Quantifying the transmission routes of gastroenteritis in Pakistan and developing targeted interventions

胃肠炎是一种由有害细菌和其他类似微生物(如病毒)感染胃和肠道的疾病。它会导致腹泻和脱水，在世界上清洁水短缺的地区，这很容易变得复杂。这种疾病是巴基斯坦的一个主要健康问题，据估计，每年有近6万人死于这种疾病。事实上，在巴基斯坦，38%的五岁以下儿童曾在一生中的某个时候接受过腹泻治疗。在这个项目中，我们的项目团队由社会科学家、微生物学家、工程师、流行病学家、化学家和统计学家组成，将采取真正的跨学科方法，了解通过农业、卫生、饮用水、食品和人与人之间的接触影响胃肠炎传播的各种社会、生物、化学和技术因素。将作出重大努力，以了解社会对水、环境卫生和个人卫生的态度，以及这些与农业、食品和社区生活方式的联系。同时，从研究这些文化问题中获得的信息将被用来帮助决定对水和其他环境样品进行抽样以进行化学和生物测量和实验的计划。我们将重点关注与胃肠炎相关的一些重要细菌和寄生虫。将开发出基于DNA测序技术的测试，使我们能够快速检测这些目标细菌(弯曲杆菌和大肠杆菌)和寄生虫(隐孢子虫和贾第虫)。其中，弯曲菌与儿童生长发育迟缓的关系尤其密切。我们最近在英国开发了新的检测方法，可以快速检测奶牛中与结核病(BTB)相关的细菌，我们将在巴基斯坦将这项技术应用于胃肠炎。开发这种低成本、易于携带和可靠的快速检测有害细菌和寄生虫的测试方法，将是疾病监测和预防的突破性发展。作为该项目的一部分，我们还将测试这些细菌在导致胃肠炎方面的各种传播途径。为了做到这一点，我们将建立实验，例如，探索有害细菌从土壤或水传播到叶类作物、根茎类蔬菜和水果中。我们还将让各种各样的社会伙伴参与进来。我们将利用调查和举办便利讲习班，满足与清洁水和食物、良好卫生条件和公共卫生相关的各种人群。这包括家庭、租户和房东；社区领袖；政界人士；地方和中央政府；政府机构，包括负责环境保护的机构；当地大学的学术伙伴；供水和废水处理公司；农业社区；医务人员；公共卫生专家和行政人员；以及包括儿童基金会在内的各种非政府组织和发展机构代表。该项目将产生大量关于影响弯曲杆菌等有害细菌传播的文化问题的信息，以及关于感染手段的技术信息。重要的是，将开发有用的测试，以帮助显著提高巴基斯坦专家监测有害细菌和预防感染的能力。我们还看到了将我们的知识和技术转移到更远的地方给其他低收入和中等收入国家的重要机会。

Gastroenteritis is an infection of the stomach and the intestine by harmful bacteria, and other similar microbes, such as viruses. It causes diarrhoea and dehydration, which can be easily complicated in areas of the world where clean water is in short supply. The disease is a major health problem in Pakistan, where it is estimated to be responsible for nearly 60,000 deaths annually. Indeed, in Pakistan, 38% of children under five years old have received treatment for diarrhoea at some point in their lives. In this project, our project team of social scientists, microbiologists, engineers, epidemiologists, chemists and statisticians will combine to take a genuinely inter-disciplinary approach to understanding the various social, biological, chemical and technical factors affecting the spread of gastroenteritis through agriculture, sanitation, drinking water, food, and person-to-person contact. A significant effort will be made to understand the social attitudes to water, sanitation, hygiene and how those link to agriculture, food and the way communities live their lives. At the same time, the information obtained from studying those cultural issues will be used to help decide on a plan for sampling water and other environmental samples for chemical and biological measurements and experiments. We will focus on some important bacteria and parasites associated with gastroenteritis. Tests will be developed that allow us to rapidly detect those target bacteria (Campylobacter and E.coli) and parasites (Cryptosporidium and Giardia) based on DNA sequencing technology. Among these, Campylobacter is particularly strongly associated with growth-stunting in children. We have recently developed new tests in the UK to allow for rapid detection of the bacteria associated with tuberculosis (bTB) in cows, and we will adapt that technology in Pakistan for gastroenteritis.The development of such low-cost, easily portable, and reliable tests for rapid detection of harmful bacteria and parasites will be a groundbreaking development for disease surveillance and prevention.As part of the project, we will also test the various transmission routes of those bacteria in causing gastroenteritis. To do this, we will set up experiments to, for example, explore the transmission of harmful bacteria from soil or water into leaf crops, root vegetables and fruit. We will also involve a wide variety of social partners. We will use surveys and run facilitated workshops to meet the various people with a stake in clean water and food, good sanitation, and public health. This includes households, tenants and landlords; community leaders; politicians; local and central government; governmental agencies, including those responsible for environmental protection; academic partners in the local universities; water and wastewater companies; the farming community; medical personnel; public health experts and administrators; and a wide variety of NGOs and development agency representatives, including UNICEF. The project will generate a large amount of information about the cultural issues affecting the transmission of harmful bacteria such as Campylobacter, as well as technical information on the means of infection. Importantly, useful tests will be developed to help significantly improve the ability of experts in Pakistan to monitor harmful bacteria and prevent infections. We also see important opportunities for transferring our knowledge and technology further afield to other low- and middle-income countries.