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Tadesse BT, Khanam F, Ahmmed F, Liu X, Islam MT, Kim DR, Kang SS, Im J, Chowdhury F, Ahmed T, Aziz AB, Hoque M, Park J, Pak G, Jeon HJ, Zaman K, Khan AI, Kim JH, Marks F, Qadri F, Clemens JD. Association Among Household Water, Sanitation, and Hygiene (WASH) Status and Typhoid Risk in Urban Slums: Prospective Cohort Study in Bangladesh. JMIR Public Health Surveill 2023; 9:e41207. [PMID: 37983081 PMCID: PMC10696503 DOI: 10.2196/41207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/30/2023] [Accepted: 10/05/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Typhoid fever, or enteric fever, is a highly fatal infectious disease that affects over 9 million people worldwide each year, resulting in more than 110,000 deaths. Reduction in the burden of typhoid in low-income countries is crucial for public health and requires the implementation of feasible water, sanitation, and hygiene (WASH) interventions, especially in densely populated urban slums. OBJECTIVE In this study, conducted in Mirpur, Bangladesh, we aimed to assess the association between household WASH status and typhoid risk in a training subpopulation of a large prospective cohort (n=98,087), and to evaluate the performance of a machine learning algorithm in creating a composite WASH variable. Further, we investigated the protection associated with living in households with improved WASH facilities and in clusters with increasing prevalence of such facilities during a 2-year follow-up period. METHODS We used a machine learning algorithm to create a dichotomous composite variable ("Better" and "Not Better") based on 3 WASH variables: private toilet facility, safe drinking water source, and presence of water filter. The algorithm was trained using data from the training subpopulation and then validated in a distinct subpopulation (n=65,286) to assess its sensitivity and specificity. Cox regression models were used to evaluate the protective effect of living in "Better" WASH households and in clusters with increasing levels of "Better" WASH prevalence. RESULTS We found that residence in households with improved WASH facilities was associated with a 38% reduction in typhoid risk (adjusted hazard ratio=0.62, 95% CI 0.49-0.78; P<.001). This reduction was particularly pronounced in individuals younger than 10 years at the first census participation, with an adjusted hazard ratio of 0.49 (95% CI 0.36-0.66; P<.001). Furthermore, we observed an inverse relationship between the prevalence of "Better" WASH facilities in clusters and the incidence of typhoid, although this association was not statistically significant in the multivariable model. Specifically, the adjusted hazard of typhoid decreased by 0.996 (95% CI 0.986-1.006) for each percent increase in the prevalence of "Better" WASH in the cluster (P=.39). CONCLUSIONS Our findings demonstrate that existing variations in household WASH are associated with differences in the risk of typhoid in densely populated urban slums. This suggests that attainable improvements in WASH facilities can contribute to enhanced typhoid control, especially in settings where major infrastructural improvements are challenging. These findings underscore the importance of implementing and promoting comprehensive WASH interventions in low-income countries as a means to reduce the burden of typhoid and improve public health outcomes in vulnerable populations.
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Affiliation(s)
- Birkneh Tilahun Tadesse
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Farhana Khanam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Faisal Ahmmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, United Kingdom
| | - Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Deok Ryun Kim
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Sophie Sy Kang
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Justin Im
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tasnuva Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Asma Binte Aziz
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Masuma Hoque
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Juyeon Park
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Gideok Pak
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Khalequ Zaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jerome H Kim
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - John D Clemens
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Bartlett AW, Mendes EP, Dahmash L, Peliganga LB, Lufunda LMM, Direito A, Mwinzi PN, Eulogio P, Lopes S, Nery SV. Knowledge, attitudes, practices and acceptability of a school preventive chemotherapy programme for schistosomiasis and soil-transmitted helminths control in Angola. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220430. [PMID: 37598703 PMCID: PMC10440166 DOI: 10.1098/rstb.2022.0430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/28/2023] [Indexed: 08/22/2023] Open
Abstract
Schistosomiasis and soil-transmitted helminth (STH) control programs require target population engagement, assessed through knowledge, attitudes and practices (KAP) surveys. We report the results of a KAP survey of Angolan schoolchildren supported by a school preventive chemotherapy (PC) programme, without or with a school water, sanitation and hygiene (WASH) programme (PC+/WASH- and PC+/WASH+, respectively); and schoolchildren without a school PC or WASH program (PC-/WASH-). Schoolchildren from PC+/WASH- (N = 218), PC+/WASH+ (N = 250) and PC-/WASH- (N = 254) schools were interviewed. Descriptive statistics were used to report demographics and survey responses. Chi-square or Fisher's exact test was used to compare PC+/WASH- schoolchildren with (i) PC+/WASH+ and (ii) PC-/WASH- schoolchildren. A lower proportion of PC+/WASH- schoolchildren used latrines and a higher proportion practised open defecation at school compared with PC+/WASH+ schoolchildren. A lower proportion of PC+/WASH- schoolchildren always washed their hands after toileting and before meals at school compared with PC+/WASH+ schoolchildren. However, the PC+/WASH- schoolchildren reported better toileting and handwashing practices at school compared to PC-/WASH- schoolchildren. Over 90% of PC+ schoolchildren agreed with schistosomiasis and STH control and accepted schoolteacher PC delivery. Expanding the integration of both school PC and WASH programs will improve health behaviours relevant to reduce the risk of schistosomiasis and STHs in schoolchildren. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.
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Affiliation(s)
- Adam W. Bartlett
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia, 2052
| | - Elsa P. Mendes
- National Directorate of Public Health, Ministry of Health, Luanda, Angola
| | | | - Luis B. Peliganga
- National Directorate of Public Health, Ministry of Health, Luanda, Angola
| | | | | | - Pauline N. Mwinzi
- Expanded Special Project for Elimination of Neglected Tropical Diseases, Brazzaville, Congo
| | - Pablo Eulogio
- National Directorate of Public Health, Ministry of Health, Luanda, Angola
| | - Sergio Lopes
- National Directorate of Public Health, Ministry of Health, Luanda, Angola
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia, 2052
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Huo S, Wang K, Liu Z, Yang Y, Hee JY, He Q, Takesue R, Tang K. Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program. JMIR Public Health Surveill 2022; 8:e33394. [PMID: 35384848 PMCID: PMC9021946 DOI: 10.2196/33394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/27/2022] Open
Abstract
Background The issue of malnutrition in the Democratic Republic of Congo is severe. Meanwhile, the Water, Sanitation, and Hygiene program has been demonstrated to be effective in reducing the rates of growth stunting among children. Objective We aimed to explore the association between maternal exposure to mass media and stunting in children through water, sanitation, and hygiene behaviors. Methods Mediation analysis was conducted using data from the 2018 Multiple Indicators Cluster Surveys. Results Mothers’ exposures to television and the internet in the Democratic Republic of Congo significantly decreases the risk of stunting in children by 5% and 10%, respectively, mediated by household water, sanitation, and hygiene facilities and practices. Conclusions These findings could inform interventions and policies to reduce the rate of stunting rate children by promoting water, sanitation, and hygiene through mass media, especially through the internet and television.
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Affiliation(s)
- Shutong Huo
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Program in Public Health, University of California, Irvine, CA, United States
| | - Kai Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zongchao Liu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Yuao Yang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Jia Yi Hee
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Qiwei He
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Rie Takesue
- Health Section Programme Division, UNICEF Headquarters, New York, NY, United States
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China.,Institute of Healthy China, Tsinghua University, Beijing, China
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Kim C, Mansoor GF, Paya PM, Ludin MH, Ahrar MJ, Mashal MO, Todd CS. Multisector nutrition gains amidst evidence scarcity: scoping review of policies, data and interventions to reduce child stunting in Afghanistan. Health Res Policy Syst 2020; 18:65. [PMID: 32527267 PMCID: PMC7291673 DOI: 10.1186/s12961-020-00569-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 05/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background Child health indicators have substantially improved across the last decade, yet Afghanistan has among the highest child stunting and malnutrition rates in Asia. Multisectoral approaches were recently introduced but evidence for this approach to improve support for and implementation of child nutrition programmes is limited compared to other countries. Methods We reviewed policy and programme data to identify best practices and gaps surrounding child malnutrition in Afghanistan. We conducted a scoping review using broad search categories and approaches, including database and website searches, reference hand-searches, purposive policy and programme document request, and key informant interviews. Inclusion and exclusion criteria were developed iteratively, with abstracts and documents assessed against the final criteria. We abstracted documents systematically and summarised and synthesised content to generate the main findings. Results We included 18 policies and strategies, 45 data sources and reports, and 20 intervention evaluations. Movement towards multisectoral efforts to address malnutrition at the policy level has started; however, integrated nutrition-specific and nutrition-sensitive interventions are not yet uniformly delivered at the community level. Many data sources capturing nutrition, food security and WASH (water, sanitation and hygiene) indicators are available but indicator definitions are not standardised and there are few longitudinal nutrition surveys. Political will to improve household nutrition status has shown increased government and donor investments in nutrition-sensitive and nutrition-specific programmes through combined small- and large-scale interventions between 2004 and 2013; however, evidence for interventions that effectively decrease stunting prevalence is limited. Conclusions This review shows a breadth of nutrition programme, policy and data in Afghanistan. Multisector approaches faced challenges of reaching sufficient coverage as they often included a package of food security, livelihoods and health interventions but were each implemented independently. Further implementation evidence is needed to aid policy and programmes on effective integration of nutrition, food security and WASH in Afghanistan.
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Affiliation(s)
- Christine Kim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Ghulam Farooq Mansoor
- FHI 360/Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project, Kabul, Afghanistan
| | - Pir Mohammad Paya
- FHI 360/Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project, Kabul, Afghanistan
| | - Mohammad Homayoun Ludin
- Public Nutrition Directorate, Ministry of Public Health, Islamic Republic of Afghanistan, Kabul, Afghanistan
| | - Mohammad Javed Ahrar
- Rural Water Supply and Irrigation Programme (RuWATSIP) Department, Ministry of Rural Rehabilitation and Development (MRRD), Islamic Republic of Afghanistan, Kabul, Afghanistan
| | - Mohammad Omar Mashal
- FHI 360/Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project, Kabul, Afghanistan
| | - Catherine S Todd
- Division of Reproductive, Maternal, Newborn, and Child Health, Global Health, Population and Nutrition Department, Durham, North, Carolina, United States of America
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Mactaggart I, Schmidt WP, Bostoen K, Chunga J, Danquah L, Halder AK, Parveen Jolly S, Polack S, Rahman M, Snel M, Kuper H, Biran A. Access to water and sanitation among people with disabilities: results from cross-sectional surveys in Bangladesh, Cameroon, India and Malawi. BMJ Open 2018; 8:e020077. [PMID: 29866723 PMCID: PMC5988144 DOI: 10.1136/bmjopen-2017-020077] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess access to adequate water, sanitation and hygiene (WASH) among people with disabilities at the household and individual level. DESIGN Cross-sectional surveys. SETTING Data were included from five district-level or regional-level surveys: two in Bangladesh (Bangladesh-1, Bangladesh-2), and one each in Cameroon, Malawi and India. PARTICIPANTS 99 252 participants were sampled across the datasets (range: 3567-75 767), including 2494 with disabilities (93-1374). OUTCOME Prevalence of access to WASH at household and individual level. DATA ANALYSIS Age/sex disaggregated disability prevalence estimates were calculated accounting for survey design. The Unicef/WHO Joint Monitoring Programme definitions were used to classify facilities as improved/unimproved. Multivariable logistic regression was undertaken to compare between households with/without a person with a disability, and to identify predictors of access among people with disabilities. RESULTS There were no differences in access to improved sanitation or water sources between households with/without members with disabilities across the datasets. In Bangladesh-2, households including a person with a disability were more likely to share facilities with other households (OR 1.3, 95% CI 1.1 to 1.5). Households with people with disabilities were more likely to spend >30 min (round-trip) collecting drinking water than households without in both Cameroon (OR 1.8, 95% CI 1.0 to 3.4) and India (OR 2.3, 95% CI 1.2 to 4.7). Within households, people with disabilities reported difficulties collecting water themselves (23%-80% unable to) and accessing the same sanitation facilities as other household members, particularly without coming into contact with faeces (up to 47% in Bangladesh-2). These difficulties were most marked for people with more severe impairments. CONCLUSIONS People with disabilities may not have poorer access to WASH at the household level, but may have poorer quality of access within their households. Further programmatic work is needed to ensure WASH facilities are inclusive of people with disabilities.
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Affiliation(s)
- Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Wolf-Peter Schmidt
- Environmental Health Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Kristof Bostoen
- Monitoring[4] ch∆nge and IRC-Associate, The Hague, The Netherlands
| | - Joseph Chunga
- Centre for Social Research, University of Malawi, Zomba, Malawi
| | - Lisa Danquah
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | | | - Saira Parveen Jolly
- Resarch and Evaluation Division, Bangladesh Rural Advancement Committee, Dhaka, Bangladesh
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Mahfuzar Rahman
- Resarch and Evaluation Division, Bangladesh Rural Advancement Committee, Dhaka, Bangladesh
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Biran
- Environmental Health Group, London School of Hygiene & Tropical Medicine, London, UK
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Mbuya MNN, Tavengwa NV, Stoltzfus RJ, Curtis V, Pelto GH, Ntozini R, Kambarami RA, Fundira D, Malaba TR, Maunze D, Morgan P, Mangwadu G, Humphrey JH. Design of an Intervention to Minimize Ingestion of Fecal Microbes by Young Children in Rural Zimbabwe. Clin Infect Dis 2016; 61 Suppl 7:S703-9. [PMID: 26602297 DOI: 10.1093/cid/civ845] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
We sought to develop a water, sanitation, and hygiene (WASH) intervention to minimize fecal-oral transmission among children aged 0-18 months in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. We undertook 4 phases of formative research, comprising in-depth interviews, focus group discussions, behavior trials, and a combination of observations and microbiological sampling methods. The resulting WASH intervention comprises material inputs and behavior change communication to promote stool disposal, handwashing with soap, water treatment, protected exploratory play, and hygienic infant feeding. Nurture and disgust were found to be key motivators, and are used as emotional triggers. The concept of a safe play space for young children was particularly novel, and families were eager to implement this after learning about the risks of unprotected exploratory play. An iterative process of formative research was essential to create a sequenced and integrated longitudinal intervention for a SHINE household as it expects (during pregnancy) and then cares for a new child.
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Affiliation(s)
- Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe Division of Nutritional Sciences, Cornell University, Ithaca, New York Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Naume V Tavengwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Valerie Curtis
- London School of Hygiene and Tropical Medicine, United Kingdom
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Dadirai Fundira
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Thokozile R Malaba
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Diana Maunze
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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