Effect of Water, Sanitation, Handwashing, and Nutrition Interventions on Enteropathogens in Children 14 Months Old: A Cluster-Randomized Controlled Trial in Rural Bangladesh
| Autor: | Ohedul Islam, Rana Miah, Shahjahan Ali, Palash Mutsuddi, Stephen P. Luby, Jie Liu, Ziaur Rahman, Audrie Lin, Jade Benjamin-Chung, John M. Colford, Leanne Unicomb, Jessica A. Grembi, Susan Holmes, James A Platts-Mills, Mami Taniuchi, Elizabeth T Rogawski McQuade, Christine P. Stewart, Benjamin F. Arnold, Mahbubur Rahman, Zahir Hussain, Saheen Hossen, Eric R. Houpt, Abdul Karim, Abul K. Shoab, Rashidul Haque, Syeda L Famida |
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| Rok vydání: | 2020 |
| Předmět: |
Sanitation
sanitation water Clinical Trials and Supportive Activities 030231 tropical medicine enteric pathogens and handwashing medicine.disease_cause Disease cluster Medical and Health Sciences Microbiology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Clinical Research law Immunology and Allergy Medicine 030212 general & internal medicine Feces Pediatric Bangladesh biology business.industry Prevention Sapovirus Biological Sciences biology.organism_classification Confidence interval nutrition Infectious Diseases Carriage Clean Water and Sanitation child health Norovirus Digestive Diseases Infection business Demography |
| Zdroj: | The Journal of infectious diseases, vol 227, iss 3 |
| ISSN: | 1537-6613 0022-1899 |
| DOI: | 10.1093/infdis/jiaa549 |
| Popis: | Background We evaluated the impact of low-cost water, sanitation, and handwashing (WSH) and child nutrition interventions on enteropathogen carriage in the WASH Benefits cluster-randomized controlled trial in rural Bangladesh. Methods We analyzed 1411 routine fecal samples from children 14 ± 2 months old in the WSH (n = 369), nutrition counseling plus lipid-based nutrient supplement (n = 353), nutrition plus WSH (n = 360), and control (n = 329) arms for 34 enteropathogens using quantitative polymerase chain reaction. Outcomes included the number of co-occurring pathogens; cumulative quantity of 4 stunting-associated pathogens; and prevalence and quantity of individual pathogens. Masked analysis was by intention-to-treat. Results Three hundred twenty-six (99.1%) control children had 1 or more enteropathogens detected (mean, 3.8 ± 1.8). Children receiving WSH interventions had lower prevalence and quantity of individual viruses than controls (prevalence difference for norovirus: –11% [95% confidence interval {CI}, –5% to –17%]; sapovirus: –9% [95% CI, –3% to –15%]; and adenovirus 40/41: –9% [95% CI, –2% to –15%]). There was no difference in bacteria, parasites, or cumulative quantity of stunting-associated pathogens between controls and any intervention arm. Conclusions WSH interventions were associated with fewer enteric viruses in children aged 14 months. Different strategies are needed to reduce enteric bacteria and parasites at this critical young age. |
| Databáze: | OpenAIRE |
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