TY - JOUR
T1 - Effect of improved water quality, sanitation, hygiene and nutrition interventions on respiratory illness in young children in Rural Bangladesh
T2 - A multi-arm cluster-randomized controlled trial
AU - Ashraf, Sania
AU - Islam, Mahfuza
AU - Unicomb, Leanne
AU - Rahman, Mahbubur
AU - Winch, Peter J.
AU - Arnold, Benjamin F.
AU - Benjamin-Chung, Jade
AU - Ram, Pavani K.
AU - Colford, John M.
AU - Luby, Stephen P.
N1 - Funding Information:
Financial support: This research was funded by Global Development grant OPPGD759 from the Bill & Melinda Gates Foundation to the University of California, Berkeley, CA. S. P. L., S. A., M. I., B. F. A., and J. M. C. report grants from the Bill & Melinda Gates Foundation during the conduct of the study. P. K. R. reports grants from Leland Stanford University during the conduct of the study for support to the WASH Benefits project. M. R. reports grants and nonfinancial support from the Bill & Melinda Gates Foundation (through a subcontract from UC Berkeley) during the conduct of the study.
Publisher Copyright:
© 2020 American Society of Tropical Medicine and Hygiene. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Acute respiratory infections cause mortality in young children. Weassessed the effects of water, sanitation, hygiene (WASH) and nutritional interventions on childhood ARI. Geographic clusters of pregnant women from rural Bangladesh were randomly assigned to receive 1) chlorinated drinking water and safe storage (W); 2) upgraded sanitation (S); 3) handwashing promotion (H); 4) combined water, sanitation, and handwashing (WSH); 5) nutrition intervention including lipid-based nutrient supplements; 6) combined WSH plus nutrition (WSHN); or 7) no intervention (control). Masking of participants was not possible. Acute respiratory illness was defined as caregiver-reported persistent cough, panting, wheezing, or difficulty breathing in the past 7 days among index children, those born to enrolled women. We assessed outcomes at 12 and 24 months of intervention using intention to treat. Compared with children in the control group (ARI prevalence, P: 8.9%), caregivers of index children reported significantly lower ARI in the water (P: 6.3%, prevalence ratio (PR): 0.71; 95% CI: 0.53, 0.96), sanitation (P: 6.4%, PR: 0.75, 95% CI: 0.58, 0.96), handwashing (P: 6.4%, PR: 0.68, 95%CI: 0.50, 0.93), and the combinedWSH+Narms(P: 5.9%, PR: 0.67, 95%CI: 0.50, 0.90). Those in the nutrition (P: 7.4%, PR: 0.84, 95% CI: 0.63, 1.10) or the WSH arm (P: 8.9%, PR: 0.99, 95% CI: 0.76, 1.28) reported similar ARI prevalence compared with control children. Single targeted water, sanitation, and hygiene interventions reduced reported respiratory illness in young children. Therewas no apparent respiratory health benefit fromcombiningWASH interventions.
AB - Acute respiratory infections cause mortality in young children. Weassessed the effects of water, sanitation, hygiene (WASH) and nutritional interventions on childhood ARI. Geographic clusters of pregnant women from rural Bangladesh were randomly assigned to receive 1) chlorinated drinking water and safe storage (W); 2) upgraded sanitation (S); 3) handwashing promotion (H); 4) combined water, sanitation, and handwashing (WSH); 5) nutrition intervention including lipid-based nutrient supplements; 6) combined WSH plus nutrition (WSHN); or 7) no intervention (control). Masking of participants was not possible. Acute respiratory illness was defined as caregiver-reported persistent cough, panting, wheezing, or difficulty breathing in the past 7 days among index children, those born to enrolled women. We assessed outcomes at 12 and 24 months of intervention using intention to treat. Compared with children in the control group (ARI prevalence, P: 8.9%), caregivers of index children reported significantly lower ARI in the water (P: 6.3%, prevalence ratio (PR): 0.71; 95% CI: 0.53, 0.96), sanitation (P: 6.4%, PR: 0.75, 95% CI: 0.58, 0.96), handwashing (P: 6.4%, PR: 0.68, 95%CI: 0.50, 0.93), and the combinedWSH+Narms(P: 5.9%, PR: 0.67, 95%CI: 0.50, 0.90). Those in the nutrition (P: 7.4%, PR: 0.84, 95% CI: 0.63, 1.10) or the WSH arm (P: 8.9%, PR: 0.99, 95% CI: 0.76, 1.28) reported similar ARI prevalence compared with control children. Single targeted water, sanitation, and hygiene interventions reduced reported respiratory illness in young children. Therewas no apparent respiratory health benefit fromcombiningWASH interventions.
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U2 - 10.4269/AJTMH.19-0769
DO - 10.4269/AJTMH.19-0769
M3 - Article
C2 - 32100681
AN - SCOPUS:85087466683
SN - 0002-9637
VL - 102
SP - 1124
EP - 1130
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 5
ER -