Title
Associations between household-level exposures and all-cause diarrhea and pathogen-specific enteric infections in children enrolled in five sentinel surveillance studies
Date Issued
01 November 2020
Access level
open access
Resource Type
journal article
Author(s)
Colston J.M.
Faruque A.S.G.
Jahangir Hossain M.
Saha D.
Kanungo S.
Mandomando I.
Imran Nisar M.
Zaidi A.K.M.
Omore R.
Breiman R.F.
Sow S.O.
Roose A.
Levine M.M.
Kotloff K.L.
Ahmed T.
Bessong P.
Bhutta Z.
Mduma E.
Yori P.P.
Shrestha P.S.
Kang G.
Lima A.A.M.
Humphrey J.
Prendergast A.
Zaitchik B.F.
Publisher(s)
MDPI AG
Abstract
Diarrheal disease remains a major cause of childhood mortality and morbidity causing poor health and economic outcomes. In low-resource settings, young children are exposed to numerous risk factors for enteric pathogen transmission within their dwellings, though the relative importance of different transmission pathways varies by pathogen species. The objective of this analysis was to model associations between five household-level risk factors—water, sanitation, flooring, caregiver education, and crowding—and infection status for endemic enteric pathogens in children in five surveillance studies. Data were combined from 22 sites in which a total of 58,000 stool samples were tested for 16 specific enteropathogens using qPCR. Risk ratios for pathogen-and taxon-specific infection status were modeled using generalized linear models along with hazard ratios for all-cause diarrhea in proportional hazard models, with the five household-level variables as primary exposures adjusting for covariates. Improved drinking water sources conferred a 17% reduction in diarrhea risk; however, the direction of its association with particular pathogens was inconsistent. Improved sanitation was associated with a 9% reduction in diarrhea risk with protective effects across pathogen species and taxa of around 10–20% risk reduction. A 9% reduction in diarrhea risk was observed in subjects with covered floors, which were also associated with decreases in risk for zoonotic enteropathogens. Caregiver education and household crowding showed more modest, inconclusive results. Combining data from diverse sites, this analysis quantified associations between five household-level exposures on risk of specific enteric infections, effects which differed by pathogen species but were broadly consistent with hypothesized transmission mechanisms. Such estimates may be used within expanded water, sanitation, and hygiene (WASH) programs to target interventions to the particular pathogen profiles of individual communities and prioritize resources.
Start page
1
End page
18
Volume
17
Issue
21
Language
English
OCDE Knowledge area
Epidemiología
Scopus EID
2-s2.0-85094963899
PubMed ID
Source
International Journal of Environmental Research and Public Health
ISSN of the container
16617827
Sponsor(s)
The Etiology: Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation (47075), the Foundation for the National Institutes of Health, and the National Institutes of Health, Fogarty International Center. Additional support for MAL-ED was obtained from the BMGF (Improved Biomarkers of Environmental Enteropathy, OPP1066146) and the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases of the Johns Hopkins School of Medicine (to MNK). The Global Enteric Multicenter Study (GEMS) was supported by grants 38774 and OPP1033572 from the Bill & Melinda Gates Foundation. The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 to Johns Hopkins Bloomberg School of Public Health and OPP1143707 to Zvitambo Institute for Maternal and Child Health Research), the UK Department for International Development, the Wellcome Trust (093768/Z/10/Z and 108065/Z/15/Z), the Swiss Agency for Development and Cooperation (8106727), UNICEF (PCA-2017-0002), and the US National Institutes of Health (R01 HD060338/HD/NICHD). The research presented in this article was supported financially by NASA’s Group on Earth Observations Work Programme (16-GEO16-0047) and The National Institutes of Health’s National Institute of Allergy and Infectious Diseases grant 1R03AI151564-01. Funding: The Etiology: Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation (47075), the Foundation for the National Institutes of Health, and the National Institutes of Health, Fogarty International Center. Additional support for MAL-ED was obtained from the BMGF (Improved Biomarkers of Environmental Enteropathy, OPP1066146) and the Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases of the Johns Hopkins School of Medicine (to MNK). The Global Enteric Multicenter Study (GEMS) was supported by grants 38774 and OPP1033572 from the Bill & Melinda Gates Foundation. The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 to Johns Hopkins Bloomberg School of Public Health and OPP1143707 to Zvitambo Institute for Maternal and Child Health Research), the UK Department for International Development, the Wellcome Trust (093768/Z/10/Z and 108065/Z/15/Z), the Swiss Agency for Development and Cooperation (8106727), UNICEF (PCA-2017-0002), and the US National Institutes of Health (R01 HD060338/HD/NICHD). The research presented in this article was supported financially by NASA’s Group on Earth Observations Work Programme (16-GEO16-0047) and The National Institutes of Health’s National Institute of Allergy and Infectious Diseases grant 1R03AI151564-01.
Sources of information: Directorio de Producción Científica Scopus