Environmental and spatial determinants of enteric pathogen infection in rural Lao People’s Democratic Republic: A cross-sectional study

Chard, Anna N.; Baker, Kelly K.; Tsai, Kevin; Chang, Howard H.; Thongpaseuth, Vonethalom; Sistrunk, Jeticia R.; Freeman, Matthew C.

doi:10.1371/journal.pntd.0008180

Cited by 14 publications

(13 citation statements)

References 76 publications

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“…Four studies suggested owning livestock to be a risk factor for infection of CU5 or adults with enteric protozoa or Campylobacter spp. ( 200 , 203 , 206 , 207 ). For families owning livestock, increasing livestock density in/around the households has been associated with visible indoor contamination of animal feces and infection by intestinal parasites (including Giardia lamblia ) in household members ( 210 , 220 ).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies defined the pathogens at the genus level (e.g., Salmonella, Cryptosporidium spp.) (202)(203)(204)(205), and 8 studies characterized pathogens with general biological groups only [i.e., enteric protozoa infection (206,207), intestinal parasite infection (208)(209)(210)(211)(212), enteric pathogen infection (213)]. We therefore defined pathogens as zoonotic (Z) and as zoonotic and/or anthroponotic (A/Z) as in section Enteric pathogens as determinants of EED or undernutrition in children under five.…”

Section: Risks Factors Of Exposure To or Infection With Zoonotic Enteric Pathogens Associated With Smallholder Livestock Productionmentioning

confidence: 99%

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Benefits and Risks of Smallholder Livestock Production on Child Nutrition in Low- and Middle-Income Countries

Chen

Mechlowitz

et al. 2021

Front. Nutr.

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Livestock production may improve nutritional outcomes of pregnant women and children by increasing household income, availability of nutrient-dense foods, and women's empowerment. Nevertheless, the relationship is complex, and the nutritional status of children may be impaired by presence of or proximity to livestock and their pathogens. In this paper, we review the benefits and risks of livestock production on child nutrition. Evidence supports the nutritional benefits of livestock farming through income, production, and women's empowerment. Increasing animal source food consumption requires a combination of efforts, including improved animal management so that herd size is adequate to meet household income needs and consumption and addressing sociocultural and gendered norms. Evidence supports the inclusion of behavior change communication strategies into livestock production interventions to facilitate the sustainability of nutritional benefits over time, particularly interventions that engage women and foster dimensions of women's empowerment. In evaluating the risks of livestock production, evidence indicates that a broad range of enteric pathogens may chronically infect the intestines of children and, in combination with dietary deficits, may cause environmental enteric dysfunction (EED), a chronic inflammation of the gut. Some of the most important pathogens associated with EED are zoonotic in nature with livestock as their main reservoir. Very few studies have aimed to understand which livestock species contribute most to colonization with these pathogens, or how to reduce transmission. Control at the point of exposure has been investigated in a few studies, but much less effort has been spent on improving animal husbandry practices, which may have additional benefits. There is an urgent need for dedicated and long-term research to understand which livestock species contribute most to exposure of young children to zoonotic enteric pathogens, to test the potential of a wide range of intervention methods, to assess their effectiveness in randomized trials, and to assure their broad adaptation and sustainability. This review highlights the benefits and risks of livestock production on child nutrition. In addition to identifying research gaps, findings support inclusion of poor gut health as an immediate determinant of child undernutrition, expanding the established UNICEF framework which includes only inadequate diet and disease.

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Section: Resultsmentioning

confidence: 99%

Section: Risks Factors Of Exposure To or Infection With Zoonotic Enteric Pathogens Associated With Smallholder Livestock Productionmentioning

confidence: 99%

Benefits and Risks of Smallholder Livestock Production on Child Nutrition in Low- and Middle-Income Countries

Chen

Mechlowitz

et al. 2021

Front. Nutr.

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“…[ 22 ], which are transmitted from person-to-person via contaminated hands in households. A community-based study involving 1159 households in rural Lao PDR showed that enteropathogen infections are strongly correlated within members of the same household, suggesting the importance of intra-household transmission [ 14 ]. A randomized controlled trial with volunteers in the U.K. showed that hand-washing with plain soap is more effective for the removal of bacterial pathogens from hands than hand-washing with water alone [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, two studies have assessed this association in Lao PDR. A cross-sectional study with 297 households in 50 villages in Saravan province examined associations between the presence of household hand-washing facilities and the infection status of diarrhea-causing pathogens among household members, including children U5 [ 14 ]. The study found that the presence of household hand-washing facilities was associated with lower infection rates of viral enteric pathogens and soil-transmitted helminths among household members.…”

Section: Introductionmentioning

confidence: 99%

Effects of Hand-Washing Facilities with Water and Soap on Diarrhea Incidence among Children under Five Years in Lao People’s Democratic Republic: A Cross-Sectional Study

Noguchi

Nonaka

Kounnavong

et al. 2021

IJERPH

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Diarrhea is a leading cause of death among children under five (U5) in Lao People’s Democratic Republic (PDR). This study assessed the association between the presence of household hand-washing facilities with water and soap and diarrhea episodes among children U5 in Lao PDR. Data from the Lao Social Indicator Survey II were used. The outcome variable was diarrhea episodes in the two weeks preceding the survey. The main predictor variable was the presence of household hand-washing facilities with or without water and/or soap. Mixed-effect logistic regression analysis was used to assess the association, controlling for clustering, and other predictor variables. Of the 8640 households surveyed with 11,404 children, 49.1% possessed hand-washing facilities with both water and soap and 34.7% possessed hand-washing facilities with water alone. Children whose households possessed hand-washing facilities with water alone were significantly more likely to have a diarrhea episode compared to children whose households possessed hand-washing facilities with both water and soap (8.1% vs. 5.9%; odds ratio, 1.49; 95% confidence interval, 1.22–1.81). The association remained significant even after adjusting for other predictors. The absence of soap in hand-washing facilities was associated with higher odds of having a diarrhea episode among children U5 in Lao PDR.

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“…The morbidity and distribution of diarrhea would be affected by various factors, including sociodemographic factors (age, education, income etc.) [10][11][12], environmental and sanitation factors (poor access to a good water source and poor sanitation) [13,14], and climate factors (rainfall, temperature and humidity) [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Exploring the Effect of the Number of Primary Care Health Workers on Diarrhea Morbidity and Where the Health Resources Should Go: a Community-based Geospatial Analysis Study From China

Guan

Lan

Liao

et al. 2021

Preprint

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Background: Diarrhea remains a major threat to developing countries like China. Improved water, sanitation, and hygiene (WASH) have been known as cost-effective ways for reducing the morbidity of diarrhea. Primary healthcare institutions in China have been playing pivotal roles in the maintenance of WASH facilities as well as providing health education intended for improving residents’ appropriateness and safety in using those facilities. In this study, we aimed to explore the association between the number of primary healthcare workers and diarrhea morbidity at community levels in order to provide evidence-based implications for optimizing primary healthcare resource allocations.Methods: We collected annually time series of diarrhea morbidity, the number of primary healthcare workers, and relevant data of 4,321 communities in Sichuan Province with 83.41 million residents, China, from 2017 to 2019. The global and local Moran’s I were calculated to detect the spatial clustering of diarrhea morbidity each year as well as to identify areas where increased primary healthcare resources should be allocated. The spatial lag fixed effects panel data model was adopted to explore the association between the number of primary healthcare workers and diarrhea morbidity.Results: Positive global autocorrelation of diarrhea morbidity was identified based on Global Moran’s I. Significantly high-high and low-low clusters of diarrhea cases as indicated by Local Moran’s I were found to be mainly distributed in western and eastern Sichuan during the studied period years, respectively, which demonstrated consistency with regional economic development status and primary healthcare resource allocations among different regions. The diarrhea morbidity was found to be negatively associated with the number of primary healthcare workers with a coefficient of -0.187 and the P-values <0.05, indicating that a 0.187 reduction of diarrhea morbidity (1/10,000) was associate with doubled amounts of primary healthcare workers.Conclusions: Our findings highlighted the role of primary healthcare resource allocation in the process of diarrhea prevention and control which was reflected by the number of primary healthcare workers among different regions. Our findings also implied that constant efforts should be addressed at governmental and health administrative levels in order to facilitate diarrhea prevention and control, especially in the remoted area where the regional economic development status and primary healthcare resource allocation remain relatively underdeveloped.

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Environmental and spatial determinants of enteric pathogen infection in rural Lao People’s Democratic Republic: A cross-sectional study

Cited by 14 publications

References 76 publications

Benefits and Risks of Smallholder Livestock Production on Child Nutrition in Low- and Middle-Income Countries

Benefits and Risks of Smallholder Livestock Production on Child Nutrition in Low- and Middle-Income Countries

Effects of Hand-Washing Facilities with Water and Soap on Diarrhea Incidence among Children under Five Years in Lao People’s Democratic Republic: A Cross-Sectional Study

Exploring the Effect of the Number of Primary Care Health Workers on Diarrhea Morbidity and Where the Health Resources Should Go: a Community-based Geospatial Analysis Study From China

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