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

Josh M. Colston, Abu S. G. Faruque, M. Jahangir Hossain, Debasish Saha, Suman Kanungo, Inácio Mandomando, M. Imran Nisar, Anita K. M. Zaidi, Richard Omore, Robert F. Breiman, Samba O. Sow, Anna Roose, Myron M. Levine, Karen L. Kotloff, Tahmeed Ahmed, Pascal Bessong, Zulfiqar Bhutta, Estomih Mduma, Pablo Penatero Yori, Prakash Sunder Shrestha, Maribel P. Olortegui, Gagandeep Kang, Aldo A. M. Lima, Jean Humphrey, Andrew Prendergast, Francesca Schiaffino, Benjamin F. Zaitchik and Margaret N. Kosek
Additional contact information
Josh M. Colston: Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
Abu S. G. Faruque: Centre for Nutrition & Food Security, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh
M. Jahangir Hossain: Medical Research Council Unit—The Gambia at the London School of Hygiene & Tropical Medicine, Banjul P.O. Box 273, Republic of Gambia
Debasish Saha: Epidemiology and Health Economics, GSK Vaccines, 1300 Wavre, Belgium
Suman Kanungo: Suman Kanungo—National Institute of Cholera and Enteric Diseases, Kolkota 700010, India
Inácio Mandomando: Centro de Investigação em Saúde de Manhiça, Manhica CP 1929, Mozambique
M. Imran Nisar: Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan
Anita K. M. Zaidi: Department of Pediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan
Richard Omore: Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Nyanza 40100, Kenya
Robert F. Breiman: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Samba O. Sow: Centre pour le Développement des Vaccins, Bamako BP 251, Mali
Anna Roose: Indiana University School of Medicine, Indianapolis, IN 46202, USA
Myron M. Levine: Departments of Medicine and Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Karen L. Kotloff: Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Tahmeed Ahmed: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
Pascal Bessong: HIV/AIDS & Global Health Research Programme, University of Venda, Thohoyandou, Limpopo 0950, South Africa
Zulfiqar Bhutta: Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
Estomih Mduma: Haydom Global Health Institute, Haydom P.O. Box 9000, Tanzania
Pablo Penatero Yori: Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
Prakash Sunder Shrestha: Department of Child Health, Institute of Medicine of Tribhuvan University, Kirtipur 44618, Nepal
Maribel P. Olortegui: Asociacion Benefica PRISMA, Iquitos 16006, Peru
Gagandeep Kang: Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, India
Aldo A. M. Lima: Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza 60020-181, Brazil
Jean Humphrey: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA 21205, USA
Andrew Prendergast: Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London E1 2AT, UK
Francesca Schiaffino: Faculty of Veterinary Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
Benjamin F. Zaitchik: Department of Earth and Planetary Sciences, Johns Hopkins Krieger School of Arts and Sciences, Baltimore, MA 21218, USA
Margaret N. Kosek: Division of Infectious Diseases, International Health and Public Health Sciences, Department of Internal Medicine, University of Virginia, Charlottesville, VA 22903, USA

IJERPH, 2020, vol. 17, issue 21, 1-18

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.

Keywords: enteropathogens; water; sanitation and hygiene; child health; diarrheal disease; zoonoses (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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