The impact of school water, sanitation, and hygiene improvements on infectious disease using serum antibody detection
The impact of school water, sanitation, and hygiene improvements on infectious disease using serum antibody detection
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DOI：
10.1371/journal.pntd.0006418
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发表时间：
2018-04-01
影响因子：
3.8
通讯作者：
Freeman, Matthew C.
中科院分区：
文献类型：
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作者：
Chard, Anna N.;Trinies, Victoria;Freeman, Matthew C.
背景 最近评估学校供水、环境卫生和个人卫生 (WASH) 干预措施对儿童健康影响的研究的证据好坏参半。疾病的自我报告存在偏见，而且很少有 WASH 影响评估采用客观的健康措施来评估疾病和病原体暴露的减少。我们利用干血斑 (DBS) 的抗体反应来衡量学校 WASH 干预措施对马里小学生传染病的影响。方法/主要发现我们随机选择了 21 所受益小学及其 21 所匹配的对照学校，参与马里综合学校 WASH 干预措施的匹配对照试验。 DBS 是从每所学校随机选择的 20 名学生中收集的 (n = 807)。我们使用 Luminex 多重微珠测定对来自 17 种不同病原体的 28 种抗原分析了从 DBS 中洗脱的 IgG。因子分析确定了三个不同的潜在变量，分别代表媒介传播的疾病（主要由登革热驱动）、食物/水传播的肠道疾病（主要由大肠杆菌和霍乱弧菌驱动）和人际传播的肠道疾病（主要由诺如病毒驱动）。使用线性潜变量模型分析数据。就读受益学校的学生中，食物/水传播的肠道疾病（潜在变量平均值变化（β）= -0.24；95% CI：-0.53，-0.13）和人与人之间传播的肠道疾病（β = -0.17；95% CI：-0.42，-0.04）的抗体证据较低。媒介传播疾病的抗体证据没有差异（β = 0.11；95% CI：-0.05，0.33）。 结论/意义 就读于受益于学校 WASH 改进的学校的学生的肠道疾病证据低于就读对照学校的学生。这些发现支持了家长研究的结果，该研究还发现受益学校学生自我报告的腹泻发生率有所下降。 DBS 收集在这种资源匮乏的现场环境中是可行的，并且以较低的分析成本提供疾病的客观证据，使其成为 WASH 领域的有效测量工具。
BackgroundEvidence from recent studies assessing the impact of school water, sanitation and hygiene (WASH) interventions on child health has been mixed. Self-reports of disease are subject to bias, and few WASH impact evaluations employ objective health measures to assess reductions in disease and exposure to pathogens. We utilized antibody responses from dried blood spots (DBS) to measure the impact of a school WASH intervention on infectious disease among pupils in Mali.Methodology/Principal findingsWe randomly selected 21 beneficiary primary schools and their 21 matched comparison schools participating in a matched-control trial of a comprehensive school-based WASH intervention in Mali. DBS were collected from 20 randomly selected pupils in each school (n = 807). We analyzed eluted IgG from the DBS using a Luminex multiplex bead assay to 28 antigens from 17 different pathogens. Factor analysis identified three distinct latent variables representing vector-transmitted disease (driven primarily by dengue), food/watertransmitted enteric disease (driven primarily by Escherichia coli and Vibrio cholerae), and person-to-person transmitted enteric disease (driven primarily by norovirus). Data were analyzed using a linear latent variable model. Antibody evidence of food/water-transmitted enteric disease (change in latent variable mean (beta) = -0.24; 95% CI: -0.53, -0.13) and person-to-person transmitted enteric disease (beta = -0.17; 95% CI: -0.42, -0.04) was lower among pupils attending beneficiary schools. There was no difference in antibody evidence of vector-transmitted disease (beta = 0.11; 95% CI: -0.05, 0.33).Conclusions/SignificanceEvidence of enteric disease was lower among pupils attending schools benefitting from school WASH improvements than students attending comparison schools. These findings support results from the parent study, which also found reduced incidence of self-reported diarrhea among pupils of beneficiary schools. DBS collection was feasible in this resource-poor field setting and provided objective evidence of disease at a low cost per antigen analyzed, making it an effective measurement tool for the WASH field.