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MacLachlan R, Kanji F, Sakib S, Khan S, Pattyn C, M Imani S, Didar TF, Soleymani L. Superomniphobic and Photoactive Surface Presents Antimicrobial Properties by Repelling and Killing Pathogens. ACS APPLIED MATERIALS & INTERFACES 2023; 15:55287-55296. [PMID: 37976404 DOI: 10.1021/acsami.3c11074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Healthcare-acquired infections place a significant burden on the cost and quality of patient care in hospitals. Reducing contamination on surfaces within healthcare environments is critical for halting the spread of these infections. Herein, we report a bifunctional─repel and kill─surface developed using photoactive TiO2 nanoparticles integrated into a hierarchical scaffold (OmniKill). To quantify the repellency of OmniKill, we developed a touch-based assay, capable of simulating the transfer of individual pathogens, multiple pathogens, or pathogen-latent fecal matter from hands to surfaces. OmniKill repels bacterial pathogens by at least 2.77-log (99.8%). The photoactive material within OmniKill further reduces the viability of transferred pathogens on the surface by an additional 2.43-log (99.6%) after 1 h of light exposure. The antipathogenic effects─repel and kill─remain robust under complex biological contaminates such as feces. These findings show the potential use of OmniKill in reducing the physical transmission of bacterial pathogens in healthcare settings.
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Affiliation(s)
- Roderick MacLachlan
- Department of Engineering Physics, McMaster University, Hamilton L8S 4L7, Ontario, Canada
| | - Farhaan Kanji
- Department of Engineering Physics, McMaster University, Hamilton L8S 4L7, Ontario, Canada
| | - Sadman Sakib
- Department of Engineering Physics, McMaster University, Hamilton L8S 4L7, Ontario, Canada
| | - Shadman Khan
- School of Biomedical Engineering, McMaster University, Hamilton L8S 4L7, Ontario, Canada
| | - Cedric Pattyn
- Department of Engineering Physics, McMaster University, Hamilton L8S 4L7, Ontario, Canada
| | - Sara M Imani
- School of Biomedical Engineering, McMaster University, Hamilton L8S 4L7, Ontario, Canada
| | - Tohid F Didar
- School of Biomedical Engineering, McMaster University, Hamilton L8S 4L7, Ontario, Canada
- Department of Mechanical Engineering, McMaster University, Hamilton L8S 4L7, Ontario, Canada
| | - Leyla Soleymani
- Department of Engineering Physics, McMaster University, Hamilton L8S 4L7, Ontario, Canada
- School of Biomedical Engineering, McMaster University, Hamilton L8S 4L7, Ontario, Canada
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2
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Monira S, Zohura F, Bhuyian MSI, Parvin T, Barman I, Jubyda FT, Nahar KS, Sultana M, Ullah W, Biswas SK, Hasan MT, Rahman KZ, Masud J, Uddin IM, Thomas ED, Perin J, George CM, Alam M, Johura FT. Fecal Sampling of Soil, Food, Hand, and Surface Samples from Households in Urban Slums of Dhaka, Bangladesh: An Evidence-Based Development of Baby Water, Sanitation, and Hygiene Interventions. Am J Trop Med Hyg 2022; 107:tpmd211041. [PMID: 35895354 PMCID: PMC9490676 DOI: 10.4269/ajtmh.21-1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/07/2022] [Indexed: 09/03/2023] Open
Abstract
The aim of this study was to identify the exposure pathways of fecal pathogens for a pediatric population living in the urban slums of Bangladesh. A total of 252 soil, food, surface, and hand rinse samples were collected from the pilot households with children less than 5 years of age. All samples were analyzed using the IDEXX Quanti-Tray System (Colilert-18) to enumerate fecal indicator bacteria Escherichia coli. Escherichia coli was detected in all soil samples collected from children play spaces (N = 46), 35% of objects and surfaces children frequently put in their mouths, and 31% of child food samples. Thirty-three percent of hand samples from the child and 46% of hand samples from the caregiver had detectable E. coli. These findings showed high fecal contamination of soil, food, and on hands and surfaces in households with young children and demonstrate the need for interventions reducing these exposure pathways for susceptible pediatric populations.
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Affiliation(s)
- Shirajum Monira
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Zohura
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Sazzadul Islam Bhuyian
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmina Parvin
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Indrajeet Barman
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Tuz Jubyda
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kazi Sumaita Nahar
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Marzia Sultana
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Wali Ullah
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shwapon Kumar Biswas
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M. Tasdik Hasan
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kazi Zillur Rahman
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jahed Masud
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ismat Minhaj Uddin
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Munirul Alam
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema-Tuz Johura
- icddr, b, formerly International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
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3
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KONISHI TATSUKI, YAMAUCHI TARO. The impact of oral contact and alloparenting on infant diarrhea in a hunter-gatherer society in Cameroon. ANTHROPOL SCI 2022. [DOI: 10.1537/ase.210926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- TATSUKI KONISHI
- Graduate School of Health Sciences, Hokkaido University, Sapporo
| | - TARO YAMAUCHI
- Graduate School of Health Sciences, Hokkaido University, Sapporo
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4
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Parvin T, Thomas ED, Bhuyian MSI, Uddin IM, Hasan MT, Rahman Z, Barman I, Zohura F, Masud J, Sultana M, Westin A, Johura FT, Monira S, Biswas SK, Sack DA, Perin J, Alam M, George CM. Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program). Am J Trop Med Hyg 2021; 105:261-266. [PMID: 34097647 DOI: 10.4269/ajtmh.20-1516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/11/2021] [Indexed: 11/07/2022] Open
Abstract
We investigated the environmental and individual-level risk factors for diarrheal disease among young children in slum areas of Dhaka, Bangladesh. A prospective cohort study was conducted among 884 children under 5 years of age. Caregiver reports were collected on sociodemographic factors and hygiene behaviors. Diarrhea surveillance data was collected monthly based on caregiver-reported diarrhea for children in the past 2 weeks during the 12-month study period. Unannounced spot checks of the household compound were performed at 1, 3, 6, 9, and 12 months after enrollment to check for the presence of feces (animal or human) and the presence of animals in the child's sleeping space, to assess child and caregiver hands for the presence of dirt, and to collect samples of the household's source and stored drinking water. Children with feces found on the household compound during spot checks had a significantly higher odds of diarrhea (odds ratio: 1.71; 95% confidence interval: 1.23-2.38). Children residing in households with > 100 colony forming units/100 mL Escherichia coli in source drinking water had a significantly higher odds of diarrhea (OR: 1.43; 95% CI: 1.06-1.92). The presence of feces on the household compound and source drinking water with > 100 colony forming units/100 mL E. coli were significant risk factors for diarrheal disease for children < 5 years of age in slum areas of Dhaka, Bangladesh. These findings demonstrate the urgent need for comprehensive interventions to reduce fecal contamination on the household compound to protect the health of susceptible pediatric populations.
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Affiliation(s)
- Tahmina Parvin
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Elizabeth D Thomas
- 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Ismat Minhaj Uddin
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Zillur Rahman
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Indrajeet Barman
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema Zohura
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jahed Masud
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marzia Sultana
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anne Westin
- 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Fatema-Tuz Johura
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shirajum Monira
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon Kumar Biswas
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,4Ministry of Health & Family Welfare, Dhaka, Bangladesh
| | - David A Sack
- 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jamie Perin
- 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Munirul Alam
- 1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Christine Marie George
- 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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5
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Investigation of the Domestic Reservoirs of Diarrheagenic Escherichia coli in Diarrhea Case Households of Urban Bangladesh. Curr Microbiol 2021; 78:2534-2547. [PMID: 33956228 DOI: 10.1007/s00284-021-02506-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
This study collected rectal swabs from diarrheal patients and in-house environmental samples from low-income households in Dhaka City, Bangladesh, over a 4-month period and investigated these to determine the domestic transmission pathways of Escherichia coli-associated diarrhea. The environmental samples included swabs from four frequently touched surfaces, drinking water and food. Both the rectal swabs and environmental samples were examined for virulence genes characteristic of diarrheagenic E. coli pathotypes by PCR. In addition, each sample was cultured for E. coli, and the strains were analyzed for virulence profile and subjected to multilocus sequence typing (MLST). The results showed that 31% (73 of 233) of all samples including rectal swabs and household samples were positive for one or more of the diarrheagenic E. coli virulence factors. PCR analyses showed that 28% (10/36) of the rectal swabs, 43% (58/136) of household swabs, 9% (3/32) of the food, and 7% (2/29) of the water samples were positive for various virulence genes. 6 Out of the 36 rectal swab samples and associated household samples were shown to have similar E. coli pathotypic genes, and the drinking vessel surface was identified as the major source of contamination. EAEC and CTEC were the most commonly identified pathotypes in the cultured isolates. The phylogenetic tree constructed by MLST data showed that the diarrheagenic isolates were clustered in several diversified lineages. This study supports the hypothesis that there are high-risk hotspots, particularly those surfaces associated with food consumption, for diarrheagenic E. coli contamination within the household environments of Bangladesh.
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6
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Schiaffino F, Rengifo Trigoso D, Colston JM, Paredes Olortegui M, Shapiama Lopez WV, Garcia Bardales PF, Pisanic N, Davis MF, Penataro Yori P, Kosek MN. Associations among Household Animal Ownership, Infrastructure, and Hygiene Characteristics with Source Attribution of Household Fecal Contamination in Peri-Urban Communities of Iquitos, Peru. Am J Trop Med Hyg 2021; 104:372-381. [PMID: 33146117 PMCID: PMC7790101 DOI: 10.4269/ajtmh.20-0810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Using previously validated microbial source tracking markers, we detected and quantified fecal contamination from avian species and avian exposure, dogs, and humans on household cooking tables and floors. The association among contamination, infrastructure, and socioeconomic covariates was assessed using simple and multiple ordinal logistic regressions. The presence of Campylobacter spp. in surface samples was linked to avian markers. Using molecular methods, animal feces were detected in 75.0% and human feces in 20.2% of 104 households. Floors were more contaminated than tables as detected by the avian marker Av4143, dog marker Bactcan, and human marker Bachum. Wood tables were consistently more contaminated than non-wood surfaces, specifically with the mitochondrial avian markers ND5 and CytB, fecal marker Av4143, and canine marker Bactcan. Final multivariable models with socioeconomic and infrastructure characteristics included as covariates indicate that detection of avian feces and avian exposure was associated with the presence of chickens, maternal age, and length of tenancy, whereas detection of human markers was associated with unimproved water source. Detection of Campylobacter in surface samples was associated with the avian fecal marker Av4143. We highlight the critical need to detect and measure the burden of animal fecal waste when evaluating household water, hygiene, and sanitation interventions, and the possibility of decreasing risk of exposure through the modification of surfaces to permit more effective household disinfection practices. Animals may be a more important source of household fecal contamination than humans in many low-resource settings, although interventions have historically focused almost exclusively on managing human waste.
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Affiliation(s)
- Francesca Schiaffino
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,2Faculty of Veterinary Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Josh M Colston
- 4Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
| | | | | | | | - Nora Pisanic
- 5Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meghan F Davis
- 5Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,6Department of Molecular and Comparative Pathobiology, Johns Hopkins Bloomberg School of Medicine, Baltimore Maryland
| | - Pablo Penataro Yori
- 3Asociacion Benefica Prisma, Iquitos, Peru.,4Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Margaret N Kosek
- 3Asociacion Benefica Prisma, Iquitos, Peru.,4Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia
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7
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George CM, Cirhuza LB, Birindwa A, Williams C, Beck S, Julian T, Kuhl J, Coglianese N, Thomas E, Bauler S, François R, Saxton R, Presence AS, Rusanga JCB, Perin J, Mirindi P. Child hand contamination is associated with subsequent pediatric diarrhea in rural Democratic Republic of the Congo (REDUCE Program). Trop Med Int Health 2020; 26:102-110. [PMID: 33151587 DOI: 10.1111/tmi.13510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program focuses on identifying exposure pathways to faecal pathogens for young children in the Democratic Republic of the Congo (DRC) and on developing scalable interventions to reduce faecal contamination from these pathways. METHODS A prospective cohort study of 690 participants was conducted to investigate the association between hand, food, and environmental faecal contamination and diarrhoeal disease prevalence among young children in Walungu Territory, South Kivu, DRC. A total of 1923 hand rinse, soil, food, object, surface, stored water and water source samples were collected during unannounced spot checks after baseline enrolment and analysed for Escherichia coli. Caregiver reports of diarrhoea were obtained from children < 5 years at a 6-month follow-up. RESULTS E.coli was detected in 73% of child and caregiver hand-rinse samples, 69% of soil samples from child play spaces, 54% of child food samples, 38% of objects and surfaces children were observed putting in their mouths, 74% of stored water samples, and 40% of source water samples. Children < 5 years with E. coli on their hands had significantly higher odds of diarrhoea at the 6-month follow-up (odds ratio: 2.03 (95% confidence interval: 1.05, 3.92)). CONCLUSION The cohort study findings from the REDUCE program have shown that child hand contamination is associated with diarrhoeal disease in rural DRC, and that there is high faecal contamination in child plays spaces and food. These findings provide evidence demonstrating the urgent need to provide clean play spaces for young children and interventions targeting hand hygiene to reduce paediatric exposure to faecal pathogens.
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Affiliation(s)
- Christine Marie George
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Lucien Bisimwa Cirhuza
- Food for the Hungry, Phoenix, Arizona, USA.,URF-ECMI, Microbiology Department, Faculty of Medicine, University of Kinshasa
| | | | - Camille Williams
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Sara Beck
- Department of Environmental Microbiology, Eawag, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - Timothy Julian
- Food for the Hungry, Phoenix, Arizona, USA.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jennifer Kuhl
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | | | - Elizabeth Thomas
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Sarah Bauler
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA.,Food for the Hungry, Phoenix, Arizona, USA
| | - Ruthly François
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | - Ronald Saxton
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
| | | | | | - Jamie Perin
- Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA
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Monira S, Bhuyian MSI, Parvin T, Uddin IM, Zohura F, Hasan MT, Biswas SK, Hasan K, Masud J, Rashid M, Rahman Z, Papri N, Rafique R, Islam A, Barman I, Jubyda FT, Johura F, Sultana M, Sanin KI, Sack DA, Perin J, Alam M, George C. Child mouthing of soil and presence of animals in child sleeping spaces are associated with growth faltering among young children in Dhaka, Bangladesh (CHoBI7 Program). Trop Med Int Health 2020; 25:1016-1023. [DOI: 10.1111/tmi.13417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Shirajum Monira
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | | | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Ismat Minhaj Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Fatema Zohura
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - M. Tasdik Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Shwapon K. Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Khaled Hasan
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Jahed Masud
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Mahamud‐ur Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Zillur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Nowshin Papri
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Raisa Rafique
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Aminul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Indrajeet Barman
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Fatema Tuz Jubyda
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Fatema‐Tuz Johura
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Marzia Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Kazi Istiaque Sanin
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - David A. Sack
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Jamie Perin
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Munirul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka Bangladesh
| | - Christine George
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
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Parvin T, Minhaj Uddin I, Islam Bhuyian MS, Saxton R, Zohura F, Sultana M, Johura FT, Monira S, Hasan MT, Papri N, Haque MA, Biswas SK, Sack DA, Perin J, Alam M, George CM. Prospective cohort study of child mouthing of faeces and fomites in Dhaka, Bangladesh (CHoBI7 Program). Trop Med Int Health 2020; 25:976-984. [PMID: 32406964 DOI: 10.1111/tmi.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To characterise childhood mouthing and handling behaviours and to assess the association between hand-to-object and object-to-mouth contacts and diarrhoea prevalence in young children in urban Dhaka, Bangladesh. METHODS A prospective cohort study was conducted among 494 children under 5 years of age in Dhaka, Bangladesh. This study was nested within the randomised controlled trial of the Cholera Hospital-Based Intervention for 7 Days (CHoBI7) mobile health (mHealth) program. The CHoBI7 mHealth program focuses on promoting handwashing with soap and water treatment to diarrhoea patients and their household members through mobile messages and a single in person visit. Mouthing and handling of faeces and fomites among young children was measured by five-hour structured observation and caregiver reports. Diarrhoea surveillance data was collected monthly for 12 months. RESULTS Fifty five percent of caregivers reported that their child put a visibly dirty fomite (object or soil) in their mouth in the past week. Caregivers reported that 50% of children had mouthed visibly dirty objects, 26% had mouthed dirt, and 2% had mouthed faeces. Forty five percent of children were observed mouthing a visibly dirty fomite during structured observation, 40% of children were observed mouthing a visibly dirty object, 10% were observed mouthing soil, and one child (0.2%) was observed mouthing faeces. Mouthing of visibly dirty fomites was highest for children 12-18 months of age with 69% of these children having caregiver reports and 54% having observed events. Children with caregiver reports of mouthing faeces had a significantly higher odds of diarrhoea over the subsequent month (Odds Ratio: 4.54; 95% Confidence Interval: 1.06, 19.48). CONCLUSION These findings demonstrate that mouthing of contaminated fomites among young children is frequent in urban environments in Bangladesh, and that mouthing faeces is associated with a significantly higher odds of diarrhoea. Interventions are urgently needed to protect young children from faecal pathogens in their play spaces.
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Affiliation(s)
- Tahmina Parvin
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ismat Minhaj Uddin
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Ronald Saxton
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Fatema Zohura
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marzia Sultana
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema-Tuz Johura
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shirajum Monira
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tasdik Hasan
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,University of Liverpool, Liverpool, UK
| | - Nowshin Papri
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ahshanul Haque
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon K Biswas
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Rangpur Medical College and Hospital, Rangpur, Bangladesh
| | - David A Sack
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Munirul Alam
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Christine Marie George
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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10
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Park GW, Ng TFF, Freeland AL, Marconi VC, Boom JA, Staat MA, Montmayeur AM, Browne H, Narayanan J, Payne DC, Cardemil CV, Treffiletti A, Vinjé J. CrAssphage as a Novel Tool to Detect Human Fecal Contamination on Environmental Surfaces and Hands. Emerg Infect Dis 2020; 26:1731-1739. [PMID: 32511090 PMCID: PMC7392416 DOI: 10.3201/eid2608.200346] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
CrAssphage is a recently discovered human gut–associated bacteriophage. To validate the potential use of crAssphage for detecting human fecal contamination on environmental surfaces and hands, we tested stool samples (n = 60), hand samples (n = 30), and environmental swab samples (n = 201) from 17 norovirus outbreaks for crAssphage by real-time PCR. In addition, we tested stool samples from healthy persons (n = 173), respiratory samples (n = 113), and animal fecal specimens (n = 68) and further sequenced positive samples. Overall, we detected crAssphage in 71.4% of outbreak stool samples, 48%–68.5% of stool samples from healthy persons, 56.2% of environmental swabs, and 60% of hand rinse samples, but not in human respiratory samples or animal fecal samples. CrAssphage sequences could be grouped into 2 major genetic clusters. Our data suggest that crAssphage could be used to detect human fecal contamination on environmental surfaces and hands.
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Amirian ES. Potential fecal transmission of SARS-CoV-2: Current evidence and implications for public health. Int J Infect Dis 2020; 95:363-370. [PMID: 32335340 PMCID: PMC7195510 DOI: 10.1016/j.ijid.2020.04.057] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/11/2020] [Accepted: 04/18/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) emerged in Hubei Province, China in December 2019 and has since become a global pandemic, with hundreds of thousands of cases and over 165 countries affected. Primary routes of transmission of the causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are through respiratory droplets and close person-to-person contact. While information about other potential modes of transmission are relatively sparse, evidence supporting the possibility of a fecally mediated mode of transmission has been accumulating. Here, current knowledge on the potential for fecal transmission is briefly reviewed and the possible implications are discussed from a public health perspective.
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Affiliation(s)
- E Susan Amirian
- Public Health and Healthcare Program, Texas Policy Lab, School of Social Sciences, Rice University, Houston, TX, USA.
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12
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Julian TR, Vithanage HSK, Chua ML, Kuroda M, Pitol AK, Nguyen PHL, Canales RA, Fujii S, Harada H. High time-resolution simulation of E. coli on hands reveals large variation in microbial exposures amongst Vietnamese farmers using human excreta for agriculture. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 635:120-131. [PMID: 29660716 DOI: 10.1016/j.scitotenv.2018.04.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 05/16/2023]
Abstract
Infectious disease transmission is frequently mediated by the environment, where people's movements through and interactions with the environment dictate risks of infection and/or illness. Capturing these interactions, and quantifying their importance, offers important insights into effective interventions. In this study, we capture high time-resolution activity data for twenty-five Vietnamese farmers during collection and land application of human excreta for agriculture. Although human excreta use improves productivity, the use increases risks of enteric infections for both farmers and end users. In our study, the activity data are integrated with environmental microbial sampling data into a stochastic-mechanistic simulation of E. coli contamination on hands and E. coli ingested. Results from the study include frequent and variable contact rates for farmers' hands (from 34 to 1344 objects contacted per hour per hand), including highly variable hand-to-mouth contact rates (from 0 to 9 contacts per hour per hand). The frequency of hand-to-mouth contacts was substantially lower than the widely-used frequency previously reported for U.S. Office Workers. Environmental microbial contamination data highlighted ubiquitous E. coli contamination in the environment, including excreta, hands, toilet pit, handheld tools, soils, surfaces, and water. Results from the simulation suggest dynamic changes in E. coli contamination on hands, and wide variation in hand contamination and E. coli ingested amongst the farmers studied. Sensitivity analysis suggests that E. coli contamination on hands and ingested doses are most influenced by contamination of handheld tools, excreta, and the toilet pit as well as by frequency of hand-to-mouth contacts. The study findings are especially relevant given the context: no farmers reported adequate storage time of human excreta, and personal protective mask availability did not prevent hand-to-mouth contacts. Integrating high time-resolution activity data into exposure assessments highlights variation in exposures amongst farmers, and offers greater insight into effective interventions and their potential impacts.
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Affiliation(s)
- Timothy R Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, CH-8600 Dübendorf, Switzerland; Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, CH-4002 Basel, Switzerland; University of Basel, P.O. Box, CH-4003 Basel, Switzerland.
| | - Hasitha S K Vithanage
- UNESCO-IHE Institute for Water Education, 2601 Delft, The Netherlands; Sri Lanka National Water Supply and Drainage Board, Dehiwala-Mount Lavinia, Sri Lanka
| | - Min Li Chua
- Graduate School of Global Environmental Studies, Kyoto University, Yoshida-honmachi, Sakyo-ku 606-8501, Kyoto, Japan
| | - Matasaka Kuroda
- Graduate School of Engineering, Katsura Campus, Kyoto University, Nisikyo-ku, 615-8510, Kyoto, Japan
| | - Ana K Pitol
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Überlandstrasse 133, CH-8600 Dübendorf, Switzerland; Laboratory of Environmental Chemistry, School of Architecture, Civil, and Environmental Engineering (ENAC), École Polytechnique FÉdÉrale de Lausanne (EPFL), CH 1015 Lausanne, Switzerland
| | - Pham Hong Lien Nguyen
- School of Environmental Science and Technology, Hanoi University of Science and Technology, Viet Nam
| | - Robert A Canales
- Community, Environment & Policy Department, Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N. Martin Avenue, Campus PO Box 245210, Drachman Hall A229, Tucson, AZ 85724, USA
| | - Shigeo Fujii
- Graduate School of Global Environmental Studies, Kyoto University, Yoshida-honmachi, Sakyo-ku 606-8501, Kyoto, Japan
| | - Hidenori Harada
- Graduate School of Global Environmental Studies, Kyoto University, Yoshida-honmachi, Sakyo-ku 606-8501, Kyoto, Japan; Research Institute for Humanity and Nature, 457-4 Kamigamo Motoyama, Kita-ku 603-8047, Kyoto, Japan.
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Morita T, Perin J, Oldja L, Biswas S, Sack RB, Ahmed S, Haque R, Bhuiyan NA, Parvin T, Bhuyian SI, Akter M, Talukder KA, Shahnaij M, Faruque AG, George CM. Mouthing of Soil Contaminated Objects is Associated with Environmental Enteropathy in Young Children. Trop Med Int Health 2017; 22:670-678. [PMID: 28319300 DOI: 10.1111/tmi.12869] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterise childhood mouthing behaviours and to investigate the association between object-to-mouth and food-to-mouth contacts, diarrhoea prevalence and environmental enteropathy. METHODS A prospective cohort study was conducted of 216 children ≤30 months of age in rural Bangladesh. Mouthing contacts with soil and food and objects with visible soil were assessed by 5-h structured observation. Stool was analysed for four faecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin. RESULTS Overall 82% of children were observed mouthing soil, objects with visible soil, or food with visible soil during the structured observation period. Sixty two percent of children were observed mouthing objects with visible soil, 63% were observed mouthing food with visible soil, and 18% were observed mouthing soil only. Children observed mouthing objects with visible soil had significantly elevated faecal calprotectin concentrations (206.81 μg/g, 95% confidence interval [CI]: 6.27, 407.36). There was also a marginally significant association between Escherichia coli counts in soil from a child's play space and the prevalence rate of diarrhoea (diarrhoea prevalence ratio: 2.03, 95% CI 0.97, 4.25). CONCLUSION These findings provide further evidence to support the hypothesis that childhood mouthing behaviour in environments with faecal contamination can lead to environmental enteropathy in susceptible paediatric populations. Furthermore, these findings suggest that young children mouthing objects with soil, which occurred more frequently than soil directly (60% vs. 18%), was an important exposure route to faecal pathogens and a risk factor for environmental enteropathy.
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Affiliation(s)
- Tomohiko Morita
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren Oldja
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shwapon Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.,Department of Internal Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh
| | - R Bradley Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nurul Amin Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Mahmuda Akter
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kaisar A Talukder
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammad Shahnaij
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abu G Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Julian TR. Environmental transmission of diarrheal pathogens in low and middle income countries. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2016; 18:944-955. [PMID: 27384220 DOI: 10.1039/c6em00222f] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Every year, more than half a million children die due to diarrheal diseases. Recent studies have identified the most important etiologies of diarrheal disease are enterotoxigenic and enteropathogenic E. coli, Shigella spp., rotavirus, norovirus and Cryptosporidium spp. These etiologies are unsurprisingly characterized by a combination of high shedding, high infectivity, and transmissibility through multiple environmental reservoirs. The relative importance of the transmission routes is likely site-specific. So the impact of interventions, which typically target only one or two environmental reservoirs, is likely also site-specific. The factors influencing the transmission routes most important for diarrheal disease are complex, including - at a minimum - etiology of endemic disease; and water, sanitation, and hygiene infrastructure and practices. The site-specific nature - and complexity of transmission - helps explain the observed variation in impacts of water, sanitation, and hygiene interventions. It may also render efforts to estimate or quantify global means for interventions' impacts irrelevant. The theme of this Perspective is that greater reductions in diarrheal disease transmission in LMICs can be achieved by designing interventions to interrupt the most important environmental transmission pathways. Intervention choice should be informed by site-specific conditions, most notably: diarrheal etiology and existing water, sanitation, and hygiene infrastructure and practices. The theme is discussed through the lens of the characteristics of the most important diarrheal diseases (shedding, infectivity, growth, and persistence) and the general characteristics of environmental reservoirs (exposure pathways and fecal contamination). The discussion highlights when interventions - and combinations of interventions - will be most effective at reducing diarrheal disease burden.
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Affiliation(s)
- Timothy R Julian
- Pathogens and Human Health, Department of Environmental Microbiology, Swiss Federal Research Institute of Aquatic Science and Technology, Eawag, BU-F08, Überlandstrasse 133, 8600 Dübendorf, Switzerland.
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Exum NG, Olórtegui MP, Yori PP, Davis MF, Heaney CD, Kosek M, Schwab KJ. Floors and Toilets: Association of Floors and Sanitation Practices with Fecal Contamination in Peruvian Amazon Peri-Urban Households. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:7373-7381. [PMID: 27338564 PMCID: PMC6400218 DOI: 10.1021/acs.est.6b01283] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Over two billion people worldwide lack access to an improved sanitation facility that adequately retains or treats feces. This results in the potential for fecal material containing enteric pathogens to contaminate the environment, including household floors. This study aimed to assess how floor type and sanitation practices impacted the concentration of fecal contamination on household floors. We sampled 189 floor surfaces within 63 households in a peri-urban community in Iquitos, Peru. All samples were analyzed for colony forming units (CFUs) of E. coli, and households were evaluated for their water, sanitation, and hygiene characteristics. Results of multivariate linear regression indicated that households with improved sanitation and cement floors in the kitchen area had reduced fecal contamination to those with unimproved sanitation and dirt floors (Beta: -1.18 log10 E. coli CFU/900 cm(2); 95% confidence interval [CI]: -1.77, -0.60). Households that did not versus did share their sanitation facility also had less contaminated kitchen floors (Beta: -0.65 log10 E. coli CFU/900 cm(2); 95% CI: -1.15, -0.16). These findings suggest that the sanitation facilities of a home may impact the microbial load found on floors, contributing to the potential for household floors to serve as an indirect route of fecal pathogen transmission to children.
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Affiliation(s)
- Natalie G. Exum
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA
| | - Maribel Paredes Olórtegui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Asociación Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Iquitos, Peru
| | - Pablo Peñataro Yori
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Asociación Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Iquitos, Peru
| | - Meghan F. Davis
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA
| | - Christopher D. Heaney
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA
| | - Margaret Kosek
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Asociación Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Iquitos, Peru
| | - Kellogg J. Schwab
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA
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Julian TR, Pickering AJ. A Pilot Study on Integrating Videography and Environmental Microbial Sampling to Model Fecal Bacterial Exposures in Peri-Urban Tanzania. PLoS One 2015; 10:e0136158. [PMID: 26295964 PMCID: PMC4546663 DOI: 10.1371/journal.pone.0136158] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 07/31/2015] [Indexed: 11/19/2022] Open
Abstract
Diarrheal diseases are a leading cause of under-five mortality and morbidity in sub-Saharan Africa. Quantitative exposure modeling provides opportunities to investigate the relative importance of fecal-oral transmission routes (e.g. hands, water, food) responsible for diarrheal disease. Modeling, however, requires accurate descriptions of individuals' interactions with the environment (i.e., activity data). Such activity data are largely lacking for people in low-income settings. In the present study, we collected activity data and microbiological sampling data to develop a quantitative microbial exposure model for two female caretakers in peri-urban Tanzania. Activity data were combined with microbiological data of contacted surfaces and fomites (e.g. broom handle, soil, clothing) to develop example exposure profiles describing second-by-second estimates of fecal indicator bacteria (E. coli and enterococci) concentrations on the caretaker's hands. The study demonstrates the application and utility of video activity data to quantify exposure factors for people in low-income countries and apply these factors to understand fecal contamination exposure pathways. This study provides both a methodological approach for the design and implementation of larger studies, and preliminary data suggesting contacts with dirt and sand may be important mechanisms of hand contamination. Increasing the scale of activity data collection and modeling to investigate individual-level exposure profiles within target populations for specific exposure scenarios would provide opportunities to identify the relative importance of fecal-oral disease transmission routes.
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Affiliation(s)
- Timothy R. Julian
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, United States of America
- Woods Institute for the Environment, Stanford University, Stanford, CA, United States of America
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Rothstein JD, Leontsini E, Olortegui MP, Yori PP, Surkan PJ, Kosek M. Determinants of Caregivers' Use and Adoption of Household Water Chlorination: A Qualitative Study with Peri-Urban Communities in the Peruvian Amazon. Am J Trop Med Hyg 2015; 93:626-635. [PMID: 26175028 PMCID: PMC4559710 DOI: 10.4269/ajtmh.14-0654] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 05/21/2015] [Indexed: 11/21/2022] Open
Abstract
The gap between the efficacy and the effectiveness of household water treatment in reducing diarrhea-related morbidity indicates the need for a better understanding of the determinants of long-term behavior change. To explore the barriers to drinking water chlorination in the Peruvian Amazon, where diarrhea is endemic among under-5 children, we conducted qualitative research with 23 caregivers from peri-urban communities of Iquitos, Peru. Our inquiry drew on the Transtheoretical Model of behavior change and the Integrated Behavioral Model for Water, Sanitation, and Hygiene to identify the most relevant contextual, psychosocial, and technological determinants of initial action and long-term adoption of chlorination. Our findings suggest that the decision to try out this practice resulted from the combined effect of knowledge of chlorination benefits and product availability and affordability. Progress from action to adoption was influenced by caretakers' understanding of dosage, the packaging of chlorine products, knowledge and skills for multipurpose laundry bleach, the taste of treated water, and reinforcement. This analysis suggests that a focus on these determinants and the household domain may help to improve the sustainability of future intervention efforts.
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Affiliation(s)
| | | | | | | | | | - Margaret Kosek
- *Address correspondence to Margaret Kosek, Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Room E5545, 615 N. Wolfe Street, Baltimore, MD 21205. E-mail:
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Genotypic and phenotypic characterization of Escherichia coli isolates from feces, hands, and soils in rural Bangladesh via the Colilert Quanti-Tray System. Appl Environ Microbiol 2014; 81:1735-43. [PMID: 25548044 DOI: 10.1128/aem.03214-14] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The increased awareness of the role of environmental matrices in enteric disease transmission has resulted in the need for rapid, field-based methods for fecal indicator bacteria and pathogen detection. Evidence of the specificity of β-glucuronidase-based assays for detection of Escherichia coli from environmental matrices relevant to enteric pathogen transmission in developing countries, such as hands, soils, and surfaces, is limited. In this study, we quantify the false-positive rate of a β-glucuronidase-based E. coli detection assay (Colilert) for two environmental reservoirs in Bangladeshi households (hands and soils) and three fecal composite sources (cattle, chicken, and humans). We investigate whether or not the isolation source of E. coli influences phenotypic and genotypic characteristics. Phenotypic characteristics include results of biochemical assays provided by the API-20E test; genotypic characteristics include the Clermont phylogroup and the presence of enteric and/or environmental indicator genes sfmH, rfaI, and fucK. Our findings demonstrate no statistically significant difference in the false-positive rate of Colilert for environmental compared to enteric samples. E. coli isolates from all source types are genetically diverse, representing six of the seven phylogroups, and there is no difference in relative frequency of phylogroups between enteric and environmental samples. We conclude that Colilert, and likely other β-glucuronidase-based assays, is appropriate for detection of E. coli on hands and in soils with low false-positive rates. Furthermore, E. coli isolated from hands and soils in Bangladeshi households are diverse and indistinguishable from cattle, chicken, and human fecal isolates, using traditional biochemical assays and phylogrouping.
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Sima LC, Ng R, Elimelech M. Modeling risk categories to predict the longitudinal prevalence of childhood diarrhea in Indonesia. Am J Trop Med Hyg 2013; 89:884-91. [PMID: 24019442 PMCID: PMC3820331 DOI: 10.4269/ajtmh.12-0540] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 07/30/2013] [Indexed: 11/07/2022] Open
Abstract
We present an innovative approach for analyzing diarrheal prevalence data that uses latent variables to model the relationships between multiple, interdependent environmental risk factors, and socioeconomic mediators. This strategy was applied to elucidate diarrheal longitudinal prevalence risk factors in children 1-4 years of age in low-income areas of Jakarta, Indonesia. Through a prospective cohort study, we identified 257 children who had at least one episode of diarrhea. At the onset of the study, we collected responses to 44 indicators, covering a wide range of previously identified diarrhea risk factors, including demographic and socioeconomic factors. We used exploratory factor analysis to uncover four latent categories of risk factors and their respective indicators from the initial pool of 44 indicators. Thereafter, we used structural equation modeling to model the relationships between the four risk categories and diarrheal longitudinal prevalence, controlling for socioeconomic and demographic covariates. Our final model elucidated several pathways to longitudinal diarrheal prevalence. Most notably, poverty exerts its effect on increased diarrheal prevalence via dual pathways: poor household hygiene and food quality, controlling for covariates. Implications of this and other findings for disease control in Jakarta are discussed.
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Affiliation(s)
| | | | - Menachem Elimelech
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Connecticut; School of Public Health, Yale University, New Haven, Connecticut
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