Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial

Tofail, Fahmida; Fernald, Lia C. H.; Das, Kishor Kumar; Rahman, Mahbubur; Ahmed, Tahmeed; Jannat, Kaniz; Unicomb, Leanne; Arnold, Benjamin F.; Ashraf, Sania; Winch, Peter J.; Kariger, Patricia; Stewart, Christine P; Colford, John M.; Luby, Stephen P.

doi:10.1016/s2352-4642(18)30031-2

Cited by 84 publications

(87 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This method of defining risk for delay was used as a conservative strategy because there was no prior research informing a culturally appropriate clinical cut-off in this study population. Binary variables were used to incorporate a quantitative definition of poor development and to be consistent with analyses used in the main WASH Benefits publications [46,58].…”

Section: Early Childhood Developmentmentioning

confidence: 99%

Association between Malaria Infection and Early Childhood Development Mediated by Anemia in Rural Kenya

Milner

Kariger

Pickering

et al. 2020

IJERPH

Self Cite

View full text Add to dashboard Cite

Malaria is a leading cause of morbidity and mortality among children under five years of age, with most cases occurring in Sub-Saharan Africa. Children in this age group in Africa are at greatest risk worldwide for developmental deficits. There are research gaps in quantifying the risks of mild malaria cases, understanding the pathways linking malaria infection and poor child development, and evaluating the impact of malaria on the development of children under five years. We analyzed the association between malaria infection and gross motor, communication, and personal social development in 592 children age 24 months in rural, western Kenya as part of the WASH Benefits environmental enteric dysfunction sub-study. Eighteen percent of children had malaria, 20% were at risk for gross motor delay, 21% were at risk for communication delay, and 23% were at risk for personal social delay. Having a positive malaria test was associated with increased risk for gross motor, communication, and personal social delay while adjusting for child characteristics, household demographics, study cluster, and intervention treatment arm. Mediation analyses suggested that anemia was a significant mediator in the pathway between malaria infection and risk for gross motor, communication, and personal social development delays. The proportion of the total effect of malaria on the risk of developmental delay that is mediated by anemia across the subscales was small (ranging from 9% of the effect on gross motor development to 16% of the effect on communication development mediated by anemia). Overall, malaria may be associated with short-term developmental delays during a vulnerable period of early life. Therefore, preventative malaria measures and immediate treatment are imperative for children’s optimal development, particularly in light of projections of continued high malaria transmission in Kenya and Africa.

show abstract

Section: Early Childhood Developmentmentioning

confidence: 99%

Association between Malaria Infection and Early Childhood Development Mediated by Anemia in Rural Kenya

Milner

Kariger

Pickering

et al. 2020

IJERPH

Self Cite

View full text Add to dashboard Cite

show abstract

“…An estimated 22% or 150 million children younger than 5 years of age are stunted [2]. Even the most optimal food-based interventions have limited effects on preventing or correcting linear growth deficits [5][6][7][8]. Recently, attention has been directed towards environmental enteric dysfunction (EED) as an important component to suboptimal childhood Environmental enteric dysfunction histology index PLOS Neglected Tropical Diseases | https://doi.org/10.1371/journal.pntd.0007975 January 13, 2020 2 / 21…”

Section: Introductionmentioning

confidence: 99%

A novel histological index for evaluation of environmental enteric dysfunction identifies geographic-specific features of enteropathy among children with suboptimal growth

et al. 2020

Self Cite

View full text Add to dashboard Cite

BackgroundA major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity. Data Availability Statement: All relevant analyses are within the manuscript and its Supporting was assessed. The histology index was further used to identify within-and between-child variations as well as features common across and unique to each cohort, and those that correlated with host phenotype. ResultsEight of the 11 histologic scoring parameters showed useful degrees of variation. The overall concordance across all parameters was 96% weighted agreement, kappa 0.70, and Gwet's AC 0.93. Zambian and Pakistani tissues shared some histologic features with GSE, but most features were distinct, particularly abundance of intraepithelial lymphocytes in the Pakistani cohort, and marked villous destruction and loss of secretory cell lineages in the Zambian cohort. ConclusionsWe propose the first EED histology index for interpreting duodenal biopsies. This index should be useful in future clinical and translational studies of this widespread, poorly understood, and highly consequential disorder, which might be caused by multiple contributing processes, in different regions of the world. Author summaryThe study of EED has been limited by the lack of a rigorously tested, reproducible histology index that can provide insight to the pathogenesis of this entity. In this study we report the first duodenal histology index that was developed using an unbiased approach, with excellent inter-observer reproducibility, for the study of EED. The EED histology index readily identified histologic features that are common or unique to cohorts of distinct geographic locations. Incorporating the histology index into future clinical studies will provide useful insight into the pathogenesis and for intervention strategy development.

show abstract

“… 15 A companion trial in Bangladesh has reported significant effects on growth with improved nutrition, reductions in diarrhoea with improvements in water, sanitation, handwashing, or nutrition, 16 and improvements in indicators of child development across all intervention groups. 17 The objective of the present analysis was to evaluate two hypotheses. First, interventions improving water quality; sanitation; handwashing with soap; water, sanitation, and handwashing in combination; nutrition; or water, sanitation, handwashing, and nutrition in combination would improve indicators of child development during the first 2 years of life.…”

Section: Introductionmentioning

confidence: 99%

Effects of water quality, sanitation, handwashing, and nutritional interventions on child development in rural Kenya (WASH Benefits Kenya): a cluster-randomised controlled trial

Stewart

Kariger

Fernald

et al. 2018

The Lancet Child & Adolescent Health

Self Cite

View full text Add to dashboard Cite

SummaryBackgroundPoor nutrition and infectious diseases can prevent children from reaching their developmental potential. We aimed to assess the effects of improvements in water, sanitation, handwashing, and nutrition on early child development in rural Kenya.MethodsIn this cluster-randomised controlled trial, we enrolled pregnant women in their second or third trimester from three counties (Kakamega, Bungoma, and Vihiga) in Kenya's western region, with an average of 12 households per cluster. Groups of nine geographically adjacent clusters were block-randomised, using a random number generator, into the six intervention groups (including monthly visits to promote target behaviours), a passive control group (no visits), or a double-sized active control group (monthly household visits to measure child mid-upper arm circumference). The six intervention groups were: chlorinated drinking water; improved sanitation; handwashing with soap; combined water, sanitation, and handwashing; improved nutrition through counselling and provision of lipid-based nutrient supplements; and combined water, sanitation, handwashing, and nutrition. Here we report on the prespecified secondary child development outcomes: gross motor milestone achievement assessed with the WHO module at year 1, and communication, gross motor, personal social, and combined scores measured by the Extended Ages and Stages Questionnaire (EASQ) at year 2. Masking of participants was not possible, but data assessors were masked. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01704105.FindingsBetween Nov 27, 2012, and May 21, 2014, 8246 women residing in 702 clusters were enrolled. No clusters were lost to follow-up, but 2212 households with 2279 children were lost to follow-up by year 2. 5791 (69%) children were measured at year 1 and 6107 (73%) at year 2. At year 1, compared with the active control group, the combined water, sanitation, handwashing, and nutrition group had greater rates of attaining the standing with assistance milestone (hazard ratio 1·23, 95% CI 1·09–1·40) and the walking with assistance milestone (1·32, 1·17–1·50), and the handwashing group had a greater rate of attaining the standing alone milestone (1·15, 1·01–1·31). There were no differences when comparing the other intervention groups with the active control group on any of the motor milestone measures at year 1. At year 2, there were no differences among groups for the communication, gross motor, personal social, or combined EASQ scores.InterpretationThe handwashing and combined water, sanitation, handwashing, and nutrition interventions might have improved child motor development after 1 year, although after 2 years there were no other differences between groups. Future research should examine ways to make community health and nutrition programmes more effective at supporting child development.FundingBill & Melinda Gates Foundation.

show abstract

Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial

Cited by 84 publications

References 55 publications

Association between Malaria Infection and Early Childhood Development Mediated by Anemia in Rural Kenya

Association between Malaria Infection and Early Childhood Development Mediated by Anemia in Rural Kenya

A novel histological index for evaluation of environmental enteric dysfunction identifies geographic-specific features of enteropathy among children with suboptimal growth

Effects of water quality, sanitation, handwashing, and nutritional interventions on child development in rural Kenya (WASH Benefits Kenya): a cluster-randomised controlled trial

Contact Info

Product

Resources

About