Effect of Sanitation Improvements on Pathogens and Microbial Source Tracking Markers in the Rural Bangladeshi Household Environment
Effect of Sanitation Improvements on Pathogens and Microbial Source Tracking Markers in the Rural Bangladeshi Household Environment
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DOI：
10.1021/acs.est.9b04835
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发表时间：
2020-04-07
影响因子：
11.4
通讯作者：
Nelson, Kara L.
中科院分区：
文献类型：
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作者：
Fuhrmeister, Erica R.;Ercumen, Ayse;Nelson, Kara L.
肠道病原体引起的腹泻疾病是低收入和中等收入国家 (LMIC) 5 岁以下儿童死亡的主要原因。卫生设施是减少肠道病原体在环境中传播的一种方法；然而，很少有研究调查农村中低收入国家卫生设施在减少环境病原体方面的有效性。在这项研究中，我们通过评估患病率、差异以及病原体基因和宿主特异性粪便标记物浓度的变化，测量了卫生干预措施（双坑厕所、卫生勺、作为随机对照试验的一部分提供的儿童便盆、WASH 福利）对孟加拉国农村家庭的影响。我们发现卫生部门和控制部门的家庭环境中致病性大肠杆菌、诺如病毒或贾第鞭毛虫基因的流行率没有差异。在调整后的模型中，卫生组中儿童手上的人类粪便标记物的流行率较低，而母亲手上的动物粪便标记物的浓度较低，但在校正多重比较后，这些关联并不显着。在每个院落人数 >= 10 人的家庭子集中，卫生部门儿童手上产肠毒素大肠杆菌基因的流行率较低。儿童和动物粪便清除不彻底或复合干预规模（相对于社区范围）可以解释改善卫生条件的有限影响。
Diarrheal illnesses from enteric pathogens are a leading cause of death in children under five in low- and middle-income countries (LMICs). Sanitation is one way to reduce the spread of enteric pathogens in the environment; however, few studies have investigated the effectiveness of sanitation in rural LMICs in reducing pathogens in the environment. In this study, we measured the impact of a sanitation intervention (dual-pit latrines, sani-scoops, child potties delivered as part of a randomized control trial, WASH Benefits) in rural Bangladeshi household compounds by assessing prevalence ratios, differences, and changes in the concentration of pathogen genes and host-specific fecal markers. We found no difference in the prevalence of pathogenic Escherichia coli, norovirus, or Giardia genes in the domestic environment in the sanitation and control arms. The prevalence of the human fecal marker was lower on child hands and the concentration of animal fecal marker was lower on mother hands in the sanitation arm in adjusted models, but these associations were not significant after correcting for multiple comparisons. In the subset of households with >= 10 individuals per compound, the prevalence of enterotoxigenic E. coli genes on child hands was lower in the sanitation arm. Incomplete removal of child and animal feces or the compound (versus community-wide) scale of intervention could explain the limited impacts of improved sanitation.