• 1.

    Troeger C et al 2018. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 18: 11911210.

    • Search Google Scholar
    • Export Citation
  • 2.

    UNICEF, 2016. One Is Too Many: Ending Child Deaths from Pneumonia and Diarrhoea. New York, NY: UNICEF.

  • 3.

    UNICEF , 2021. Under-Five Mortality. Available at: https://data.unicef.org/topic/child-survival/under-five-mortality/.

  • 4.

    Jackson S et al.2013. Risk factors for severe acute lower respiratory infections in children: a systematic review and meta-analysis. Croat Med J 54: 110121.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 6.

    Luby SP et al.2005. Effect of handwashing on child health: a randomised controlled trial. Lancet 366: 225233.

  • 7.

    Nicholson JA et al.2014. An investigation of the effects of a hand washing intervention on health outcomes and school absence using a randomised trial in Indian urban communities. Trop Med Int Health 19: 284292.

    • Search Google Scholar
    • Export Citation
  • 8.

    Arnold B, Arana B, Mäusezahl D, Hubbard A, Colford JM Jr , 2009. Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala. Int J Epidemiol 38: 16511661.

    • Search Google Scholar
    • Export Citation
  • 9.

    Huda TM, 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.

    • Search Google Scholar
    • Export Citation
  • 10.

    Gera T, Shah D, Sachdev HS , 2018. Impact of water, sanitation and hygiene interventions on growth, non-diarrheal morbidity and mortality in children residing in low- and middle-income countries: a systematic review. Indian Pediatr 55: 381393.

    • Search Google Scholar
    • Export Citation
  • 11.

    Ashraf S et al.2020. Effect of improved water quality, sanitation, hygiene and nutrition interventions on respiratory illness in young children in rural Bangladesh: a multi-arm cluster-randomized controlled trial. Am J Trop Med Hyg 102: 11241130.

    • Search Google Scholar
    • Export Citation
  • 12.

    Swarthout J et al.2020. Effects of individual and combined water, sanitation, handwashing, and nutritional interventions on child respiratory infections in rural Kenya: a cluster-randomized controlled trial. Am J Trop Med Hyg 102: 12861295.

    • Search Google Scholar
    • Export Citation
  • 13.

    Rosales FJ, Reznick JS, Zeisel SH , 2009. Understanding the role of nutrition in the brain and behavioral development of toddlers and preschool children: identifying and addressing methodological barriers. Nutr Neurosci 12: 190202.

    • Search Google Scholar
    • Export Citation
  • 14.

    Chandra RK , 1997. Nutrition and the immune system: an introduction. Am J Clin Nutr 66: 460s463s.

  • 15.

    Sonego M, Pellegrin MC, Becker G, Lazzerini M , 2015. Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies. PLoS One 10: e0116380.

    • Search Google Scholar
    • Export Citation
  • 16.

    Rodríguez L, Cervantes E, Ortiz R , 2011. Malnutrition and gastrointestinal and respiratory infections in children: a public health problem. Int J Environ Res Public Health 8: 11741205.

    • Search Google Scholar
    • Export Citation
  • 17.

    Humphrey JH et al.2019. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial. Lancet Glob Health 7: e132e47.

    • Search Google Scholar
    • Export Citation
  • 18.

    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: e302e15.

    • Search Google Scholar
    • Export Citation
  • 19.

    Null C et al.2018. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: a cluster-randomised controlled trial. Lancet Glob Health 6: e316e29.

    • Search Google Scholar
    • Export Citation
  • 20.

    Randolph TF et al.2007. Invited review: role of livestock in human nutrition and health for poverty reduction in developing countries. J Anim Sci 85: 27882800.

    • Search Google Scholar
    • Export Citation
  • 21.

    American Thoracic Society , 1998. Respiratory health hazards in agriculture. Am J Respir Crit Care Med 158: S1S76.

  • 22.

    Ercumen A, Prottas C, Harris A, Dioguardi A, Dowd G, Guiteras R , 2020. Poultry ownership associated with increased risk of child diarrhea: cross-sectional evidence from Uganda. Am J Trop Med Hyg 102: 526533.

    • Search Google Scholar
    • Export Citation
  • 23.

    Ministère du Plan et Suivi de la Mise en œuvre de la Révolution de la Modernité - MPSMRM/Congo, Ministère de la Santé Publique - MSP/Congo, ICF International , 2014. République Démocratique du Congo Enquête Démographique et de Santé (EDS-RDC) 2013-2014. Rockville, MD: MPSMRM, MSP, and ICF International.

    • Search Google Scholar
    • Export Citation
  • 24.

    Moursi MM, Arimond M, Dewey KG, Trèche S, Ruel MT, Delpeuch F , 2008. Dietary diversity is a good predictor of the micronutrient density of the diet of 6- to 23-month-old children in Madagascar. J Nutr 138: 24482453.

    • Search Google Scholar
    • Export Citation
  • 25.

    INDDEX Project , 2018. Data4Diets: Building Blocks for Diet-related Food Security Analysis. Boston, MA: Tufts University. Available at: https://inddex.nutrition.tufts.edu/node/158.

    • Search Google Scholar
    • Export Citation
  • 26.

    World Health Organization, 2014. Integrated Management of Childhood Illness (IMCI) (revised). Geneva, Switzerland: WHO Press.

  • 27.

    World Health Organization , 2018. The 2018 Update, Causes of Child Death. Geneva, Switzerland: WHO. Available at: https://apps.who.int/gho/data/node.main.COCD?lang=en.

    • Search Google Scholar
    • Export Citation
  • 28.

    Kumar S et al.2017. Handwashing in 51 countries: analysis of proxy measures of handwashing behavior in multiple indicator cluster surveys and demographic and health surveys, 2010–2013. Am J Trop Med Hyg 97: 447459.

    • Search Google Scholar
    • Export Citation
  • 29.

    Halder A, Tronchet C, Akhter S, Bhuiya A, Johnston R, Luby S , 2010. Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh. BMC Public Health 10: 545.

    • Search Google Scholar
    • Export Citation
  • 30.

    Kamm KB et al.2014. Associations between presence of handwashing stations and soap in the home and diarrhoea and respiratory illness, in children less than five years old in rural western Kenya. Trop Med Int Health 19: 398406.

    • Search Google Scholar
    • Export Citation
  • 31.

    Najnin N et al.2019. Impact of a large-scale handwashing intervention on reported respiratory illness: findings from a cluster-randomized controlled trial. Am J Trop Med Hyg 100: 742749.

    • Search Google Scholar
    • Export Citation
  • 32.

    Centers for Disease Control and Prevention , 2020. When and How to Wash Your Hands .Atlanta, GA: CDC. Available at: https://www.cdc.gov/handwashing/when-how-handwashing.html.

    • Search Google Scholar
    • Export Citation
  • 33.

    Kuhl J et al.2021. Formative research for the development of baby water, sanitation, and hygiene interventions for young children in the Democratic Republic of the Congo (REDUCE program). BMC Public Health 21: 427.

    • Search Google Scholar
    • Export Citation
  • 34.

    Amin N et al.2014. Microbiological evaluation of the efficacy of soapy water to clean hands: a randomized, non-inferiority field trial. Am J Trop Med Hyg 91: 415423.

    • Search Google Scholar
    • Export Citation
  • 35.

    Calder PC, Jackson AA , 2000. Undernutrition, infection and immune function. Nutr Res Rev 13: 329.

  • 36.

    Kamenju P et al.2017. Complementary feeding and diarrhea and respiratory infection among HIV-exposed Tanzanian infants. J Acquir Immune Defic Syndr 74: 265272.

    • Search Google Scholar
    • Export Citation
  • 37.

    Headey D, Hirvonen K , 2016. Is exposure to poultry harmful to child nutrition? An observational analysis for rural Ethiopia. PLoS One 11: e0160590.

    • Search Google Scholar
    • Export Citation
  • 38.

    Marquis GS et al.1990. Fecal contamination of shanty town toddlers in households with non-corralled poultry, Lima, Peru. Am J Public Health 80: 146149.

    • Search Google Scholar
    • Export Citation
  • 39.

    George CM et al.2021. Child mouthing of feces and fomites and animal contact are associated with diarrhea and impaired growth among young children in the Democratic Republic of the Congo: a prospective cohort study (REDUCE Program). J Pediatr 228: 1106 e1.

    • Search Google Scholar
    • Export Citation
  • 40.

    World Health Organization, Regional Office for Europe&European Centre for Environment and Health,2005.Effects of Air Pollution on Children’s Health and Development: A Review of the Evidence.Copenhagen, Denmark: WHO Regional Office for Europe.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Water, Sanitation, and Hygiene and Nutritional Risk Factors for Acute Respiratory Illness in the Democratic Republic of the Congo: REDUCE Prospective Cohort Study

View More View Less
  • 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
  • | 2 Food for the Hungry, Phoenix, Arizona;
  • | 3 Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
Restricted access

ABSTRACT.

The objective of this cohort study was to examine the prevalence of acute respiratory illness among children under 5 years of age and to identify water, sanitation, and hygiene (WASH) and nutritional risk factors. This prospective cohort study was conducted in Walungu Territory, South Kivu, Democratic Republic of the Congo (DRC) and enrolled 512 participants. Spot checks of the household environment were conducted at baseline. Baseline minimum dietary diversity (MDD) was defined by consumption of five or more of the following food groups: 1) breast milk; 2) grains, roots, and tubers; 3) legumes and nuts; 4) dairy products; 5) flesh foods; 6) eggs; 7) vitamin A rich fruits and vegetables; and 8) other fruits and vegetables. Acute respiratory illness was defined as caregiver-reported rapid breathing, difficulty breathing, lower chest wall in-drawing, or coughing in the previous 2 weeks obtained at a 6-month follow-up. A total of 58% of children had acute respiratory illness, 19% had soap present in the household cooking area, and 4% in the defecation area, and 21% of children met MDD. A decreased odds of acute respiratory illness was associated with soap being present in the household cooking area (odds ratio [OR]: 0.49, 95% confidence interval [CI]: 0.38–0.88) and children with MDD (OR: 0.62, 95% CI: 0.38–1.00). These findings highlight the need for interventions targeting hygiene and improved dietary diversity among rural DRC households to reduce the rate of respiratory illnesses in children under 5 years.

Author Notes

Address correspondence to Christine Marie George, Associate Professor, Department of International Health, Program in Global Disease Epidemiology and Control, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5535, Baltimore, MD 21205-2103. E-mail: cmgeorge@jhu.edu

Financial support: This material is based in part upon work supported by the USAID Bureau for Humanitarian Assistance (BHA), under a Development Food Security Activity (DFSA), led by Food for the Hungry in the Sud Kivu and Tanganyika provinces of DRC (Cooperative Agreement AID-FFP-A-16-00010).

Disclaimer: Any opinion, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of partner organizations or the U.S. Government.

Authors’ addresses: Kelly Endres, Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, E-mail: kendres4@jhu.edu. Presence Sanvura, Food for the Hungry, Phoenix, AZ, E-mail: presencesanvura@gmail.com. Camille Williams, Elizabeth D. Thomas, and Jennifer Kuhl, Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, E-mails: cwill302@jhmi.edu, liz.thomas@jhu.edu, and jennifer.m.kuhl@gmail.com. Nicole Coglianese and Sarah Bauler, Food for the Hungry, Phoenix, AZ, E-mails: nicole.coglianese@gmail.com and sarahbauler@gmail.com. Ruthly François, Department of International Health, Johns Hopkins School of Public Health, International Health, Baltimore, MD, E-mail: ruthly.francois@gmail.com. Jean Claude Bisimwa and Patrick Mirindi, Food for the Hungry, Phoenix, AZ, E-mails: jcbisrus@gmail.com and patrick.mirindi@gmail.com. Jamie Perin and Alain Namegabe, Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, E-mails: jperin@jhu.edu and alainmwish@gmail.com. Lucien Bisimwa, Food for the Hungry, Phoenix, Arizona, E-mail: lucienbis86@gmail.com. Daniel Leung, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, E-mail: daniel.leung@utah.edu. Christine Marie George, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: cmgeorge@jhu.edu.

Save