c01538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fecal source tracking (FST) may be useful to assess pathways of fecal contamination in domestic environments and to estimate the impacts of water, sanitation, and hygiene (WASH) interventions in low-income settings. We measured two nonspecific and two human-associated fecal indicators in water, soil, and surfaces before and after a shared latrine intervention from low-income households in Maputo, Mozambique, participating in the Maputo Sanitation (MapSan) trial. Up to a quarter of households were impacted by human fecal contamination, but trends were unaffected by improvements to shared sanitation facilities. The intervention reduced Escherichia coli gene concentrations in soil but did not impact culturable E. coli or the prevalence of human FST markers in a difference-in-differences analysis. Using a novel Bayesian hierarchical modeling approach to account for human marker diagnostic sensitivity and specificity, we revealed a high amount of uncertainty associated with human FST measurements and intervention effect estimates. The field of microbial source tracking would benefit from adding measures of diagnostic accuracy to better interpret findings, particularly when FST analyses convey insufficient information for robust inference. With improved measures, FST could help identify dominant pathways of human and animal fecal contamination in communities and guide the implementation of effective interventions to safeguard health.
Collapse
Affiliation(s)
- David A. Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
| | - Jackie Knee
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States of America
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Drew Capone
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States of America
| | - Trent Sumner
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States of America
| | | | - Rassul Nalá
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
| | - Jill R. Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
| |
Collapse
|
26
|
Capone D, Berendes D, Cumming O, Holcomb D, Knee J, Konstantinidis KT, Levy K, Nalá R, Risk BB, Stewart J, Brown J. Impact of an Urban Sanitation Intervention on Enteric Pathogen Detection in Soils. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:9989-10000. [PMID: 34236178 PMCID: PMC8327413 DOI: 10.1021/acs.est.1c02168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Environmental fecal contamination is common in many low-income cities, contributing to a high burden of enteric infections and associated negative sequelae. To evaluate the impact of a shared onsite sanitation intervention in Maputo, Mozambique on enteric pathogens in the domestic environment, we collected 179 soil samples at shared latrine entrances from intervention (n = 49) and control (n = 51) compounds during baseline (preintervention) and after 24 months (postintervention) as part of the Maputo Sanitation Trial. We tested soils for the presence of nucleic acids associated with 18 enteric pathogens using a multiplex reverse transcription qPCR platform. We detected at least one pathogen-associated gene target in 91% (163/179) of soils and a median of 3 (IQR = 1, 5) pathogens. Using a difference-in-difference analysis and adjusting for compound population, visibly wet soil, sun exposure, wealth, temperature, animal presence, and visible feces, we estimate the intervention reduced the probability of detecting ≥1 pathogen gene by 15% (adjusted prevalence ratio, aPR = 0.85; 95% CI: 0.70, 1.0) and the total number of pathogens by 35% (aPR = 0.65; 0.44, 0.95) in soil 24 months following the intervention. These results suggest that the intervention reduced the presence of some fecal contamination in the domestic environment, but pathogen detection remained prevalent 24 months following the introduction of new latrines.
Collapse
Affiliation(s)
- Drew Capone
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Holcomb
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jackie Knee
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Konstantinos T. Konstantinidis
- Civil and Environmental Engineering, Georgia Institute of Technology, 311 Ferst Drive, Atlanta, Georgia, United States of America
| | - Karen Levy
- Environmental and Occupational Health Sciences, University of Washington, 2980 15th Ave NE, Seattle, Washington, United States of America
| | - Rassul Nalá
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Benjamin B. Risk
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, United States of America
| | - Jill Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
27
|
Vila-Guilera J, Parikh P, Chaturvedi H, Ciric L, Lakhanpaul M. Towards transformative WASH: an integrated case study exploring environmental, sociocultural, economic and institutional risk factors contributing to infant enteric infections in rural tribal India. BMC Public Health 2021; 21:1331. [PMID: 34229646 PMCID: PMC8262041 DOI: 10.1186/s12889-021-11353-z] [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: 12/04/2020] [Accepted: 06/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite clear linkages between poor Water, Sanitation, Hygiene (WASH) and enteric disease, the design of effective WASH interventions that reduce child enteric infections and stunting rates has proved challenging. WASH factors as currently defined do not capture the overall exposure factors to faecal pathogens through the numerous infection transmission pathways. Understanding the multiple and multifaceted factors contributing to enteric infections and their interconnectedness is key to inform future interventions. This study aimed to perform an in-depth holistic exploration of the environmental, socio-cultural, economic and institutional context surrounding infants to develop an integrated understanding of enteric infection drivers in rural tribal Banswara, in Rajasthan State, India. METHODS This study relied on the triangulation of mixed-methods to capture critical influences contributing to infant enteric infection transmission. We conducted structured observations and exploratory qualitative research across 9 rural tribal villages, including transect walks, household observations, interviews with frontline health workers and group discussions with mothers. The emergent social themes and identified factors were mapped based on the scale of agency (individual, family or community-level factor) and on their nature (environmental, socio-cultural, economic and institutional factors). RESULTS Infants aged 5 to 24 months were seen to have constant exposures to dirt via mouthing of soil, soiled hands, soiled objects and food. Rudimentary household environments with dirt floors and domestic animals lacked a hygiene-enabling environment that hindered hygienic behaviour adoption. Several unsafe behaviours failing to interrupt infants' exposures to pathogens were captured, but caregivers reported a lack of self-efficacy skills to separate children from faecal exposures due to the rural farming environments where they lived. Conceptual mapping helped understand how wider-level societal factors such as socio-economic limitations, caste inequalities, and political corruption may have trickle-down effects on the caregivers' motivation and perceived self-efficacy for improving hygiene levels around children, highlighting the influence of interconnected broader factors. CONCLUSIONS Conceptual mapping proved useful to develop an integrated understanding of the interlinked factors across socio-ecological levels and domains, highlighting the role of wider sociocultural, economic and institutional factors contributing to infant's enteric infection risks. Future WASH interventions are likely to require similar integrated approaches that account for the complex factors at all levels.
Collapse
Affiliation(s)
- Julia Vila-Guilera
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK.
| | - Priti Parikh
- Engineering for International Development Centre, The Bartlett, UCL Faculty of the Built Environment, London, WC1H 0QB, UK
| | - Hemant Chaturvedi
- Aceso Global Health Consultants Ltd., Chanakya Place 1, New Delhi, 110059, India
| | - Lena Ciric
- Healthy Infrastructure Research Group, UCL Department of Civil, Environmental and Geomatic Engineering, London, WC1E 6BT, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Whittington Health NHS Trust, London, N19 5NF, UK
| |
Collapse
|
28
|
Kapoor R, Ebdon J, Wadhwa A, Chowdhury G, Wang Y, Raj SJ, Siesel C, Durry SE, Mairinger W, Mukhopadhyay AK, Kanungo S, Dutta S, Moe CL. Evaluation of Low-Cost Phage-Based Microbial Source Tracking Tools for Elucidating Human Fecal Contamination Pathways in Kolkata, India. Front Microbiol 2021; 12:673604. [PMID: 34093494 PMCID: PMC8173070 DOI: 10.3389/fmicb.2021.673604] [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: 02/27/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
Phages, such as those infecting Bacteroides spp., have been proven to be reliable indicators of human fecal contamination in microbial source tracking (MST) studies, and the efficacy of these MST markers found to vary geographically. This study reports the application and evaluation of candidate MST methods (phages infecting previously isolated B. fragilis strain GB-124, newly isolated Bacteroides strains (K10, K29, and K33) and recently isolated Kluyvera intermedia strain ASH-08), along with non-source specific somatic coliphages (SOMCPH infecting strain WG-5) and indicator bacteria (Escherichia coli) for identifying fecal contamination pathways in Kolkata, India. Source specificity of the phage-based methods was first tested using 60 known non-human fecal samples from common animals, before being evaluated with 56 known human samples (municipal sewage) collected during both the rainy and dry season. SOMCPH were present in 40-90% of samples from different animal species and in 100% of sewage samples. Phages infecting Bacteroides strain GB-124 were not detected from the majority (95%) of animal samples (except in three porcine samples) and were present in 93 and 71% of the sewage samples in the rainy and dry season (Mean = 1.42 and 1.83 log10PFU/100mL, respectively), though at lower levels than SOMCPH (Mean = 3.27 and 3.02 log10PFU/100mL, respectively). Phages infecting strain ASH-08 were detected in 89 and 96% of the sewage samples in the rainy and dry season, respectively, but were also present in all animal samples tested (except goats). Strains K10, K29, and K30 were not found to be useful MST markers due to low levels of phages and/or co-presence in non-human sources. GB-124 and SOMCPH were subsequently deployed within two low-income neighborhoods to determine the levels and origin of fecal contamination in 110 environmental samples. E. coli, SOMCPH, and phages of GB-124 were detected in 68, 42, and 28% of the samples, respectively. Analyses of 166 wastewater samples from shared community toilets and 21 samples from sewage pumping stations from the same districts showed that SOMCPH were present in 100% and GB-124 phages in 31% of shared toilet samples (Median = 5.59 and <1 log10 PFU/100 mL, respectively), and both SOMCPH and GB-124 phages were detected in 95% of pumping station samples (Median = 5.82 and 4.04 log10 PFU/100 mL, respectively). Our findings suggest that GB-124 and SOMCPH have utility as low-cost fecal indicator tools which can facilitate environmental surveillance of enteric organisms, elucidate human and non-human fecal exposure pathways, and inform interventions to mitigate exposure to fecal contamination in the residential environment of Kolkata, India.
Collapse
Affiliation(s)
- Renuka Kapoor
- Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - James Ebdon
- Environment and Public Health Research and Enterprise Group (EPHREG), University of Brighton, Brighton, United Kingdom
| | - Ashutosh Wadhwa
- Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Goutam Chowdhury
- ICMR – National Institute of Cholera and Enteric Diseases (NICED), Kolkata, India
| | - Yuke Wang
- Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Suraja J. Raj
- Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Casey Siesel
- Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Sarah E. Durry
- Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Wolfgang Mairinger
- Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Suman Kanungo
- ICMR – National Institute of Cholera and Enteric Diseases (NICED), Kolkata, India
| | - Shanta Dutta
- ICMR – National Institute of Cholera and Enteric Diseases (NICED), Kolkata, India
| | - Christine L. Moe
- Center for Global Safe Water, Sanitation and Hygiene, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| |
Collapse
|
29
|
Thomas E, Brown J. Using Feedback to Improve Accountability in Global Environmental Health and Engineering. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:90-99. [PMID: 33305578 DOI: 10.1021/acs.est.0c04115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Engineered environmental health interventions and services in low-income and resource-limited settings-such as water supply and treatment, sanitation, and cleaner household energy services-have had a less than expected record of sustainability and have sometimes not delivered on their potential to improve health. These interventions require both effectively functioning technologies as well as supporting financial, political, and human resource systems, and may depend on user behaviors as well as professionalized service delivery to reduce harmful exposures. In this perspective, we propose that the application of smarter, more actionable monitoring and decision support systems and aligned financial incentives can enhance accountability between donors, implementers, service providers, governments, and the people who are the intended beneficiaries of development programming. Made possible in part by new measurement techniques, including emerging sensor technologies, rapid impact evaluation, citizen science, and performance-based contracting, such systems have the potential to propel the development of solutions that can work over the long-term, allowing the benefits of environmental health improvements to be sustained in settings where they are most critical by improving trust and mutual accountability among stakeholders.
Collapse
Affiliation(s)
- Evan Thomas
- Mortenson Center in Global Engineering University of Colorado Boulder 4001 Discovery Drive, Suite N290 Boulder, Colorado, 80303 United States
| | - Joe Brown
- Department of Environmental Sciences and Engineering Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill, North Carolina 27599 United States
| |
Collapse
|