1
|
Lehnen AC, Hanke S, Schneider M, Radelof CML, Perestrelo J, Reinicke S, Reifarth M, Taubert A, Arndt KM, Hartlieb M. Modification of 3D-Printed PLA Structures Using Photo-Iniferter Polymerization: Toward On-Demand Antimicrobial Water Filters. Macromol Rapid Commun 2023; 44:e2300408. [PMID: 37581256 DOI: 10.1002/marc.202300408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/04/2023] [Indexed: 08/16/2023]
Abstract
Water filtration is an important application to ensure the accessibility of clean drinking water. As requirements and contaminants vary on a local level, adjustable filter devices and their evaluation with contaminants are required. Within this work, modular filter devices are designed featuring an adjustable surface functionalization. For this purpose, 3D-printed structures are created consisting of bio-based poly(lactic acid) (PLA) that are manufactured by extrusion printing. The surface of PLA is activated with amino groups that are used to install xanthates as chain transfer agents. Subsequently, photo-iniferter (PI) polymerization is used to create cationic polymer brushes on the surface of PLA substrates. Multiple surface characterization techniques are employed to prove successful growth of polymer brushes on PLA. After initial optimization studies on flat surfaces, filter devices are printed, functionalized, and used to remove bacteria from contaminated water. Significant reduction of the number of microorganisms is detected after filtration (single filtration or cycling) and contaminating organism can also be removed from freshwater samples by simple incubation with a 3D-printed filter. The herein developed setup for producing functional filter devices and probing their performance in affinity filtration is a useful platform technology, enabling the rapid testing of polymer brushes for such applications.
Collapse
Affiliation(s)
- Anne-Catherine Lehnen
- University of Potsdam, Institute of Chemistry, Karl-Liebknecht-Straße 24-25, D-14476, Potsdam, Germany
- Fraunhofer Institute for Applied Polymer Research IAP, Geiselbergstraße 69, 14476, Potsdam-Golm, Germany
| | - Sebastian Hanke
- Molecular Biotechnology, Institute of Biochemistry and Biology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Matthias Schneider
- University of Potsdam, Institute of Chemistry, Karl-Liebknecht-Straße 24-25, D-14476, Potsdam, Germany
| | - Charlotte M L Radelof
- University of Potsdam, Institute of Chemistry, Karl-Liebknecht-Straße 24-25, D-14476, Potsdam, Germany
| | - Joana Perestrelo
- University of Potsdam, Institute of Chemistry, Karl-Liebknecht-Straße 24-25, D-14476, Potsdam, Germany
| | - Stefan Reinicke
- Fraunhofer Institute for Applied Polymer Research IAP, Geiselbergstraße 69, 14476, Potsdam-Golm, Germany
| | - Martin Reifarth
- University of Potsdam, Institute of Chemistry, Karl-Liebknecht-Straße 24-25, D-14476, Potsdam, Germany
- Fraunhofer Institute for Applied Polymer Research IAP, Geiselbergstraße 69, 14476, Potsdam-Golm, Germany
| | - Andreas Taubert
- University of Potsdam, Institute of Chemistry, Karl-Liebknecht-Straße 24-25, D-14476, Potsdam, Germany
| | - Katja M Arndt
- Molecular Biotechnology, Institute of Biochemistry and Biology, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Matthias Hartlieb
- University of Potsdam, Institute of Chemistry, Karl-Liebknecht-Straße 24-25, D-14476, Potsdam, Germany
- Fraunhofer Institute for Applied Polymer Research IAP, Geiselbergstraße 69, 14476, Potsdam-Golm, Germany
| |
Collapse
|
2
|
Deichsel EL, Tickell KD, Rogawski McQuade ET. Minimizing error in estimates of the effect of interventions by accounting for baseline measurements: A simulation study analyzing effects on child growth. MATERNAL & CHILD NUTRITION 2023; 19:e13547. [PMID: 37439573 PMCID: PMC10483953 DOI: 10.1111/mcn.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/08/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
Interventions to reduce childhood stunting burden require clinical trials with a primary outcome of linear growth. When growth is measured longitudinally, there are several options for including baseline measurements in the analysis. This study compares the performance of several methods. Randomized controlled trials evaluating a hypothetical intervention to improve length-for-age z-score (LAZ) from birth through 24 months of age were simulated. The intervention effect was evaluated using linear regression and five methods for handling baseline measurements: comparing final measurements only (FINAL), comparing final measurement adjusted for baseline (ADJUST), comparing the change in the measurement over time (DELTA), adjusting for baseline when comparing the changes over time (DELTA+ADJUST) and adjusting for baseline in two-step residuals approach (RESIDUALS). We calculated bias, precision and power of each method for scenarios with and without a baseline imbalance in LAZ. Using a 0.15 effect size at 18 months, FINAL and DELTA required 1200 and 1500 enroled participants, respectively, to reach 80% power, whereas ADJUST, DELTA+ADJUST and RESIDUALS only required 900 participants. The adjusted models also produced unbiased estimates when there was a baseline imbalance, whereas the FINAL and DELTA methods produced biased estimates, as large as 0.07 lower and higher, respectively, than the true effect. Adjusted methods required smaller sample size and produced more precise results than both DELTA and FINAL methods in all test scenarios. If randomization fails, and there is an imbalance in LAZ at baseline, DELTA and FINAL methods can produce biased estimates, but adjusted models remain unbiased. These results warn against using the FINAL or DELTA methods.
Collapse
Affiliation(s)
- Emily L Deichsel
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | | |
Collapse
|
3
|
Desye B, Tesfaye AH, Berihun G, Sisay T, Daba C, Berhanu L. Household water treatment practice and associated factors in Ethiopia: A systematic review and meta-analysis. PLoS One 2023; 18:e0285794. [PMID: 37289814 PMCID: PMC10249828 DOI: 10.1371/journal.pone.0285794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
The provision of potable water is crucial to ensuring the health and dignity of individuals. In many developing countries, including Ethiopia, waterborne disease has become a major public health problem. There is a significant gap in accessing comprehensive national-wide evidence on Household Water Treatment (HWT) practices and associated factors in Ethiopia. Therefore, this study aims to assess the pooled HWT practice and associated factors in Ethiopia. A comprehensive search of published studies before October 15, 2022, was identified using databases and other sources. Data were extracted using Microsoft Excel, and analysis was performed using STATA 14/SE software. A random-effects model was used to estimate the pooled proportion of HWT practices and the odds ratio of associated factors. The funnel plot and Egger's regression test were used to assess publication bias, and I2 test statistics was used to assess heterogeneity. Duval and Tweedie's "trim and fill" method was performed to adjust the pooled estimate. A subgroup analysis was also conducted to identify the sources of heterogeneity. In this study, a total of 708 articles were retrieved, and 16 eligible studies were included. The pooled proportion of HWT practice in Ethiopia was found to be 21% (95% CI: 17-24). Having a formal education (OR: 2.42, 95% CI (2.11-2.74)), being male (OR: 1.32, 95% CI (1.13-1.51)), owning radio (OR: 1.33, 95% CI (1.18-1.47)), having a higher income (OR: 1.73, 95% CI (1.41-2.04)), unimproved water source (OR: 1.71, 95% CI (1.41-2.01)), fetching water at more frequently (OR: 3.31, 95% CI (1.99-4.64)), dipping methods of water drawing (OR: 2.08, 95% CI (1.66-2.51)), and taken training of water treatment (OR: 2.15, 95% CI (1.55-2.75)) were all found to be associated with HWT practice. Based on the findings of this study, the pooled proportion of HWT practice in Ethiopia was found to be one-fifth, which indicated that it was significantly low. Therefore, the authors recommend that households could better receive adequate information about HWT practices through strengthened health education and intensive training on HWT.
Collapse
Affiliation(s)
- Belay Desye
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gete Berihun
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tadesse Sisay
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Chala Daba
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Leykun Berhanu
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
4
|
Field and Laboratory Assessment of a New Electrolytic Point-of-Use Water Treatment Technology. WATER 2022. [DOI: 10.3390/w14071077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
This research creates and implements a new electrolytic point-of-use water treatment (POUWT) device. Device development began by applying two voltages common to commercially available batteries to an apparatus with either two silver or copper wires submerged into synthetic groundwater. The effects of wire diameter, ionic strength of groundwater, and other POUWT parameters on metallic ion release were analyzed. We determined that the silver wire apparatus need only to be run for 2 min at 9 V to yield the target 50 µg/L concentration for water treatment. The 50 µg/L silver yielded up to a 5-log reduction in E. coli bacteria. The copper wire apparatus was excluded in prototype fabrication because it required 62 min to release the target 500 µg/L for disinfection when nine volts were applied to the system and was less effective in disinfection than silver wires. The electrolytic prototype was evaluated in 20 households in Limpopo, South Africa, over a four-week period. The device achieved a 2-log reduction in total coliform bacteria in household drinking water, which is comparable to the field performance of other POUWT devices in low-resource settings. The device also consistently released enough silver sufficient for disinfection while remaining below the WHO drinking water guideline.
Collapse
|
5
|
Kann S, Concha G, Hartmann M, Köller T, Alker J, Schotte U, Kreienbrock L, Frickmann H, Warnke P. Only Low Effects of Water Filters on the Enteric Carriage of Gastrointestinal Pathogen DNA in Colombian Indigenous People. Microorganisms 2022; 10:microorganisms10030658. [PMID: 35336233 PMCID: PMC8955181 DOI: 10.3390/microorganisms10030658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/28/2022] [Accepted: 03/17/2022] [Indexed: 12/18/2022] Open
Abstract
Water filtration is a common strategy of water sanitation in resource-poor tropical settings. Here, we assessed the intermediate term effect of this preventive procedure including specific filter-related as well as general hygiene training on the molecular detection of enteric pathogens in stool samples from Colombian Indigenous people. From a total of 89 individuals from an Indigenous tribe called Wiwa, stool samples were assessed by real-time PCR for enteropathogenic microorganisms prior to the implementation of water filtration-based infection prevention. Three years after the onset of the preventive strategy, a follow-up assessment was performed. A significantly beneficial effect of water filtration could be shown for Ascaris spp. only (p = 0.035) and a tendency (p = 0.059) for Hymenolepis nana. No hints for effects on the gastrointestinal shedding of Giardia duodenalis, Entamoeba histolytica, Cryptosporidium spp., Campylobacter spp., Shigella spp./enteroinvasive Escherichia coli, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, and Taenia spp. were seen. In conclusion, the study indicates that water filtration can only be an element of a multi-modal hygiene concept to reduce enteric pathogen carriage in inhabitants of resource-poor tropical settings in spite of tendencies of beneficial effects.
Collapse
Affiliation(s)
- Simone Kann
- Medical Mission Institute, 97074 Würzburg, Germany
- Correspondence: (S.K.); (P.W.)
| | - Gustavo Concha
- Organization Wiwa Yugumaiun Bunkauanarrua Tayrona (OWYBT), Department Health Advocacy, Valledupar 2000001, Colombia;
| | - Maria Hartmann
- Institute for Biometry, Epidemiology and Information Processing, Veterinary Medical University Hannover, 30559 Hannover, Germany; (M.H.); (L.K.)
| | - Thomas Köller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (T.K.); (H.F.)
| | - Juliane Alker
- Department A-Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, 24119 Kronshagen, Germany; (J.A.); (U.S.)
| | - Ulrich Schotte
- Department A-Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, 24119 Kronshagen, Germany; (J.A.); (U.S.)
| | - Lothar Kreienbrock
- Institute for Biometry, Epidemiology and Information Processing, Veterinary Medical University Hannover, 30559 Hannover, Germany; (M.H.); (L.K.)
| | - Hagen Frickmann
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany; (T.K.); (H.F.)
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
| | - Philipp Warnke
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
- Correspondence: (S.K.); (P.W.)
| |
Collapse
|
6
|
Admasie A, Abera K, Feleke FW. Household Water Treatment Practice and Associated Factors in Rural Households of Sodo Zuria District, Southern Ethiopia: Community-Based Cross-Sectional Study. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221095036. [PMID: 35479294 PMCID: PMC9036349 DOI: 10.1177/11786302221095036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/28/2022] [Indexed: 05/10/2023]
Abstract
INTRODUCTION In Ethiopia, access to safe drinking water is very low, and even safe water at the point of distribution is subjected to frequent and substantial contamination during collection, transport, and storage. The purpose of this study was to assess the level of household water treatment practices and associated factors in rural households of the Sodo Zuria district, southern Ethiopia. METHODS A community-based cross-sectional study was conducted in 836 households using a multistage sampling technique. A structured and pre-tested questionnaire was used. Binary and multivariate logistic regression analysis was used. RESULTS The household water treatment practice was 44.1%. Households having a higher estimated monthly income, AOR = 1.5 (1.23, 3.47), older age greater than 45 years, AOR = 1.69 (1.08, 2.64), fetching water twice a day, AOR = 2.8 (1.21, 9.17), weekly washing of the water storage container, AOR = 0.3 (0.11, 0.83), and using the dipping technique to draw water from the collection jar, AOR = 1.67 (1.14, 2.42) were significant factors in the practice of household water treatment in the study. CONCLUSIONS The household water treatment practice was low. Higher estimated monthly income, older household heads, fetching water twice per day, washing the water storage container weekly, and dipping techniques to draw water from water storage containers were significant factors of household water treatment practices. Thus, proper hygiene of water storage, and engaging the community in income-generating activities were recommended.
Collapse
Affiliation(s)
- Amha Admasie
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kefelegn Abera
- Teaching and Referral Hospital, Wolaita Sodo University, Bahir Dar, Ethiopia
| | - Fentaw Wassie Feleke
- College of Health Science, Woldia University, Wodia, Ethiopia
- Fentaw Wassie Feleke, College of Health Science, Woldia University, P.O.BOX: 400, Wodia, Ethiopia.
| |
Collapse
|
7
|
Tafesse B, Gobena T, Baraki N, Alemeshet Asefa Y, Adare Mengistu D. Household Water Treatment Practice and Associated Factors in Gibe District Southern Ethiopia: A Community Based Cross-Sectional Study. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211060150. [PMID: 34866908 PMCID: PMC8637709 DOI: 10.1177/11786302211060150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/25/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Household water treatment practice or managing water at the point-of-use provides a means of improving drinking water quality and preventing diarrheal diseases. However, evidence regarding household water treatment practice and associated factors in Ethiopia, particularly in Southern Ethiopia are limited. This study was, therefore, designed to assess household water treatment practice and associated factors among households in Southern Ethiopia. METHODS A community-based cross-sectional study design was conducted among 627 households in Southern Ethiopia. A stratified random sampling technique was used in this study and a pre-tested structured questionnaire was used to collect data about household water treatment practice and associated factors among selected households through face-to-face interviews. The data were analyzed using descriptive statistical tests and binary logistic regression was performed to assess the association between independent and dependent variables. Odds ratio with 95% confidence intervals were used to determine the level of association. RESULTS This study revealed that the level of household water treatment practice was 34.3% with 95% CI (30.7-38.1) and boiling was the most common method of household water treatment in the study area. Educational status of having formal education (AOR = 2.01, 95% CI = 1.34-3), withdrawing water from storage vessel by dipping (AOR = 1.86, 95% CI = 1.2-2.87) and frequency of fetching water 3 or more times and above a day (AOR = 2.65, 95% CI = 1.45-4.88) were significantly associated with household water treatment practice. CONCLUSION Household water treatment practice is low in the study area. Educational status of having a formal education, drawing water by dipping, and those who collect their drinking water 3 or more times a day were predictors of household water treatment practice. Thus, efforts should be made to increase the level of household water treatment practice especially among those with no formal education and further studies should be conducted to understand the behavioral factors associated with household water treatment practice.
Collapse
Affiliation(s)
- Bereket Tafesse
- Gibe Woreda Enterprise and Industry
Development Office, Hadiya, Ethiopia
| | - Tesfaye Gobena
- Department of Environmental Health,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Negga Baraki
- Department of Environmental Health,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohanis Alemeshet Asefa
- Department of Environmental Health,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dechasa Adare Mengistu
- Department of Environmental Health,
College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
8
|
Meyer DD, Hill C, McCain K, Smith JA, Bessong PO, Rogawski McQuade ET, Wright NC. Embedding Usage Sensors in Point-of-Use Water Treatment Devices: Sensor Design and Application in Limpopo, South Africa. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:8955-8964. [PMID: 34133882 PMCID: PMC9207768 DOI: 10.1021/acs.est.0c08683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Health benefits from point-of-use (POU) water treatment devices come only with consistent use. Embedded sensors can measure the consistency of POU-device use and can provide insights about improving it. We demonstrate both potentials with data from SmartSpouts: accelerometer-based sensors embedded in spigot handles that record the duration and timing of use. In the laboratory, most sensor readings correlated well (>0.98) with manually timed water withdrawals. In the field, SmartSpouts measured >60,000 water withdrawals across 232 households in Limpopo, South Africa. Sensors proved critical to understanding consistent use; surveys overestimated it by 53 percentage points. Sensor data showed when households use POU devices (evening peaks and delayed weekend routines) and user preferences (safe storage over filters). We demonstrate analytically and with data that (i) consistent use (e.g., 7 continuous days) is extremely sensitive to single-day use prevalence and (ii) use prevalence affects the performance of contact-time-based POU devices, exemplified with silver tablets. Deployed SmartSpouts had limitations, including memory overflows and confounding device relocation with water withdrawal. Nevertheless, SmartSpouts provided useful and objective data on the prevalence of single-day and consistent use. Considerably less expensive than alternatives, SmartSpouts enable an order of magnitude increase in how many POU-device sensors can be deployed.
Collapse
Affiliation(s)
- David D Meyer
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Courtney Hill
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - Kelly McCain
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - James A Smith
- University of Virginia, Charlottesville, Virginia 22904, United States
| | - Pascal O Bessong
- University of Virginia, Charlottesville, Virginia 22904, United States
- University of Venda, Thohoyandou 0950, Limpopo, South Africa
| | | | - Natasha C Wright
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| |
Collapse
|
9
|
Nguyen KH, Operario DJ, Nyathi ME, Hill CL, Smith JA, Guerrant RL, Samie A, Dillingham RA, Bessong PO, Rogawski McQuade ET. Seasonality of drinking water sources and the impact of drinking water source on enteric infections among children in Limpopo, South Africa. Int J Hyg Environ Health 2020; 231:113640. [PMID: 33115698 DOI: 10.1016/j.ijheh.2020.113640] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023]
Abstract
Enteric infections and water-related illnesses are more frequent during times of relative water abundance, especially in regions that experience bimodal rainfall patterns. However, it is unclear how seasonal changes in water availability and drinking water source types affect enteric infections in young children. This study investigated seasonal shifts in primary drinking water source type and the effect of water source type on enteric pathogen prevalence in stool samples from 404 children below age 5 in rural communities in Limpopo Province, South Africa. From wet to dry season, 4.6% (n = 16) of households switched from a source with a higher risk of contamination to a source with lower risk, with the majority switching to municipal water during the dry season. In contrast, 2.6% (n = 9) of households switched from a source with a lower risk of contamination to a source with higher risk. 74.5% (n = 301) of the total households experienced interruptions in their water supply, regardless of source type. There were no significant differences in enteric pathogen prevalence between drinking water sources. Intermittent municipal water distribution and household water use and storage practices may have a larger impact on enteric infections than water source type. The limited differences in enteric pathogen prevalence in children by water source could also be due to other exposure pathways in addition to drinking water, for example through direct contact and food-borne transmission.
Collapse
Affiliation(s)
- Kathy H Nguyen
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, 22908, USA
| | - Darwin J Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22908, USA
| | - Mzwakhe E Nyathi
- Department of Animal Science, University of Venda, Limpopo Province, Thohoyandou, 0950, South Africa
| | - Courtney L Hill
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, 22904, USA
| | - James A Smith
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA, 22904, USA
| | - Richard L Guerrant
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22908, USA
| | - Amidou Samie
- Department of Microbiology, University of Venda, Limpopo Province, Thohoyandou, 0950, South Africa
| | - Rebecca A Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22908, USA
| | - Pascal O Bessong
- Department of Microbiology, University of Venda, Limpopo Province, Thohoyandou, 0950, South Africa
| | - Elizabeth T Rogawski McQuade
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, 22908, USA; Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, 22908, USA.
| |
Collapse
|