Effects of household concrete floors on child health

家用混凝土地板对儿童健康的影响

• 批准号: 10419834
• 负责人: Jade Benjamin-Chung
• 金额: $ 61.47万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10419834
• 关键词: 5 year old; Age; Anemia; Ascaris; Ascaris lumbricoides; Bangladesh; Bangladeshi; Birth; Cause of Death; Child; Child Development; Child Health; Colony-forming units; Cost Effectiveness Analysis; Diarrhea; Eating; Escherichia coli; Exposure to; Feces; Floor; Food; Frequencies; Geography; Growth; Hand; Handwashing; Health; Health Benefit; Health Promotion; Helminths; Home; Home environment; Hour; Household; Housing; Hygiene; Impairment; Infectious Disease Epidemiology; Ingestion; Interruption; Intervention; Intervention Trial; Latrine; Life; Life Stress; Low Prevalence; Maintenance; Measurement; Measures; Mental Depression; Morbidity - disease rate; Necator americanus; Observational Study; Oral cavity; Outcome; Outcome Measure; Participant; Pathway interactions; Play; Policies; Pregnant Women; Prevalence; Public Health; Quality of life; Randomized; Recording of previous events; Research; Resource-limited setting; Resources; Risk; Rural; Sampling; Sanitation; Scientist; Second Pregnancy Trimester; Sentinel; Soil; Structure; Swab; Taxes; Testing; Third Pregnancy Trimester; Time; Toy; Trichocephalus trichiura; Water; age group; aged; base; behavior change; chlorination; cohort; cost-effectiveness ratio; disability-adjusted life years; egg; enteric infection; enteric pathogen; experience; follow-up; helminth infection; improved; in utero; incremental cost-effectiveness; innovation; lower income families; maternal depression; maternal outcome; maternal stress; mortality; prevent; primary endpoint; public health intervention; randomized trial; rural setting; scale up; secondary endpoint; therapy design; transmission process

PROJECT SUMMARY Soil-transmitted helminth infections and diarrhea are responsible for a large burden of morbidity and mortality among children under 5 years and are associated with increased growth faltering, anemia, impaired child development, and mortality. The primary public health interventions to prevent enteric infections are household water, sanitation, and hygiene (WASH) interventions. However, recent WASH intervention trials found only modest impacts on enteric infection prevalence in children. Observational studies have found that children in households with concrete floors have a lower prevalence of diarrhea and soil-transmitted helminth infection than those in households with soil floors. However, these findings may be strongly confounded by household wealth. We propose a randomized trial in rural Bangladesh to measure whether installing concrete floors in households with soil floors reduces child enteric infection. We will randomize 800 eligible households with pregnant women and install concrete floors before the birth cohort is born. We will collect follow-up measurements when children are ages 6, 12, 18, and 24 months. Our team is comprised of experts in environmental and infectious disease epidemiology, including Bangladeshi scientists. We have extensive experience implementing large-scale health intervention trials in Bangladesh and other low resource settings. Aim 1 is to measure the effect of household concrete floors on household fecal contamination and child soil contact and ingestion over time. The primary endpoint is Ascaris lumbricoides prevalence at any follow-up measurement. Secondary endpoints include prevalence of other soil-transmitted helminths and diarrhea. Other outcomes include maternal quality of life and stress. Aim 2 is to measure the effect of household concrete floors on household fecal contamination and child soil contact and ingestion over time. We will detect soil- transmitted helminths (N=800) in floor swabs and E. coli in floor, child hands, and sentinel toy samples in a random subsample (N=220). In a subsample (N=60), we will conduct video observations to estimate the frequency of child soil contact and ingestion. We will estimate the incremental cost-effectiveness ratio for both maternal and child outcomes using disability adjusted life years. This trial will determine whether concrete floors reduce enteric infection, and investigate mechanisms for how floors impact health, or if they do not, why. Household concrete floors are an innovative potential health intervention that may have additional benefits that we will measure in this study, including reducing the bandwidth tax that low-income families experience by making it easier to maintain a hygienic home environment, and in turn improve quality of life. Our findings will provide rigorous, policy-relevant evidence about whether concrete flooring installation should be delivered as a public health intervention to reduce child enteric infection. More broadly, this study marks a paradigm shift in intervention design for improving child health by expanding its scope to include housing improvements.

项目概要 土源性蠕虫感染和腹泻造成巨大的发病率和负担 5 岁以下儿童死亡率增加，并与生长迟缓、贫血、受损 儿童发育和死亡率。预防肠道感染的主要公共卫生干预措施是 家庭用水、环境卫生和个人卫生 (WASH) 干预措施。然而，最近的 WASH 干预试验 发现对儿童肠道感染患病率影响不大。观察性研究发现 水泥地板家庭中的儿童腹泻和土源性蠕虫感染率较低 感染率高于有土壤地板的家庭。然而，这些发现可能会受到以下因素的强烈混淆： 家庭财富。我们建议在孟加拉国农村进行一项随机试验，以衡量是否安装混凝土 有土地板的家庭的地板可以减少儿童肠道感染。我们将随机抽取 800 个符合条件的家庭 与孕妇一起工作，并在出生队列出生之前安装混凝土地板。我们将收集后续信息 儿童 6、12、18 和 24 个月时的测量值。我们的团队由以下领域的专家组成 环境和传染病流行病学，包括孟加拉国科学家。我们有广泛的 拥有在孟加拉国和其他资源匮乏地区实施大规模健康干预试验的经验。 目标 1 是测量家用混凝土地板对家庭粪便污染和儿童土壤的影响 随着时间的推移接触和摄入。主要终点是任何随访中蛔虫的患病率 测量。次要终点包括其他土源性蠕虫和腹泻的患病率。其他 结果包括孕产妇的生活质量和压力。目标 2 是测量家用混凝土的效果 随着时间的推移，家庭粪便污染和儿童土壤接触和摄入的地板。我们将检测土壤- 地板拭子中传播蠕虫 (N=800)，地板、儿童手和哨兵玩具样本中传播大肠杆菌。 随机子样本 (N=220)。在子样本（N=60）中，我们将进行视频观察来估计 儿童接触和摄入土壤的频率。我们将估计两者的增量成本效益比 使用残疾调整生命年的孕产妇和儿童结果。该试验将确定是否具体 地板可以减少肠道感染，并研究地板如何影响健康的机制，或者如果不会影响健康，原因是什么。 家用混凝土地板是一种创新的潜在健康干预措施，可能具有以下额外好处： 我们将在这项研究中进行衡量，包括减少低收入家庭所承受的带宽税 使保持卫生的家庭环境变得更容易，从而提高生活质量。我们的研究结果将 提供严格的、与政策相关的证据，说明混凝土地板安装是否应作为 减少儿童肠道感染的公共卫生干预。更广泛地说，这项研究标志着范式的转变 通过扩大范围以包括住房改善来改善儿童健康的干预设计。