Effects of sanitation on pathogen transmission and child health in Bangladesh

孟加拉国卫生设施对病原体传播和儿童健康的影响

• 批准号: 8615696
• 负责人: JOHN M COLFORD
• 金额: $ 59.21万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-16 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8615696
• 关键词: Accounting; Address; Adoption; Animals; Area; Bacteria; Bangladesh; Behavior; Behavior monitoring; Behavioral; Birth; Centers for Disease Control and Prevention (U.S.); Cessation of life; Child; Child health care; Complex; Country; Data; Data Collection; Developing Countries; Diarrhea; Disease; Effectiveness; Enrollment; Enteral; Environment; Feces; Field Workers; Foundations; Funding; Future; Hand; Health; Helminths; Household; Human; Hygiene; Individual; Infection; Intention; Intervention; Intervention Trial; Intestinal parasite; Latrine; Lead; Life; Low income; Measurement; Measures; Mediating; Methods; Molecular; Monitor; Mouth Diseases; Organism; Outcome; Outcome Measure; Parasites; Parasitic infection; Pathway Analysis; Pathway interactions; Play; Prevalence; Protocols documentation; Protozoa; Protozoan Infections; Randomized; Randomized Controlled Trials; Relative (related person); Research Infrastructure; Risk; Rural; Sampling; Sanitation; Sewage; Soil; Source; Spottings; System; Testing; United States National Institutes of Health; Visit; Water; Water Pollution; arm; base; behavior change; behavior measurement; burden of illness; cohort; cost; design; disease transmission; drinking water; experience; follow-up; gastrointestinal; gastrointestinal infection; improved; insight; microbial; mortality; novel; oral pathogen; pathogen; prevent; programs; public health relevance; randomized trial; sensor; tool; transmission process; uptake

PROJECT SUMMARY / ABSTRACT Background: Diarrheal illness creates a large and persistent disease burden among children in low-income countries; mortality estimates attribute 10% of global deaths among children < 5 to diarrhea. Fecal-oral pathogens (believed to be the most important causes of diarrhea) are transmitted from feces to new hosts through a variety of complex, environmentally mediated pathways that interact with each other and are also influenced by human behavior. Sanitation interventions that prevent the spread of pathogens from feces into the environment (e.g. provision of latrines) could block these transmission pathways and reduce the burden of diarrheal disease. Despite the potential importance of sanitation in reducing diarrhea, all studies to date of sanitation interventions on child gastrointestinal infections in rural settings have used non-randomized designs. Additionally, few studies have included detailed monitoring of sanitation-related behaviors and microbiological assessment of the complex pathogen transmission pathways that lead from feces to child illness. Aims: The principal aims of this study are to assess the impact of improvements in sanitation infrastructure and household sanitation practices on fecal contamination along pathogen transmission pathways in rural Bangladesh, and to assess how these pathways mediate the impact of sanitation improvements on diarrhea and parasitic infections in children < 24 months old. We hypothesize that improved sanitation will reduce contamination of drinking water, household soil, and children's hands; we also posit that these pathways will mediate any reductions in diarrhea prevalence and parasitic infections caused by the intervention. Methods: We will test our hypotheses by nesting microbiological and behavioral measurements within WASH Benefits, a randomized controlled trial currently underway in rural Bangladesh funded by the Gates Foundation and led by our team. We will visit a total of 720 households from the trial's sanitation and control arms quarterly for 2 years, starting 12 months after intervention. At each visit, we will collect samples from tubewells, ponds, stored water, soil from the child play area, soil near tubewells and from children's hands for analysis of fecal indicator bacteria. During the last two sampling rounds, we will analyze samples for prominent fecal pathogens and perform source tracking to distinguish fecal contamination from humans versus animals. We will monitor sanitation practices through spot checks and passive infrared sensor measurements. These data will leverage the health outcomes measured in the existing trial protocol (diarrhea and helminth and protozoan infections in stool). We will compare fecal contamination between the study arms using intention to treat and complier average causal effect estimators. We will estimate the contribution of contamination to health outcomes through individual pathways by analysis of direct and indirect effects. Our team (UC Berkeley, Stanford, ICDDR,B) has extensive experience collaborating on studies of water, sanitation and hygiene in Bangladesh and other low-income countries on projects funded by the NIH, CDC, DFID, USEPA and the Gates Foundation.

项目摘要 /摘要 背景：腹泻病在低收入儿童中造成巨大而持续的疾病负担 国家死亡率估计将<5的儿童全球死亡的10％归因于腹泻。粪便 病原体（认为是腹泻最重要的原因）是从粪便传播到新宿主的 通过各种复杂的环境介导的途径，它们相互相互作用，也是 受人类行为的影响。防止病原体从粪便传播到的卫生干预措施 环境（例如，厕所的提供）可能会阻止这些传输途径，并减轻 腹泻病。尽管卫生在减少腹泻中可能具有重要意义，但迄今为止的所有研究 农村环境中儿童胃肠道感染的卫生干预使用了非随机设计。 此外，很少有研究包括对卫生相关行为和微生物学的详细监测 评估从粪便到儿童疾病导致的复杂病原体传播途径。 目的：本研究的主要目的是评估卫生基础设施改善的影响 以及沿农村病原体传播途径的粪便污染的家庭卫生实践 孟加拉国，并评估这些途径如何介导卫生对腹泻的影响的影响 <24个月大的儿童和寄生感染。我们假设改善的卫生将减少 饮用水，家用土壤和儿童手的污染；我们还认为这些途径将 调解由干预措施引起的腹泻患病率和寄生虫感染的任何降低。 方法：我们将通过将微生物学和行为测量嵌套在WASH中来检验我们的假设 福利是孟加拉国农村目前正在进行的一项随机对照试验，由盖茨基金会资助 并由我们的团队领导。我们将从审判的卫生和控制武器季刊中访问总共720个家庭 两年后，从干预后12个月开始。每次访问时，我们都会从池塘的池塘收集样品 储存水，儿童游乐区的土壤，靠近小管的土壤和儿童手，以分析粪便 指示细菌。在最近的两个抽样回合中，我们将分析样品中突出的粪便病原体 并执行来源跟踪，以区分粪便污染与人类与动物的污染。我们将监视 通过点检查和被动红外传感器测量进行卫生实践。这些数据将利用 在现有试验方案中测量的健康结果（腹泻和蠕虫和原生动物感染 凳子）。我们将使用意图和适应器的意图比较研究臂之间的粪便污染 平均因果效应估计器。我们将估计污染对健康结果的贡献 通过分析直接和间接效应的单个途径。我们的团队（加州大学伯克利分校，斯坦福大学， ICDDR，b）在孟加拉国的水，卫生和卫生研究方面拥有丰富的经验 以及由NIH，CDC，DFID，USEPA和盖茨基金会资助的项目的其他低收入国家。