Associations between Household-Level Exposures and All-Cause Diarrhea and Pathogen-Specific Enteric Infections in Children Enrolled in Five Sentinel Surveillance Studies

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.

High Prevalence of Stunting and Anaemia Is Associated with Multiple Micronutrient Deficiencies in School Children of Small-Scale Farmers from Chamwino and Kilosa Districts, Tanzania

“…Furthermore, malaria and diarrhoeal infections [52,53], as reported in Chamwino and even more so in Kilosa, as well as parasitic worm infection, especially hookworms, as previously described in relation to anaemia in school children in Zanzibar and Lindi, Tanzania [8,54,55], were very likely the constant 'companions' and contributing factors to anaemia, ID, and VAD [56][57][58][59]. In addition, the lack of clean drinking water and poor sanitation and hygiene (WASH) are also very likely responsible for the high prevalence of diarrhoeal diseases [52].…”

Associations Between Eight Earth Observation‐Derived Climate Variables and Enteropathogen Infection: An Independent Participant Data Meta‐Analysis of Surveillance Studies With Broad Spectrum Nucleic Acid Diagnostics

“…Over the past decade considerable progress has been made in elucidating these relationships due to improved accessibility, accuracy, and resolution of climatological data on the one hand (J. M. Colston, Ahmed, Mahopo, et al., 2018 ) and sensitivity and affordability of broad‐based tools for differential diagnosis of diarrhea‐causing agents on the other (Brown & Cumming, 2019 ). Concurrent advances in statistical methods are now able to account for complex non‐linear, time‐lagged and highly seasonally varying associations (Alsova et al., 2019 ; J. M. Colston et al., 2019 ), and analysis of data pooled from multiple sites and studies has been demonstrated to offer insights into the general epidemiology of enteric pathogens that might not be apparent from considering just a single location (Andersson et al., 2018 ; J. M. Colston et al., 2020 ; Hasso‐Agopsowicz et al., 2019 ). Analyses of time‐series data from particular cities, regions or countries have identified significant associations between individual climatological parameters—such as relative humidity in Singapore (Aik et al., 2020 ), temperature in Bhutan (Wangdi & Clements, 2017 ) and precipitation in Mozambique (Horn et al., 2018 )—and diarrheal outcomes.…”

Molecular Detection of Sapovirus in Children Under Five Years with Acute Gastroenteritis in Mansoura, Egypt between January 2019 and February 2020

“…Viral pathogens represent a significant aetiology for acute gastroenteritis. These infections are usually self-limited in high income countries while it may lead to mortality in underdeveloped countries, especially in children 15,22 .…”