TY - JOUR
T1 - Impact of water quality, sanitation, handwashing, and nutritional interventions on enteric infections in rural zimbabwe
T2 - The sanitation hygiene infant nutrition efficacy (SHINE) trial
AU - McQuade, Elizabeth T.Rogawski
AU - Platts-Mills, James A.
AU - Gratz, Jean
AU - Zhang, Jixian
AU - Moulton, Lawrence H.
AU - Mutasa, Kuda
AU - Majo, Florence D.
AU - Tavengwa, Naume
AU - Ntozini, Robert
AU - Prendergast, Andrew J.
AU - Humphrey, Jean H.
AU - Liu, Jie
AU - Houpt, Eric R.
N1 - Funding Information:
Financial support. The SHINE trial is funded by the Bill & Melinda Gates Foundation (grant numbers OPP1021542 and OPP1143707); the UK Department for International Development; the Wellcome Trust, United Kingdom (grant numbers 093768/Z/10/Z, 108065/Z/15/Z, and 201293/Z/16/Z); the Swiss Agency for Development and Cooperation; the US National Institutes of Health (grant number 2R01HD060338-06); and the European Union. This analysis was further supported by the US National Institutes of Health (grant number K01AI130326 to E. T. R. M.).
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/3/28
Y1 - 2020/3/28
N2 - Background. We assessed the impact of water, sanitation, and hygiene (WASH) and infant and young child feeding (IYCF) interventions on enteric infections in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Methods. We tested stool samples collected at 1, 3, 6, and 12 months of age and during diarrhea using quantitative molecular diagnostics for 29 pathogens. We estimated the effects of the WASH, IYCF, and combined WASH + IYCF interventions on individual enteropathogen prevalence and quantity, total numbers of pathogens detected, and incidence of pathogen-attributable diarrhea. Results. WASH interventions decreased the number of parasites detected (difference in number compared to non-WASH arms, -0.07 [95% confidence interval, -.14 to -.02]), but had no statistically significant effects on bacteria, viruses, or the prevalence and quantity of individual enteropathogens after accounting for multiple comparisons. IYCF interventions had no significant effects on individual or total enteropathogens. Neither intervention had significant effects on pathogen-attributable diarrhea. Conclusions. The WASH interventions implemented in SHINE (improved pit latrine, hand-washing stations, liquid soap, pointof- use water chlorination, and clean play space) did not prevent enteric infections. Transformative WASH interventions are needed that are more efficacious in interrupting fecal-oral microbial transmission in children living in highly contaminated environments.
AB - Background. We assessed the impact of water, sanitation, and hygiene (WASH) and infant and young child feeding (IYCF) interventions on enteric infections in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Methods. We tested stool samples collected at 1, 3, 6, and 12 months of age and during diarrhea using quantitative molecular diagnostics for 29 pathogens. We estimated the effects of the WASH, IYCF, and combined WASH + IYCF interventions on individual enteropathogen prevalence and quantity, total numbers of pathogens detected, and incidence of pathogen-attributable diarrhea. Results. WASH interventions decreased the number of parasites detected (difference in number compared to non-WASH arms, -0.07 [95% confidence interval, -.14 to -.02]), but had no statistically significant effects on bacteria, viruses, or the prevalence and quantity of individual enteropathogens after accounting for multiple comparisons. IYCF interventions had no significant effects on individual or total enteropathogens. Neither intervention had significant effects on pathogen-attributable diarrhea. Conclusions. The WASH interventions implemented in SHINE (improved pit latrine, hand-washing stations, liquid soap, pointof- use water chlorination, and clean play space) did not prevent enteric infections. Transformative WASH interventions are needed that are more efficacious in interrupting fecal-oral microbial transmission in children living in highly contaminated environments.
KW - Enteric infections
KW - Environmental enteric dysfunction
KW - Hygiene
KW - Sanitation
KW - Stunting
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U2 - 10.1093/infdis/jiz179
DO - 10.1093/infdis/jiz179
M3 - Article
C2 - 31004129
AN - SCOPUS:85082561509
VL - 221
SP - 1379
EP - 1386
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
SN - 0022-1899
IS - 8
ER -