Effects of Individual and Combined Water, Sanitation, Handwashing, and Nutritional Interventions on Child Respiratory Infections in Rural Kenya: A Cluster-Randomized Controlled Trial

Swarthout, Jenna; Ram, Pavani K.; Dentz, Holly N.; Arnold, Benjamin F.; Kalungu, Stephen; Lin, Audrie; Njenga, Sammy M.; Stewart, Christine P; Colford, John M.; Null, Clair; Pickering, Amy J.

doi:10.4269/ajtmh.19-0779

Cited by 17 publications

(7 citation statements)

References 29 publications

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“…The WASH Benefits Kenya and Bangladesh trials provided latrine upgrades, child feces management tools, and behavioral promotion in rural Kenya and Bangladesh. The Kenya trial found no effect on diarrheal disease [17], soil-transmitted helminth infections [19], and ARI [20] from the sanitation intervention. In Bangladesh, the sanitation intervention led to prevalence reductions of 39% for diarrheal disease, 25% for Giardia infections, 29% for Trichuris trichiura infections, and 25% for ARI [16,[21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh

et al. 2022

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Background Diarrhea and acute respiratory infection (ARI) are leading causes of death in children. The WASH Benefits Bangladesh trial implemented a multicomponent sanitation intervention that led to a 39% reduction in the prevalence of diarrhea among children and a 25% reduction for ARI, measured 1 to 2 years after intervention implementation. We measured longer-term intervention effects on these outcomes between 1 to 3.5 years after intervention implementation, including periods with differing intensity of behavioral promotion. Methods and findings WASH Benefits Bangladesh was a cluster-randomized controlled trial of water, sanitation, hygiene, and nutrition interventions (NCT01590095). The sanitation intervention included provision of or upgrades to improved latrines, sani-scoops for feces removal, children’s potties, and in-person behavioral promotion. Promotion was intensive up to 2 years after intervention initiation, decreased in intensity between years 2 to 3, and stopped after 3 years. Access to and reported use of latrines was high in both arms, and latrine quality was significantly improved by the intervention, while use of child feces management tools was low. We enrolled a random subset of households from the sanitation and control arms into a longitudinal substudy, which measured child health with quarterly visits between 1 to 3.5 years after intervention implementation. The study period therefore included approximately 1 year of high-intensity promotion, 1 year of low-intensity promotion, and 6 months with no promotion. We assessed intervention effects on diarrhea and ARI prevalence among children <5 years through intention-to-treat analysis using generalized linear models with robust standard errors. Masking was not possible during data collection, but data analysis was masked. We enrolled 720 households (360 per arm) from the parent trial and made 9,800 child observations between June 2014 and December 2016. Over the entire study period, diarrheal prevalence was lower among children in the sanitation arm (11.9%) compared to the control arm (14.5%) (prevalence ratio [PR] = 0.81, 95% CI 0.66, 1.00, p = 0.05; prevalence difference [PD] = −0.027, 95% CI −0.053, 0, p = 0.05). ARI prevalence did not differ between sanitation (21.3%) and control (22.7%) arms (PR = 0.93, 95% CI 0.82, 1.05, p = 0.23; PD = −0.016, 95% CI −0.043, 0.010, p = 0.23). There were no significant differences in intervention effects between periods with high-intensity versus low-intensity/no promotion. Study limitations include use of caregiver-reported symptoms to define health outcomes and limited data collected after promotion ceased. Conclusions The observed effect of the WASH Benefits Bangladesh sanitation intervention on diarrhea in children appeared to be sustained for at least 3.5 years after implementation, including 1.5 years after heavy promotion ceased. Existing latrine access was high in the study setting, suggesting that improving on-site latrine quality can deliver health benefits when latrine use practices are in place. Further work is needed to understand how latrine adoption can be achieved and sustained in settings with low existing access and how sanitation programs can adopt transformative approaches of excreta management, including safe disposal of child and animal feces, to generate a hygienic home environment. Trial registration ClinicalTrials.gov; NCT01590095; https://clinicaltrials.gov/ct2/show/NCT01590095.

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Section: Introductionmentioning

confidence: 99%

Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh

et al. 2022

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“…In Bangladesh, children receiving WSH and nutrition interventions had reduced prevalence of diarrhea 20 and respiratory infections 21 compared to controls. In Kenya, children receiving the nutrition intervention had marginally lower prevalence of respiratory infections than controls; there were no other intervention effects 22,23 . In both countries, the nutrition intervention improved child linear growth 20,22 .…”

Section: Introductionmentioning

confidence: 92%

Can drinking water, sanitation, handwashing, and nutritional interventions reduce antibiotic use in young children?

Ercumen,

Mertens,

Butzin-Dozier

et al. 2024

Preprint

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Frequent antibiotic use in areas with high infection burdens can lead to antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and child undernutrition can reduce infections and subsequent antibiotic use. We assessed effects of water, sanitation, handwashing (WSH) and nutrition interventions on pediatric antibiotic use in Bangladesh and Kenya, using longitudinal data from birth cohorts (at ages 3-28 months) enrolled in the WASH Benefits cluster-randomized trials. Over 50% of children used antibiotics at least once in the last 90 days. In Bangladesh, the prevalence of using antibiotics at least once was 10-14% lower in groups receiving WSH (prevalence ratio [PR]=0.90 (0.82-0.99)), nutrition (PR=0.86 (0.78-0.94)), and nutrition+WSH (PR=0.86 (0.79-0.93)) interventions. The prevalence of using antibiotics multiple times was 24-35% lower in intervention arms. Intervention effects were strongest when the birth cohort was younger. In Kenya, interventions did not affect antibiotic use. Improving WSH and nutrition can reduce antibiotic use in some low- and middle-income settings. Studies should assess whether such reductions translate to reduced carriage of antimicrobial resistance.

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“…Untuk mengatasi tantangan yang ditimbulkan oleh faktor lingkungan pada penyakit menular, sangat penting untuk menerapkan intervensi yang meningkatkan praktik air, sanitasi, dan kebersihan (WASH), serta intervensi gizi. Sebagai contoh, uji coba acak klaster WASH Benefits di Kenya mengevaluasi dampak intervensi air, sanitasi, cuci tangan, dan gizi secara individu dan gabungan terhadap infeksi saluran pernapasan anak (Swarthout et al, 2020). Intervensi semacam itu dapat membantu mengurangi paparan terhadap patogen dan mendorong respons kekebalan tubuh yang sehat, yang pada akhirnya mengurangi risiko penyakit menular.…”

Section: Literature Review a Kesehatan Lingkungan Dan Penyakit Menularunclassified

Peran Kesehatan Lingkungan dalam Pencegahan Penyakit Menular pada Remaja di Jakarta: Integrasi Ilmu Lingkungan, Epidemiologi, dan Kebijakan Kesehatan

Nelson Tanjung,

Restu Auliani,

Mustar Rusli

et al. 2023

JMWS

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Penyakit menular terus menjadi tantangan kesehatan global yang berat, dengan remaja sebagai segmen populasi yang sangat rentan. Penelitian ini menyelidiki interaksi yang rumit antara kesehatan lingkungan, epidemiologi, dan kebijakan kesehatan dalam konteks pencegahan penyakit menular di kalangan remaja di Jakarta, Indonesia. Dengan pendekatan penelitian metode campuran, yang menggabungkan survei kuantitatif dan wawancara kualitatif, penelitian ini menyelidiki berbagai dinamika yang membentuk lanskap kesehatan remaja di Jakarta. Temuan ini menggarisbawahi peran penting faktor lingkungan dalam penularan penyakit menular. Polusi udara, kurangnya akses terhadap air bersih, dan sanitasi yang buruk muncul sebagai faktor risiko lingkungan yang signifikan, yang mempengaruhi prevalensi penyakit. Analisis epidemiologi menunjukkan pola yang berbeda, dengan demam berdarah menjadi perhatian utama, terutama selama musim hujan. Kajian terhadap kebijakan kesehatan menunjukkan adanya tantangan dalam pelaksanaannya, yang disebabkan oleh keterbatasan sumber daya dan kesenjangan kesadaran. Studi ini mengadvokasi pendekatan terpadu yang mengakui keterkaitan antara ilmu lingkungan, epidemiologi, dan kebijakan kesehatan. Rekomendasi yang diberikan mencakup peningkatan perencanaan kota, peraturan kualitas udara, infrastruktur kesehatan yang lebih baik, dan pelibatan masyarakat untuk mengoptimalkan efektivitas kebijakan. Dengan mendorong kolaborasi interdisipliner dan penyesuaian kebijakan berbasis bukti, Jakarta dapat mengambil langkah substantif untuk melindungi kesehatan dan kesejahteraan populasi remaja dalam menghadapi penyakit menular. Temuan ini berkontribusi pada wacana yang lebih luas tentang intervensi kesehatan masyarakat yang komprehensif, yang menekankan pentingnya strategi holistik untuk mengatasi tantangan kesehatan yang rumit. Penelitian lebih lanjut dan tindakan kebijakan diperlukan untuk membangun wawasan ini dan meningkatkan hasil kesehatan remaja Jakarta.

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Effects of Individual and Combined Water, Sanitation, Handwashing, and Nutritional Interventions on Child Respiratory Infections in Rural Kenya: A Cluster-Randomized Controlled Trial

Cited by 17 publications

References 29 publications

Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh

Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh

Can drinking water, sanitation, handwashing, and nutritional interventions reduce antibiotic use in young children?

Peran Kesehatan Lingkungan dalam Pencegahan Penyakit Menular pada Remaja di Jakarta: Integrasi Ilmu Lingkungan, Epidemiologi, dan Kebijakan Kesehatan

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