Volume 102, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Most health impact trials of water, sanitation, and hygiene use caregiver-reported diarrhea in children as the primary outcome; this measure is known to be subject to considerable bias, especially when used in unblinded trials. Detection of enteric pathogens in stool or fecal waste via multiplex molecular methods may offer advantages over—and is complementary to—caregiver-reported diarrhea because these measures are objective, on the causal pathway from exposures of interest to disease outcomes, and increasingly feasible in high-burden countries.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Stanaway JD et al., 2018, Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392: 19231994.
    [Google Scholar]
  2. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJG, Sterne JAC, 2008. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 336: 601605.
    [Google Scholar]
  3. Kotloff KL et al., 2013. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet 382: 209222.
    [Google Scholar]
  4. Knee J, Sumner T, Adriano Z, Berendes D, de Bruijn E, Schmidt WP, Nalá R, Cumming O, Brown J, 2018. Risk factors for childhood enteric infection in urban Maputo, Mozambique: a cross-sectional study. PLoS Negl Trop Dis 12: e0006956.
    [Google Scholar]
  5. Walson JL, Pavlinac PB, 2018. Targeting enteric pathogens to improve childhood survival and growth. Lancet Glob Health 6: e1258e1259.
    [Google Scholar]
  6. Liu J et al., 2016 Use of quantitative molecular diagnostic methods to identify causes of diarrhoea in children: a reanalysis of the GEMS case-control study. Lancet 388: 12911301.
    [Google Scholar]
  7. Chhabra P et al., 2017 Comparison of three multiplex gastrointestinal platforms for the detection of gastroenteritis viruses. J Clin Virol 95: 6671.
    [Google Scholar]
  8. Freeman K, Mistry H, Tsertsvadze A, Royle P, McCarthy N, Taylor-Phillips S, Manuel R, Mason J, 2017. Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis. Health Technol Assess 21: 1188.
    [Google Scholar]
  9. Humphrey JH, 2009. Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet 374: 10321035.
    [Google Scholar]
  10. Rogawski ET et al., 2018 Use of quantitative molecular diagnostic methods to investigate the effect of enteropathogen infections on linear growth in children in low-resource settings: longitudinal analysis of results from the MAL-ED cohort study. Lancet Glob Health 6: e1319e1328.
    [Google Scholar]
  11. Stewart CP et al., 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on child development in rural Kenya (WASH Benefits Kenya): a cluster-randomised controlled trial. Lancet Child Adolesc Health 2: 269280.
    [Google Scholar]
  12. Oria RB, Murray-Kolb LE, Scharf RJ, Pendergast LL, Lang DR, Kolling GL, Guerrant RL, 2016. Early-life enteric infections: relation between chronic systemic inflammation and poor cognition in children. Nutr Rev 74: 374386.
    [Google Scholar]
  13. Church JA, Parker EP, Kirkpatrick BD, Grassly NC, Prendergast AJ, 2019. Interventions to improve oral vaccine performance: a systematic review and meta-analysis. Lancet Infect Dis 19: 203214.
    [Google Scholar]
  14. O’Brien E, Nakyazze J, Wu H, Kiwanuka N, Cunningham W, Kaneene JB, Xagoraraki I, 2017. Viral diversity and abundance in polluted waters in Kampala, Uganda. Water Res 127: 4149.
    [Google Scholar]
  15. Falman JC, Fagnant-Sperati CS, Kossik AL, Boyle DS, Meschke JS, 2019. Evaluation of secondary concentration methods for poliovirus detection in wastewater. Food Environ Virol 11: 2031.
    [Google Scholar]
  • Received : 28 Aug 2019
  • Accepted : 24 Sep 2019
  • Published online : 04 Nov 2019
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