Quality of Piped and Stored Water in Households with Children Under Five Years of Age Enrolled in the Mali Site of the Global Enteric Multi-Center Study (GEMS)

Baker, Kelly K.; Sow, Samba O.; Kotloff, Karen L.; Nataro, James P.; Farag, Tamer H.; Tamboura, Boubou; Doumbia, Mama N.; Sanogo, Doh; Diarra, D; O’Reilly, Ciara E.; Mintz, Eric D.; Panchalingam, Sandra; Wu, Yukun; Blackwelder, William C.; Levine, Myron M.

doi:10.4269/ajtmh.12-0256

Cited by 22 publications

(14 citation statements)

References 38 publications

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“…Each pathway suggests potential interventions to reduce the risks associated with shared sanitation. A previous GEMS paper found shared sanitation access to be an important contributor to MSD, after adjusting for household drinking water practices, suggesting that combination approaches are necessary [ 51 ]. While our data suggest household latrines are the safest option, well-maintained, hygienic shared facilities that consistently ensure safety and privacy and provide access to soap and water for handwashing may motivate facility usage and reduce open defecation.…”

Section: Discussionmentioning

confidence: 99%

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study

et al. 2016

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BackgroundDiarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child's risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age.Methods/FindingsThe GEMS matched case-control study was conducted between December 1, 2007, and March 3, 2011, at seven sites in Basse, The Gambia; Nyanza Province, Kenya; Bamako, Mali; Manhiça, Mozambique; Mirzapur, Bangladesh; Kolkata, India; and Karachi, Pakistan. Data was collected for 8,592 case children aged <5 y old experiencing MSD and for 12,390 asymptomatic age, gender, and neighborhood-matched controls. An MSD case was defined as a child with a diarrheal illness <7 d duration comprising ≥3 loose stools in 24 h and ≥1 of the following: sunken eyes, skin tenting, dysentery, intravenous (IV) rehydration, or hospitalization. Site-specific conditional logistic regression models were used to explore the association between sanitation and hygiene exposures and MSD. Most households at six sites (>93%) had access to a sanitation facility, while 70% of households in rural Kenya had access to a facility. Practicing open defecation was a risk factor for MSD in children <5 y old in Kenya. Sharing sanitation facilities with 1–2 or ≥3 other households was a statistically significant risk factor for MSD in Kenya, Mali, Mozambique, and Pakistan. Among those with a designated handwashing area near the home, soap or ash were more frequently observed at control households and were significantly protective against MSD in Mozambique and India.ConclusionsThis study suggests that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. These findings support the current World Health Organization/ United Nations Children's Emergency Fund (UNICEF) system that categorizes shared sanitation as unimproved.

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Section: Discussionmentioning

confidence: 99%

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study

et al. 2016

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“…Considering the Global Enteric Multi-Center Study (GEMS) from 2012, in sub-Saharan Africa, 83% of urban and 49% of rural populations have access to improved water sources, while the numbers are much lower when access to improved sanitation facilities is considered (43% of urban and 23% of rural populations) [46]. Improving these conditions became a strong priority and one of the Millennium Development Goals of the WHO.…”

Section: Discussionmentioning

confidence: 99%

Characterization of rotavirus infection in children with acute gastroenteritis in Bengo province, Northwestern Angola, prior to vaccine introduction

Gasparinho¹,

Piedade

Mirante³

et al. 2017

PLoS ONE

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BackgroundRotavirus group A (RVA) is considered the leading cause of pediatric diarrhea, responsible for the high burden of diarrheal diseases in sub-Saharan Africa. Despite recent studies, the existent data are scarce for some African countries like Angola, a country with one of the highest RVA-related death estimates. The aim of this study was to determine the RVA detection rate and circulating genotypes in children less than five years of age with acute gastroenteritis attended at the Bengo General Hospital in Caxito, Bengo province, Angola, before vaccine introduction.MethodsBetween September 2012 and December 2013, 342 fecal specimens were collected from children enrolled. Positive samples for RVA by immunochromatographic rapid test were G and P-typed by hemi-nested type-specific multiplex PCR, and subgrouped for the VP6 gene. VP4 and VP7 genes from a subset of samples were sequenced for phylogenetic analysis.ResultsDuring the study period, a high RVA detection rate was registered (25.1%, 86/342).The age group most affected by RVA infection includes children under 6 months of age (p<0.01). Vomiting was highly associated with RVA infection (72.1%; p<0.001).From the 86 RVA-positive samples, 72 (83.7%) were genotyped. The most prevalent genotype was G1P[8] (34/72; 47.2%), followed by the uncommon G1P[6] (21/72; 29.2%), and G2P[4] (9/72; 12.5%). Only two G-types were found: G1 (60/72; 83.3%) and G2 (11/72; 15.3%). Among the P-genotypes, P[8] was the most prevalent (34/72; 47.2%), followed by P[6] (22/72; 30.6%) and P[4] (9/72; 12.5%). In the phylogenetic trees, the identified G and P-types clustered tightly together and with reference sequences in specific monophyletic groups, with highly significant bootstrap values (≥92%).ConclusionThis pre-vaccination study revealed, for the first time for Bengo province (Angola), the RVA genotype profile, including phylogenetic relationships, and a high RVA detection rate, supporting the immediate introduction of a RVA vaccine in the national immunization programme.

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“…Some studies have explored the effect of the timing of infection, in relation to children's age, on short term and long term linear growth impairment. An analysis conducted by Richard et al (40) found that diarrhea in the previous 30 days had an effect on weight only, suggesting that a diarrheal episode in a single month does not have a significant association with length in the following 1, 2 or 3 months (40). When they explored the lagged effects of diarrheal episodes on growth over time, they found that the cumulative burden of diarrhea resulted in a measurable effect on growth (40).…”

Section: Timing Of Enteropathogen Infectionmentioning

confidence: 99%

“…An analysis conducted by Richard et al (40) found that diarrhea in the previous 30 days had an effect on weight only, suggesting that a diarrheal episode in a single month does not have a significant association with length in the following 1, 2 or 3 months (40). When they explored the lagged effects of diarrheal episodes on growth over time, they found that the cumulative burden of diarrhea resulted in a measurable effect on growth (40). They also suggest that if there is adequate time between diarrheal episodes that the child may experience catch-up growth (40,41).…”

Section: Timing Of Enteropathogen Infectionmentioning

confidence: 99%

“…When they explored the lagged effects of diarrheal episodes on growth over time, they found that the cumulative burden of diarrhea resulted in a measurable effect on growth (40). They also suggest that if there is adequate time between diarrheal episodes that the child may experience catch-up growth (40,41). The opportunity for catch up growth may be limited or missed if periods without diarrhea are short due to repeated episodes (41).…”

Section: Timing Of Enteropathogen Infectionmentioning

confidence: 99%

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Enteropathogen infection and household factors associated with linear child growth in Bangladesh

Sanchez¹,

Johanna²

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BACKGROUND: The dual burden of enteropathogen infection and childhood malnutrition continues to be a global health concern and a leading cause of morbidity and death among children. Despite improvements in recent decades, Bangladesh continues to be one of the countries with the highest burden of growth impairment. In addition, enteropathogen infection continues to be highly prevalent in the country. An understanding of factors associated with infection and growth could contribute to public health efforts to reduce this burden through targeted community interventions. This PhD thesis aimed to examine the association between household factors and enteropathogen infection and linear child growth in Bangladesh using both national surveys and study-specific data. METHODS: The association of household-level factors with childhood growth, as measured by length-forage z-score (LAZ), were first analysed using data of children 1-24 months of age from two cross-sectional national surveys in Bangladesh: the 2014 Demographic and Health Survey (DHS), and the 2012-2013 Multiple Indicator Cluster Survey (MICS). Both analyses were age-stratified (1-12 months and 13-24 months), and then further stratified into rural vs urban households to identify heterogeneity in associations of factors with LAZ by age and location. An analysis of longitudinal data was then carried out of children participating in the Etiology, Risk Factors, and Interaction of Enteric Infections and Malnutrition and Consequences for Child Health (MAL-ED) Study in Mirpur, Bangladesh. Latent growth curve modelling (LGCM), a form of longitudinal modelling technique, was applied to this data to evaluate the trajectories of change in LAZ and explore the effect of enteropathogen infection and household-level factors on this growth trajectory. RESULTS: In all three analyses, an inverse association was found between increasing age and LAZ, consistent with previous research. In the DHS and MICS survey data, older children (13-24 months) had more household factors associated with LAZ. Maternal education was positively associated with linear growth in both national-level datasets, as were improved toilet facilities. In the MICS analysis, rural households had more factors associated with LAZ. Male sex, dirt flooring material, and unimproved toilet facility, and animal ownership were negatively associated with LAZ, while refrigerator ownership and increased maternal education were positively associated. In rural households in the DHS analysis, an episode of diarrhea in the preceding two weeks, a shared toilet facility and no maternal education were negatively associated with LAZ. In the LGCM analysis of children from the MAL-ED Bangladesh site, Campylobacter infection was highly prevalent and had an effect on growth at specific age intervals. Infection in the preceding 3-month interval was negatively associated with LAZ between 12 and 18 months of age; similarly, infection in the preceding 6-month interval was negatively associated with LAZ at between 15 and 21 months of age....

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Quality of Piped and Stored Water in Households with Children Under Five Years of Age Enrolled in the Mali Site of the Global Enteric Multi-Center Study (GEMS)

Cited by 22 publications

References 38 publications

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study

Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007–2011: Case-Control Study

Characterization of rotavirus infection in children with acute gastroenteritis in Bengo province, Northwestern Angola, prior to vaccine introduction

Enteropathogen infection and household factors associated with linear child growth in Bangladesh

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