1921
Volume 102, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Acute respiratory infections cause mortality in young children. We assessed 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, : 8.9%), caregivers of index children reported significantly lower ARI in the water (: 6.3%, prevalence ratio (PR): 0.71; 95% CI: 0.53, 0.96), sanitation (: 6.4%, PR: 0.75, 95% CI: 0.58, 0.96), handwashing (: 6.4%, PR: 0.68, 95% CI: 0.50, 0.93), and the combined WSH+N arms (: 5.9%, PR: 0.67, 95% CI: 0.50, 0.90). Those in the nutrition (: 7.4%, PR: 0.84, 95% CI: 0.63, 1.10) or the WSH arm (: 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. There was no apparent respiratory health benefit from combining WASH interventions.

[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.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.19-0769
2020-02-24
2020-09-22
Loading full text...

Full text loading...

/deliver/fulltext/14761645/102/5/tpmd190769.html?itemId=/content/journals/10.4269/ajtmh.19-0769&mimeType=html&fmt=ahah

References

  1. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE, 2015. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 385: 430440.
    [Google Scholar]
  2. Rudan I et al., 2013. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. J Glob Health 3: 010401.
    [Google Scholar]
  3. Jackson S, Mathews KH, Pulanic D, Falconer R, Rudan I, Campbell H, Nair H, 2013. Risk factors for severe acute lower respiratory infections in children: a systematic review and meta-analysis. Croat Med J 54: 110121.
    [Google Scholar]
  4. Humphrey JH, 2009. Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet 374: 10321035.
    [Google Scholar]
  5. Aiello AE, Coulborn RM, Perez V, Larson EL, 2008. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health 98: 13721381.
    [Google Scholar]
  6. Sedgwick W, Macnutt J, 1910. On the Mills-Reincke phenomenon and Hazen’s theorem concerning the decrease in mortality from diseases other than typhoid fever following the purification of public water-supplies. J Infect Dis 7: 489564.
    [Google Scholar]
  7. Bhutta ZA, Das JK, Walker N, Campbell H, Rudan I, Black RE, 2013. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet 381: 14171429.
    [Google Scholar]
  8. Ashraf S, Hamidul Huque M, Kenah E, Agboatwalla M, Luby SP, 2013. Effect of recent diarrhoeal episodes on risk of pneumonia in children under the age of 5 years in Karachi, Pakistan. Int J Epidemiol 42: 194200.
    [Google Scholar]
  9. Trinies V, Garn JV, Chang HH, Freeman MC, 2016. The impact of a school-based water, sanitation, and hygiene program on absenteeism, diarrhea, and respiratory infection: a matched-control trial in Mali. Am J Trop Med Hyg 94: 14181425.
    [Google Scholar]
  10. Patel MK et al., 2012. Impact of a hygiene curriculum and the installation of simple handwashing and drinking water stations in rural Kenyan primary schools on student health and hygiene practices. Am J Trop Med Hyg 87: 594601.
    [Google Scholar]
  11. Schlaudecker EP, Steinhoff MC, Moore SR, 2011. Interactions of diarrhea, pneumonia, and malnutrition in childhood: recent evidence from developing countries. Curr Opin Infect Dis 24: 496502.
    [Google Scholar]
  12. Arnold BF et al., 2013. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH benefits study design and rationale. BMJ Open 3: e003476.
    [Google Scholar]
  13. Luby SP et al., 2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial. Lancet Glob Health 6: e302e315.
    [Google Scholar]
  14. Feikin DR, Olack B, Bigogo GM, Audi A, Cosmas L, Aura B, Burke H, Njenga MK, Williamson J, Breiman RF, 2011. The burden of common infectious disease syndromes at the clinic and household level from population-based surveillance in rural and Urban Kenya. PLoS One 6: e16085.
    [Google Scholar]
  15. Arnold BF, Ercumen A, Benjamin-Chung J, Colford JM, 2016. Brief report: negative controls to detect selection bias and measurement bias in epidemiologic studies. Epidemiology 27: 637641.
    [Google Scholar]
  16. Parvez SM et al., 2018. Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh. Trials 19: 358.
    [Google Scholar]
  17. Huda TMN, Unicomb L, Johnston RB, Halder AK, Yushuf Sharker MA, Luby SP, 2012. Interim evaluation of a large scale sanitation, hygiene and water improvement programme on childhood diarrhea and respiratory disease in rural Bangladesh. Soc Sci Med 75: 604611.
    [Google Scholar]
  18. Arnold B, Arana B, Mäusezahl D, Hubbard A, Colford John MJ, 2009. Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala. Int J Epidemiol 38: 16511661.
    [Google Scholar]
  19. Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, Colford JM Jr., Gertler PJ, 2015. The effect of India’s total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial. Plos Med 11: 1012.
    [Google Scholar]
  20. Ercumen A et al., 2018. Effects of single and combined water, sanitation and handwashing interventions on fecal contamination in the domestic environment: a cluster-randomized controlled trial in rural Bangladesh. Environ Sci Technol 52: 1207812088.
    [Google Scholar]
  21. Sungurlu S, Balk RA, 2018. The role of biomarkers in the diagnosis and management of pneumonia. Clin Chest Med 39: 691701.
    [Google Scholar]
  22. Jannat K, Luby SP, Unicomb L, Rahman M, Winch PJ, Parvez SM, Das KK, Leontsini E, Ram PK, Stewart CP, 2019. Complementary feeding practices among rural Bangladeshi mothers: results from WASH Benefits study. Matern Child Nutr 15: e12654.
    [Google Scholar]
  23. Lin A et al., 2019. Effects of water, sanitation, handwashing, and nutritional interventions on environmental enteric dysfunction in young children: a cluster-randomized controlled trial in rural Bangladesh. Clin Infect Dis ciz291.
    [Google Scholar]
  24. Mangani C, Ashorn P, Maleta K, Phuka J, Thakwalakwa C, Dewey K, Manary M, Puumalainen T, Cheung YB, 2014. Lipid-based nutrient supplements do not affect the risk of malaria or respiratory morbidity in 6-to 18-month-old Malawian children in a randomized controlled trial 1–3. J Nutr 144: 18351842.
    [Google Scholar]
  25. Bendabenda J, Alho L, Ashorn U, Cheung YB, Dewey KG, Vosti SA, Phuka J, Maleta K, Ashorn P, 2016. The effect of providing lipid-based nutrient supplements on morbidity in rural Malawian infants and young children: a randomized controlled trial. Public Health Nutr 19: 18931903.
    [Google Scholar]
  26. Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM, 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4252.
    [Google Scholar]
  27. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJ, Sterne JA, 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]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.19-0769
Loading
/content/journals/10.4269/ajtmh.19-0769
Loading

Data & Media loading...

Supplemental material, tables, and figure

  • Received : 16 Oct 2019
  • Accepted : 23 Jan 2020
  • Published online : 24 Feb 2020
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error