A comparison of traditional diarrhoea measurement methods with microbiological and biochemical indicators: A cross-sectional observational study in the Cox's Bazar displaced persons camp

Low cost and real-time surveillance of enteric infection and diarrhoeal disease using rapid diagnostic tests: A pilot study

“…In previous work in Cox’s Bazar, we collected stool samples in the same manner, but then froze them and shipped them to a laboratory in Dhaka where we then used an appropriate lab-based methods to identify pathogens. [28] We estimated the cost per sample was at least 80% lower with the RDTs than in our earlier study. The field workers in the current study were recruited locally and provided with training and the appropriate materials, which further provided a useful link between the research and the population.…”

“…In previous work, we have shown how diarrhoea is poorly associated with enteric infection, irrespective of how diarrhoea is measured. [28] We argue that diarrhoea itself can be seen as an imperfect test of enteric infection, albeit with much poorer diagnostic performance than the RDTs we used in this study. The diagnostic error associated with diarrhoea is unknown and is likely to vary from place to place, meaning an appropriate correction cannot be made, leading to bias in estimators of prevalence and hence the effectiveness of interventions using these measures.…”

“…We aimed to conduct a survey at the heights of both the wet and dry seasons, as the prevalence of viruses and bacteria vary. [28] However, this was not possible and the two rounds of our survey took place in relatively similar climates. We also aimed to follow up with the same households in rounds 1 and 2 to consider intra-person comparisons and facilitate sampling in round 2.…”

The impact of diarrhoea measurement methods for under 5s in low‐ and middle‐income countries on estimated diarrhoea rates at the population level: A systematic review and meta‐analysis of methodological and primary empirical studies

“…It is also likely that any measurement errors will bias results towards the null, rather than towards reports of intervention effectiveness [30]. It is therefore possible that the choice of methodology is at least partially responsible for the widely varying, and often disappointing, results of evaluations on WASH interventions [14, 27, 29, 31, 32].…”

“…Furthermore, direct measurement of environmental contamination and pathogen levels in stool samples should complement diarrhoea rates in clinical studies. This would also allow for determination of how much diarrhoea is attributable to infection (and which can be reduced by WASH interventions), rather than non‐infective reasons (which would likely not be impacted by WASH interventions) [32]. Investigation of the link between interventions, environmental contamination and the profiles of pathogen carriage in childhood stools is an important topic for scientific research.…”