Simplified sewerage to prevent urban leptospirosis transmission: a cluster non-randomised controlled trial protocol in disadvantaged urban communities of Salvador, Brazil.

Autor:	Cremonese C; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil cleber.cremonese@gmail.com., Souza FN; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil.; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil.; Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil., Palma FAG; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil.; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil., Sodré JFA; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil., Brito RL; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil., Ribeiro PDS; Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil.; Institute of Biological Science, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.; National Institute of Science and Technology in Interdisciplinary and Transdisciplinary Studies in Ecology and Evolution (INCT IN-TREE), Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil., Santana JO; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil.; Institute of Geosciences, Federal University of Bahia, Salvador, Bahia, Brazil., Coelho RH; Faculty of Economics, Federal University of Bahia, Salvador, Bahia, Brazil., Ticona JPA; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil.; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil., Nazaré RJ; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil., de Oliveira D; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil.; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil., Silva CQ; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil., Eyre MT; London School of Hygiene & Tropical Medicine, Faculty of Infectious Tropical Diseases, Disease Control Department, London, UK., Mendes VA; Faculty of Economics, Federal University of Bahia, Salvador, Bahia, Brazil., Knee J; London School of Hygiene & Tropical Medicine, Faculty of Infectious Tropical Diseases, Disease Control Department, London, UK., Ristow P; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil.; Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil.; National Institute of Science and Technology in Interdisciplinary and Transdisciplinary Studies in Ecology and Evolution (INCT IN-TREE), Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil., Stauber CE; Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA., López YAA; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil., Giorgi E; Lancaster University Lancaster Medical School, Lancaster, UK., Diggle PJ; Lancaster University Lancaster Medical School, Lancaster, UK., Reis MGG; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil.; Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, USA., Cumming O; London School of Hygiene & Tropical Medicine, Faculty of Infectious Tropical Diseases, Disease Control Department, London, UK., Ko A; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil.; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, USA., Costa F; Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil.; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brasil.; Lancaster University Lancaster Medical School, Lancaster, UK.; Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2023 Jun 23; Vol. 13 (6), pp. e065009. Date of Electronic Publication: 2023 Jun 23.
DOI:	10.1136/bmjopen-2022-065009
Abstrakt:	Introduction: Leptospirosis is a globally distributed zoonotic and environmentally mediated disease that has emerged as a major health problem in urban slums in developing countries. Its aetiological agent is bacteria of the genus Leptospira , which are mainly spread in the urine of infected rodents, especially in an environment where adequate sanitation facilities are lacking, and it is known that open sewers are key transmission sources of the disease. Therefore, we aim to evaluate the effectiveness of a simplified sewerage intervention in reducing the risk of exposure to contaminated environments and Leptospira infection and to characterise the transmission mechanisms involved. Methods and Analysis: This matched quasi-experimental study design using non-randomised intervention and control clusters was designed to assess the effectiveness of an urban simplified sewerage intervention in the low-income communities of Salvador, Brazil. The intervention consists of household-level piped sewerage connections and community engagement and public involvement activities. A cohort of 1400 adult participants will be recruited and grouped into eight clusters consisting of four matched intervention-control pairs with approximately 175 individuals in each cluster in baseline. The primary outcome is the seroincidence of Leptospira infection assessed through five serological measurements: one preintervention (baseline) and four postintervention. As a secondary outcome, we will assess Leptospira load in soil, before and after the intervention. We will also assess Leptospira exposures before and after the intervention, through transmission modelling, accounting for residents' movement, contact with flooding, contaminated soil and water, and rat infestation, to examine whether and how routes of exposure for Leptospira change following the introduction of sanitation. Ethics and Dissemination: This study protocol has been reviewed and approved by the ethics boards at the Federal University of Bahia and the Brazilian National Research Ethics Committee. Results will be disseminated through peer-reviewed publications and presentations to implementers, researchers and participating communities. Trial Registration Number: Brazilian Clinical Trials Registry (RBR-8cjjpgm). Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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