1
|
Zerfu TA, Nguyen G, Duncan AJ, Baltenweck I, Brown F, Iannotti LL, McNeill G. Associations between livestock keeping, morbidity and nutritional status of children and women in low- and middle-income countries: a systematic review. Nutr Res Rev 2023; 36:526-543. [PMID: 36522652 DOI: 10.1017/s0954422422000233] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Livestock keeping can positively influence the nutritional status of populations and households through increased consumption of animal-source foods (ASF) and other indirect pathways, but can also adversely affect health by increasing the risk of diseases. We conducted a systematic review synthesising the current state of knowledge on the associations among livestock keeping, infectious disease and the nutritional status of children under 5 years and women of reproductive age in low- and lower-middle-income countries (LMICs). A comprehensive search of 12 electronic databases and grey literature sources published from 1991 to the end of December 2020 was conducted. Investigations exploring relationships between livestock keeping and risk of infectious disease transmission and nutritional status were selected using pre-defined inclusion criteria. After screening and filtering of 34,402 unique references, 176 references were included in the final synthesis. Most (160/176, 90.1%) of the references included in the final synthesis were from sub-Saharan Africa (SSA) and Asia. About two out of every five (42%) studies reviewed showed that livestock production is associated with improved height-for-age Z scores (HAZ) and weight-for-length/height Z scores (WHZ), while close to a third (30.7%) with improved weight-for-age Z scores (WAZ). Similarly, livestock production showed a positive or neutral relationship with women's nutritional status in almost all the references that reported on the topic. Conversely, four-fifths (66/81, 79.5%) of the references reporting on infection and morbidity outcomes indicated that livestock keeping is linked to a wide range of infectious disease outcomes, which are spread primarily through water, food and insects. In conclusion, in many LMIC settings, livestock production is associated with better nutritional outcomes but also a higher risk of disease transmission or morbidity among women and children.This review was prospectively registered on PROSPERO 2020 [CRD42020193622].
Collapse
Affiliation(s)
- Taddese Alemu Zerfu
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | - Giang Nguyen
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
| | - Alan J Duncan
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
- International Livestock Research Institute (ILRI), Nairobi, Kenya
| | | | - Fiona Brown
- Library and University Collections, Information Services, University of Edinburgh, Edinburgh, UK
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Geraldine McNeill
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Ballard AM, Laramee N, Haardörfer R, Freeman MC, Levy K, Caruso BA. Measurement in the study of human exposure to animal feces: A systematic review and audit. Int J Hyg Environ Health 2023; 249:114146. [PMID: 36868140 PMCID: PMC10044406 DOI: 10.1016/j.ijheh.2023.114146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/31/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Human exposure to animal feces is increasingly recognized as an important transmission route of enteric pathogens. Yet, there are no consistent or standardized approaches to measurement of this exposure, limiting assessment of the human health effects and scope of the issue. OBJECTIVE To inform and improve approaches to the measurement of human exposure to animal feces, we audited existing measurement in low- and middle-income countries. METHODS We systematically searched peer-reviewed and gray literature databases for studies with quantitative measures of human exposure to animal feces and we classified measures in two ways. First, using a novel conceptual model, we categorized measures into three 'Exposure Components' identified a priori (i.e., Animal, Environmental, Human Behavioral); one additional Component (Evidence of Exposure) inductively emerged. Second, using the exposure science conceptual framework, we determined where measures fell along the source-to-outcome continuum. RESULTS We identified 1,428 measures across 184 included studies. Although studies overwhelmingly included more than one single-item measure, the majority only captured one Exposure Component. For example, many studies used several single-item measures to capture the same attribute for different animals, all of which were classified as the same Component. Most measures captured information about the source (e.g. animal presence) and contaminant (e.g. animal-sourced pathogens), which are most distal from exposure on the source-to-outcome continuum. DISCUSSION We found that measurement of human exposure to animal feces is diverse and largely distal from exposure. To facilitate better assessment of the human health effects of exposure and scope of the issue, rigorous and consistent measures are needed. We recommend a list of key factors from the Animal, Environmental, and Human Behavioral Exposure Components to measure. We also propose using the exposure science conceptual framework to identify proximal measurement approaches.
Collapse
Affiliation(s)
- April M Ballard
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | - Nicholas Laramee
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Regine Haardörfer
- Department of Behavioral, Social and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, USA
| | - Bethany A Caruso
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| |
Collapse
|
3
|
Risk Factors Associated with Diarrheal Episodes in an Agricultural Community in Nam Dinh Province, Vietnam: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042456. [PMID: 35206644 PMCID: PMC8872501 DOI: 10.3390/ijerph19042456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 02/05/2023]
Abstract
In Vietnam, data on the risk factors for diarrhea at the community level remain sparse. This study aimed to provide an overview of diarrheal diseases in an agricultural community in Vietnam, targeting all age groups. Specifically, we investigated the incidence of diarrheal disease at the community level and described the potential risk factors associated with diarrheal diseases. In this prospective cohort study, a total of 1508 residents were enrolled during the 54-week study period in northern Vietnam. The observed diarrheal incidence per person-year was 0.51 episodes. For children aged <5 years, the incidence per person-year was 0.81 episodes. Unexpectedly, the frequency of diarrhea was significantly higher among participants who used tap water for drinking than among participants who used rainwater. Participants who used a flush toilet had less frequent diarrhea than those who used a pit latrine. The potential risk factors for diarrhea included the source of water used in daily life, drinking water, and type of toilet. However, the direct reason for the association between potential risk factors and diarrhea was not clear. The infection routes of diarrheal pathogens in the environment remain to be investigated at this study site.
Collapse
|
4
|
Ercumen A, Prottas C, Harris A, Dioguardi A, Dowd G, Guiteras R. Poultry Ownership Associated with Increased Risk of Child Diarrhea: Cross-Sectional Evidence from Uganda. Am J Trop Med Hyg 2020; 102:526-533. [PMID: 31971130 PMCID: PMC7056431 DOI: 10.4269/ajtmh.19-0012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 12/10/2019] [Indexed: 01/30/2023] Open
Abstract
Domestic animals have been associated with enteric infections in young children and can also be carriers of respiratory viruses. We conducted a cross-sectional assessment of health outcomes in children aged < 5 years associated with animal presence among 793 rural households in Uganda. We recorded the 2-week prevalence of diarrhea and respiratory infections in children, and the number of cows, poultry, sheep/goats, and pigs in the household. We used generalized linear models with robust standard errors to estimate the prevalence ratio (PR) for diarrhea and respiratory infections associated with households owning the above- versus below-median number of animals. We conducted unadjusted and adjusted analyses controlling for socioeconomic, water, sanitation, and hygiene indicators. Children in households with the above-median number (> 5) of poultry had 83% higher diarrhea prevalence than those with ≤ 5 poultry (adjusted PR = 1.83 [1.04, 3.23], P = 0.04). Children in households with the above-median number (> 2) of cows had 48% lower prevalence of respiratory infection than those with ≤ 2 cows (adjusted PR = 0.52 [0.35, 0.76], P < 0.005). There were no other significant associations between domestic animals and child health. Studies should assess if barring chickens from indoor living quarters and sanitary disposal of chicken and other animal feces can reduce childhood zoonotic infections.
Collapse
Affiliation(s)
- Ayse Ercumen
- Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina
| | | | - Angela Harris
- Civil, Construction and Environmental Engineering, North Carolina State University, Raleigh, North Carolina
| | | | - Greg Dowd
- Agricultural and Resource Economics, North Carolina State University, Raleigh, North Carolina
| | - Raymond Guiteras
- Agricultural and Resource Economics, North Carolina State University, Raleigh, North Carolina
| |
Collapse
|
5
|
Dang-Xuan S, MacDonald LE, Schurer JM, Nguyen-Viet H, Pham-Duc P. Household Exposure to Livestock and Health in the CHILILAB HDSS Cohort, Vietnam. Asia Pac J Public Health 2017; 29:72S-83S. [PMID: 28719770 DOI: 10.1177/1010539517712758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Vietnam, pigs and poultry are predominantly produced by small-scale farmers, creating challenges for zoonotic disease management. The objective of this study was to characterize practices related to livestock and manure management and to measure association with 3 self-reported health symptoms (coughing, fever, and diarrhea/nausea/vomiting) in a region currently undergoing health transitions. We analyzed cross-sectional survey data collected from a subset (N = 5520) of the Chi Linh Health and Demographic Surveillance System cohort in Chi Linh district, Vietnam. Bivariate analyses indicated that female gender was a significant risk factor for all 3 health symptoms, whereas age (≥60 years), suburban living, low education level, and household wealth were risk factors for 2 symptoms. Overall, we found no indication that biogas production or exposure to livestock and manure adversely affected human health. Efforts to control zoonotic disease transmission should prioritize utilization of veterinarians, enhanced farm biosecurity, and improvements to commune drinking water/wastewater infrastructure.
Collapse
Affiliation(s)
| | | | - Janna M Schurer
- 1 Hanoi University of Public Health, Hanoi, Vietnam.,2 University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hung Nguyen-Viet
- 1 Hanoi University of Public Health, Hanoi, Vietnam.,3 International Livestock Research Institute, Hanoi, Vietnam
| | | |
Collapse
|
6
|
Hoa-Tran TN, Nakagomi O, Dao ATH, Nguyen AT, Agbemabiese CA, Vu HM, Nakagomi T, Thanh NTH. Molecular epidemiology of noroviruses detected in Vietnamese children with acute gastroenteritis from 2012 to 2015. J Med Microbiol 2017; 66:34-45. [DOI: 10.1099/jmm.0.000417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- T. N. Hoa-Tran
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - O. Nakagomi
- Department of Molecular Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - A. T. H. Dao
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - A. T. Nguyen
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - C. A. Agbemabiese
- Department of Molecular Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - H. M. Vu
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - T. Nakagomi
- Department of Molecular Epidemiology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - N. T. H. Thanh
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| |
Collapse
|
7
|
Senoh M, Morita M. [Infectious diseases in Asia/International collaboration in bacterial infectious diseases]. Nihon Saikingaku Zasshi 2016; 70:329-32. [PMID: 26028213 DOI: 10.3412/jsb.70.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Proactive approaches to collect precise information are necessary to control infectious diseases in the whole world. A collaborative research for infectious diseases with institute or university of countries that infectious diseases occur is one of the good approaches. In this paper, we introduce collaborative researches on infectious diseases with Asian countries, such as Vietnam, Philippines, Thailand, and India.
Collapse
Affiliation(s)
- Mitsutoshi Senoh
- Department of Bacteriology II, National Institute of Infectious Diseases
| | | |
Collapse
|
8
|
Exposure to cows is not associated with diarrhoea or impaired child growth in rural Odisha, India: a cohort study. Epidemiol Infect 2015; 144:53-63. [PMID: 26041605 DOI: 10.1017/s0950268815001090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Exposure to animal livestock has been linked to zoonotic transmission, especially of gastrointestinal pathogens. Exposure to animals may contribute to chronic asymptomatic intestinal infection, environmental enteropathy and child under-nutrition in low-income settings. We conducted a cohort study to explore the effect of exposure to cows on growth and endemic diarrhoea in children aged <5 years in a rural, low-income setting in the Indian state of Odisha. The study enrolled 1992 households with 2739 children. Height measurements were available for 824 children. Exposure to cows was measured as (1) the presence of a cowshed within or outside the compound, (2) the number of cows owned by a household, and (3) the number of cowsheds located within 50 m of a household. In a sub-study of 518 households, fly traps were used to count the number of synanthropic flies that may act as vectors for gastrointestinal pathogens. We found no evidence that environmental exposure to cows contributes to growth deficiency in children in rural India, neither directly by affecting growth, nor indirectly by increasing the risk of diarrhoea. We found no strong evidence that the presence of a cowshed increased the number synanthropic flies in households.
Collapse
|
9
|
Mitchell PD. Human Parasites in Medieval Europe: Lifestyle, Sanitation and Medical Treatment. ADVANCES IN PARASITOLOGY 2015; 90:389-420. [PMID: 26597073 DOI: 10.1016/bs.apar.2015.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Parasites have been infecting humans throughout our evolution. However, not all people suffered with the same species or to the same intensity throughout this time. Our changing way of life has altered the suitability of humans to infection by each type of parasite. This analysis focuses upon the evidence for parasites from archaeological excavations at medieval sites across Europe. Comparison between the patterns of infection in the medieval period allows us to see how changes in sanitation, herding animals, growing and fertilizing crops, the fishing industry, food preparation and migration all affected human susceptibility to different parasites. We go on to explore how ectoparasites may have spread infectious bacterial diseases, and also consider what medieval medical practitioners thought of parasites and how they tried to treat them. While modern research has shown the use of a toilet decreases the risk of contracting certain intestinal parasites, the evidence for past societies presented here suggests that the invention of latrines had no observable beneficial effects upon intestinal health. This may be because toilets were not sufficiently ubiquitous until the last century, or that the use of fresh human faeces for manuring crops still ensured those parasite species were easily able to reinfect the population.
Collapse
Affiliation(s)
- Piers D Mitchell
- Department of Archaeology and Anthropology, University of Cambridge, Cambridge, United Kingdom.
| |
Collapse
|
10
|
Yoshida LM, Suzuki M, Thiem VD, Smith WP, Tsuzuki A, Huong VTT, Takahashi K, Miyakawa M, Anh NTH, Watanabe K, Ai NTT, Tho LH, Kilgore P, Yoshino H, Toizumi M, Yasunami M, Moriuchi H, Anh DD, Ariyoshi K. Population based cohort study for pediatric infectious diseases research in Vietnam. Trop Med Health 2014; 42:47-58. [PMID: 25425951 PMCID: PMC4204059 DOI: 10.2149/tmh.2014-s07] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A population-based cohort study on pediatric infectious diseases was established at Khanh Hoa Province, central Vietnam in 2006, to determine the etiology and risk factors for severe pediatric infectious diseases (SPID) such as acute respiratory infection (ARI), diarrhea and dengue which are the major causes of under 5 mortality. A population census survey was conducted in Nha-Trang and Ninh-Hoa to collect demographic, social-behavioral data and disease burden on SPID. The study site covered a population of 353,525 residing in 75,826 households with 24,781 children less than 5 years. Hospital databases from two hospitals covering the region were obtained. Linking the census and hospital databases, we were able to investigate on a variety of SPID such as environmental tobacco smoking exposure and increased risked of pediatric pneumonia hospitalization, population density, water supply and risk of dengue fever and animal livestock and risk of hospitalized diarrhea. To determine incidence, viral etiology and risk factors for pediatric ARI/pneumonia, we setup a population based prospective hospitalized Pediatric ARI surveillance at Khanh Hoa General Hospital, Nha-Trang in February 2007. The study has revealed RSV, rhinovirus and influenza A as major viral pathogens, role of multiple viral infection and its interaction with bacteria in the development of pneumonia. In addition, we are also conducting a birth cohort study to investigate the incidence of congenital infection and its impact on physical-neurological development, and role of host genetic polymorphism on SPID hospitalization in Vietnam. Population mobility, high cost of regular census update and low mortality are the challenges.
Collapse
Affiliation(s)
- Lay-Myint Yoshida
- Institute of Tropical Medicine, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | - Motoi Suzuki
- Institute of Tropical Medicine, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | - Vu Dinh Thiem
- National Institute of Hygiene and Epidemiology , No 1, Yersin street, Hanoi, Vietnam
| | - Wolf Peter Smith
- London School of Tropical Medicine and Hygiene , Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom
| | - Ataru Tsuzuki
- Institute of Tropical Medicine, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | - Vu Thi Thu Huong
- National Institute of Hygiene and Epidemiology , No 1, Yersin street, Hanoi, Vietnam
| | - Kensuke Takahashi
- Institute of Tropical Medicine, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | - Masami Miyakawa
- Department of Pediatrics, Nagasaki University Hospital, Graduate School of Biomedical Sciences, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | - Nguyen Thi Hien Anh
- National Institute of Hygiene and Epidemiology , No 1, Yersin street, Hanoi, Vietnam
| | - Kiwao Watanabe
- Institute of Tropical Medicine, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | | | - Le Huu Tho
- KhanhHoa Provincial Public Health Service , 3A Han Thuyen Street, Nha Trang City, Khanh Hoa Province, Vietnam
| | - Paul Kilgore
- College of Pharmacy and Health Sciences, Wayne State University , 259 Mack Ave. Suite 2118, Detroit, MI 48201
| | - Hiroshi Yoshino
- Institute of Tropical Medicine, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | - Michiko Toizumi
- Institute of Tropical Medicine, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | - Michio Yasunami
- Institute of Tropical Medicine, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Hospital, Graduate School of Biomedical Sciences, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology , No 1, Yersin street, Hanoi, Vietnam
| | - Koya Ariyoshi
- Institute of Tropical Medicine, Nagasaki University , 1-12-4, Sakamoto, Nagasaki 852-8523, Japan
| |
Collapse
|
11
|
Zambrano LD, Levy K, Menezes NP, Freeman MC. Human diarrhea infections associated with domestic animal husbandry: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2014; 108:313-25. [PMID: 24812065 DOI: 10.1093/trstmh/tru056] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Domestic animal husbandry, a common practice globally, can lead to zoonotic transmission of enteric pathogens. However, this risk has received little attention to date. This systematic review and meta-analysis examines the evidence for an association between domestic exposure to food-producing animals and cases of human diarrhea and specific enteric infections. We performed a systematic review of available literature to examine domestic livestock and poultry as risk factors for diarrhea and applied pre-determined quality criteria. Where possible, we carried out meta-analysis of specific animal-pathogen pairs. We found consistent evidence of a positive association between exposure to domestic food-producing animals and diarrheal illness across a range of animal exposures and enteric pathogens. Out of 29 studies included in the review, 20 (69.0%) reported a positive association between domestic animal exposure and diarrhea. Domestic exposure to poultry revealed a substantial association with human campylobacteriosis (OR 2.73, 95% CI 1.90-3.93). Our results suggest that domestic poultry and livestock exposures are associated with diarrheal illness in humans. Failure to ascertain the microbial cause of disease may mask this effect. Exposure to domestic animals should be considered a risk factor for human diarrheal illness and additional studies may identify potential mitigation strategies to address this risk.
Collapse
Affiliation(s)
- Laura D Zambrano
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, CNR 2027, Atlanta, GA 30322, USA
| | - Karen Levy
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, CNR 2027, Atlanta, GA 30322, USA
| | - Neia P Menezes
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, CNR 2027, Atlanta, GA 30322, USA
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, CNR 2027, Atlanta, GA 30322, USA
| |
Collapse
|
12
|
Clasen T, Boisson S, Routray P, Cumming O, Jenkins M, Ensink JHJ, Bell M, Freeman MC, Peppin S, Schmidt WP. The effect of improved rural sanitation on diarrhoea and helminth infection: design of a cluster-randomized trial in Orissa, India. Emerg Themes Epidemiol 2012; 9:7. [PMID: 23148587 PMCID: PMC3558431 DOI: 10.1186/1742-7622-9-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 11/01/2012] [Indexed: 11/23/2022] Open
Abstract
Background Infectious diseases associated with poor sanitation such as diarrhoea, intestinal worms, trachoma and lymphatic filariasis continue to cause a large disease burden in low income settings and contribute substantially to child mortality and morbidity. Obtaining health impact data for rural sanitation campaigns poses a number of methodological challenges. Here we describe the design of a village-level cluster-randomised trial in the state of Orissa, India to evaluate the impact of an ongoing rural sanitation campaign conducted under the umbrella of India’s Total Sanitation Campaign (TSC).We randomised 50 villages to the intervention and 50 villages to control. In the intervention villages the implementing non-governmental organisations conducted community mobilisation and latrine construction with subsidies given to poor families. Control villages receive no intervention. Outcome measures include (1) diarrhoea in children under 5 and in all ages, (2) soil-transmitted helminth infections, (3) anthropometric measures, (4) water quality, (5) number of insect vectors (flies, mosquitoes), (6) exposure to faecal pathogens in the environment. In addition we are conducting process documentation (latrine construction and use, intervention reach), cost and cost-effectiveness analyses, spatial analyses and qualitative research on gender and water use for sanitation. Results Randomisation resulted in an acceptable balance between trial arms. The sample size requirements appear to be met for the main study outcomes. Delays in intervention roll-out caused logistical problems especially for the planning of health outcome follow-up surveys. Latrine coverage at the end of the construction period (55%) remained below the target of 70%, a result that may, however, be in line with many other TSC intervention areas in India. Conclusion We discuss a number of methodological problems encountered thus far in this study that may be typical for sanitation trials. Nevertheless, it is expected that the trial procedures will allow measuring the effectiveness of a typical rural sanitation campaign, with sufficient accuracy and validity.
Collapse
Affiliation(s)
- Thomas Clasen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|