Impact of water quality, sanitation, handwashing, and nutritional interventions on enteric infections in rural Zimbabwe: the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial.

Authors:
James A Platts-Mills
James A Platts-Mills
University of Virginia
United States
Jean Gratz
Jean Gratz
University of Virginia
United States
Jixian Zhang
Jixian Zhang
University of Virginia
Lungsod Quezon | Philippines
Lawrence H Moulton
Lawrence H Moulton
Johns Hopkins Bloomberg School of Public Health
Baltimore | United States
Kuda Mutasa
Kuda Mutasa
Johns Hopkins Bloomberg School of Public Health
United States
Florence D Majo
Florence D Majo
Zvitambo Institute for Maternal and Child Health Research
Naume Tavengwa
Naume Tavengwa
Zvitambo Institute for Maternal and Child Health Research

J Infect Dis 2019 Apr 20. Epub 2019 Apr 20.

Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA, USA.

Background: We assessed the impact of water, sanitation, and hygiene (WASH) and infant and young child feeding (IYCF) interventions on enteric infections in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe.

Methods: We tested stool samples collected at 1, 3, 6, and 12 months of age and during diarrhea using quantitative molecular diagnostics for 29 pathogens. We estimated the effects of the WASH, IYCF, and combined WASH+IYCF on individual enteropathogen prevalence and quantity, total numbers of pathogens detected, and incidence of pathogen-attributable diarrhea.

Results: WASH interventions decreased the number of parasites detected (difference in number compared to non-WASH arms: -0.07, 95% CI: -0.14, -0.02), but had no statistically significant effects on bacteria, viruses, or the prevalence and quantity of individual enteropathogens after accounting for multiple comparisons. IYCF interventions had no significant effects on individual or total enteropathogens. Neither intervention had significant effects on pathogen-attributable diarrhea.

Conclusion: The WASH interventions implemented in SHINE (improved pit latrine, hand-washing stations, liquid soap, point-of-use water chlorination, and clean play space) did not prevent enteric infections. Transformative WASH interventions are needed that are more efficacious in interrupting fecal-oral microbial transmission in children living in highly contaminated environments.

Clinicaltrials.gov Identifier: NCT01824940 (https://clinicaltrials.gov/ct2/show/NCT01824940).

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Source
https://academic.oup.com/jid/advance-article/doi/10.1093/inf
Publisher Site
http://dx.doi.org/10.1093/infdis/jiz179DOI Listing
April 2019
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References

(Supplied by CrossRef)
Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh
Black et al.
Pediatrics 1984
Multi-sectoral interventions for healthy growth
Carmen Casanovas et al.
Matern Child Nutr 2013

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