8 results on '"Leontsini, Elli"'
Search Results
2. Impact of adding hand-washing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial.
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Najnin, Nusrat, Leder, Karin, Qadri, Firdausi, Forbes, Andrew, Unicomb, Leanne, Winch, Peter J., Ram, Pavani K., Leontsini, Elli, Nizame, Fosiul A., Arman, Shaila, Begum, Farzana, Biswas, Shwapon K., Clemens, John D., Ali, Mohammad, Cravioto, Alejandro, and Luby, Stephen P.
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RANDOMIZED controlled trials ,HYGIENE ,CHOLERA vaccines ,CHOLERA treatment ,DIARRHEA ,THERAPEUTICS ,HOSPITAL care ,PATIENTS ,PREVENTION of cholera ,CHOLERA ,CLUSTER analysis (Statistics) ,COMPARATIVE studies ,FAMILIES ,FECES ,GRAM-negative bacteria ,HAND washing ,IMMUNIZATION ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,AQUATIC microbiology ,WATER supply ,EVALUATION research ,PROPORTIONAL hazards models - Abstract
Background: Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specified secondary outcome of a cluster-randomized controlled trial among >400 000 low-income residents in Dhaka, Bangladesh, we examined the impact of cholera vaccination plus a behaviour change intervention on diarrhoea-associated hospitalization.Methods: Ninety neighbourhood clusters were randomly allocated into three areas: cholera-vaccine-only; vaccine-plus-behaviour-change (promotion of hand-washing with soap plus drinking water chlorination); and control. Study follow-up continued for 2 years after intervention began. We calculated cluster-adjusted diarrhoea-associated hospitalization rates using data we collected from nearby hospitals, and 6-monthly census data of all trial households.Results: A total of 429 995 people contributed 500 700 person-years of data (average follow-up 1.13 years). Vaccine coverage was 58% at the start of analysis but continued to drop due to population migration. In the vaccine-plus-behaviour-change area, water plus soap was present at 45% of hand-washing stations; 4% of households had detectable chlorine in stored drinking water. Hospitalization rates were similar across the study areas [events/1000 person-years, 95% confidence interval (CI), cholera-vaccine-only: 9.4 (95% CI: 8.3-10.6); vaccine-plus-behaviour-change: 9.6 (95% CI: 8.3-11.1); control: 9.7 (95% CI: 8.3-11.6)]. Cholera cases accounted for 7% of total number of diarrhoea-associated hospitalizations.Conclusions: Neither cholera vaccination alone nor cholera vaccination combined with behaviour-change intervention efforts measurably reduced diarrhoea-associated hospitalization in this highly mobile population, during a time when cholera accounted for a small fraction of diarrhoea episodes. Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating faeces from the environment, food and water, with minimal behavioural demands on impoverished communities, remain an important area for research. [ABSTRACT FROM AUTHOR]- Published
- 2017
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3. Advantages and limitations for users of double pit pour-flush latrines: a qualitative study in rural Bangladesh.
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Hussain, Faruqe, Clasen, Thomas, Akter, Shahinoor, Bawel, Victoria, Luby, Stephen P., Leontsini, Elli, Unicomb, Leanne, Barua, Milan Kanti, Thomas, Brittany, and Winch, Peter J.
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TOILETS ,SANITATION ,WATER table ,BIODEGRADATION ,PUBLIC health ,POVERTY ,RESTROOMS ,RURAL population ,QUALITATIVE research ,PILOT projects - Abstract
Background: In rural Bangladesh, India and elsewhere, pour-flush pit latrines are the most common sanitation system. When a single pit latrine becomes full, users must empty it themselves and risk exposure to fresh feces, pay an emptying service to remove pit contents or build a new latrine. Double pit pour-flush latrines may serve as a long-term sanitation option including high water table areas because the pits do not need to be emptied immediately and the excreta decomposes into reusable soil.Methods: Double pit pour-flush latrines were implemented in rural Bangladesh for 'hardcore poor' households by a national NGO, BRAC. We conducted interviews, focus groups, and spot checks in two low-income, rural areas of Bangladesh to explore the advantages and limitations of using double pit latrines compared to single pit latrines.Results: The rural households accepted the double pit pour-flush latrine model and considered it feasible to use and maintain. This latrine design increased accessibility of a sanitation facility for these low-income residents and provided privacy, convenience and comfort, compared to open defecation. Although a double pit latrine is more costly and requires more space than a single pit latrine the households perceived this sanitation system to save resources, because households did not need to hire service workers to empty pits or remove decomposed contents themselves. In addition, the excreta decomposition process produced a reusable soil product that some households used in homestead gardening. The durability of the latrine superstructures was a problem, as most of the bamboo-pole superstructure broke after 6-18 months of use.Conclusions: Double pit pour-flush latrines are a long-term improved sanitation option that offers users several important advantages over single pit pour-flush latrines like in rural Bangladesh which can also be used in areas with high water table. Further research can provide an understanding of the comparative health impacts and effectiveness of the model in preventing human excreta from entering the environment. [ABSTRACT FROM AUTHOR]- Published
- 2017
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4. Randomized Controlled Trial of Hospital-Based Hygiene and Water Treatment Intervention (CHoBI7) to Reduce Cholera.
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George, Christine Marie, Monira, Shirajum, Sack, David A., Rashid, Mahamud-ur, Saif-Ur-Rahman, K. M., Mahmud, Toslim, Rahman, Zillur, Mustafiz, Munshi, Bhuyian, Sazzadul Islam, Winch, Peter J., Leontsini, Elli, Perin, Jamie, Begum, Farzana, Zohura, Fatema, Biswas, Shwapon, Parvin, Tahmina, Xiaotong Zhang, Jung, Danielle, Sack, R. Bradley, and Alam, Munirul
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PREVENTION of cholera ,WATER disinfection ,HAND washing ,COMMUNICABLE diseases ,PUBLIC health ,CROSS infection prevention ,CHOLERA ,COMPARATIVE studies ,CROSS infection ,FAMILIES ,GRAM-negative bacteria ,HOSPITALS ,HYGIENE ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,RESEARCH funding ,WATER supply ,EVALUATION research ,RANDOMIZED controlled trials ,ODDS ratio - Abstract
The risk for cholera infection is >100 times higher for household contacts of cholera patients during the week after the index patient seeks hospital care than it is for the general population. To initiate a standard of care for this high-risk population, we developed Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), which promotes hand washing with soap and treatment of water. To test CHoBI7, we conducted a randomized controlled trial among 219 intervention household contacts of 82 cholera patients and 220 control contacts of 83 cholera patients in Dhaka, Bangladesh, during 2013-2014. Intervention contacts had significantly fewer symptomatic Vibrio cholerae infections than did control contacts and 47% fewer overall V. cholerae infections. Intervention households had no stored drinking water with V. cholerae and 14 times higher odds of hand washing with soap at key events during structured observation on surveillance days 5, 6, or 7. CHoBI7 presents a promising approach for controlling cholera among highly susceptible household contacts of cholera patients. [ABSTRACT FROM AUTHOR]
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- 2016
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5. Complementary feeding practices among rural Bangladeshi mothers: Results from WASH Benefits study.
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Jannat, Kaniz, Luby, Stephen P., Unicomb, Leanne, Rahman, Mahbubur, Winch, Peter J., Parvez, Sarker M., Das, Kishor K., Leontsini, Elli, Ram, Pavani K., and Stewart, Christine P.
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ARTIFICIAL feeding ,BREASTFEEDING ,COMMUNITY health workers ,CONFIDENCE intervals ,COUNSELING ,DIETARY supplements ,HAND washing ,HEALTH behavior ,HEALTH promotion ,INFANT nutrition ,INGESTION ,MOTHERS ,NUTRITIONAL requirements ,POISSON distribution ,PREGNANT women ,REGRESSION analysis ,RESEARCH funding ,RESTROOMS ,RURAL conditions ,STATISTICAL sampling ,SANITATION ,SURVEYS ,WATER supply ,RESIDENTIAL patterns ,SOCIOECONOMIC factors ,RANDOMIZED controlled trials - Abstract
Inappropriate complementary feeding contributes to linear growth faltering in early childhood. Behaviour change interventions have been effective at improving practice, but few studies have investigated the effects of multicomponent integrated interventions. We conducted a cluster‐randomized controlled trial in rural Bangladesh in which geographic clusters were randomized into seven arms: water treatment (W), sanitation (S), handwashing (H), water, sanitation, and handwashing (WSH), improved nutrition with infant and young child feeding messages and lipid‐based nutrient supplementation for 6‐ to 24‐month olds (N), N+WSH, and control. The objective of this paper was to examine the independent and combined effects of interventions on indicators of complementary feeding. Approximately 1 and 2 years after initiation of the intervention, research assistants surveyed mothers about infant feeding practices. Complementary feeding was examined using the World Health Organization indicators of infant and young child feeding practices. We used Poisson regression models to estimate prevalence ratios and linear regression models for prevalence differences with clustered sandwich estimators to adjust for clustering. A total of 4,718 households from 720 clusters were surveyed at year 1 and 4,667 at year 2. The children in the nutrition arms had a higher prevalence of meeting the minimum dietary diversity score compared with controls (year 1: N: 66.4%; N+WSH: 65.0% vs. C:32.4%; year 2: N: 91.5%; N+WSH: 91.6% vs. C:77.7%). Children in the nutrition arms received diverse food earlier than the children in control arm. In addition, the average consumption of lipid‐based nutrient supplementation was >90% in each follow‐up. Nutrition‐specific interventions could be integrated with nutrition‐sensitive interventions such as WSH without compromising the uptake of the nutrition intervention. [ABSTRACT FROM AUTHOR]
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- 2019
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6. Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh.
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Parvez, Sarker Masud, Azad, Rashidul, Rahman, Mahbubur, Unicomb, Leanne, Ram, Pavani K., Naser, Abu Mohd, Stewart, Christine P., Jannat, Kaniz, Rahman, Musarrat Jabeen, Leontsini, Elli, Winch, Peter J., and Luby, Stephen P.
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SANITATION ,HAND washing ,NUTRITION ,COMMUNITY health workers ,DRINKING water ,CHILD nutrition ,COMPARATIVE studies ,ENVIRONMENTAL monitoring ,HEALTH behavior ,HYGIENE ,RESEARCH methodology ,MEDICAL cooperation ,NUTRITIONAL requirements ,RESEARCH ,STATISTICAL sampling ,EVALUATION research ,RANDOMIZED controlled trials - Abstract
Background: Uptake matters for evaluating the health impact of water, sanitation and hygiene (WASH) interventions. Many large-scale WASH interventions have been plagued by low uptake. For the WASH Benefits Bangladesh efficacy trial, high uptake was a prerequisite. We assessed the degree of technology and behavioral uptake among participants in the trial, as part of a three-paper series on WASH Benefits Intervention Delivery and Performance.Methods: This study is a cluster randomized trial comprised of geographically matched clusters among four districts in rural Bangladesh. We randomly allocated 720 clusters of 5551 pregnant women to individual or combined water, sanitation, handwashing, and nutrition interventions, or a control group. Behavioral objectives included; drinking chlorine-treated, safely stored water; use of a hygienic latrine and safe feces disposal at the compound level; handwashing with soap at key times; and age-appropriate nutrition behaviors (pregnancy to 24 months) including a lipid-based nutrition supplement (LNS). Enabling technologies and behavior change were promoted by trained local community health workers through periodic household visits. To monitor technology and behavioral uptake, we conducted surveys and spot checks in 30-35 households per intervention arm per month, over a 20-month period, and structured observations in 324 intervention and 108 control households, approximately 15 months after interventions commenced.Results: In the sanitation arms, observed adult use of a hygienic latrine was high (94-97% of events) while child sanitation practices were moderate (37-54%). In the handwashing arms, handwashing with soap was more common after toilet use (67-74%) than nonintervention arms (18-40%), and after cleaning a child's anus (61-72%), but was still low before food handling. In the water intervention arms, more than 65% of mothers and index children were observed drinking chlorine-treated water from a safe container. Reported LNS feeding was > 80% in nutrition arms. There was little difference in uptake between single and combined intervention arms.Conclusions: Rigorous implementation of interventions deployed at large scale in the context of an efficacy trial achieved high levels of technology and behavioral uptake in individual and combined WASH and nutrition intervention households. Further work should assess how to achieve similar uptake levels under programmatic conditions.Trial Registration: WASH Benefits Bangladesh: ClinicalTrials.gov, identifier: NCT01590095 . Registered on April 30, 2012. [ABSTRACT FROM AUTHOR]- Published
- 2018
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7. WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial.
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Rahman, Mahbubur, Ashraf, Sania, Unicomb, Leanne, Mainuddin, A. K. M., Parvez, Sarker Masud, Begum, Farzana, Das, Kishor Kumar, Naser, Abu Mohd., Hussain, Faruqe, Clasen, Thomas, Luby, Stephen P., Leontsini, Elli, and Winch, Peter J.
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PUBLIC health ,COMMUNITY health services ,COMMUNITY health workers ,HAND washing ,SANITATION ,CHILD nutrition ,COMPARATIVE studies ,ENVIRONMENTAL monitoring ,HEALTH behavior ,HYGIENE ,RESEARCH methodology ,MEDICAL cooperation ,NUTRITIONAL requirements ,RESEARCH ,RESTROOMS ,STATISTICAL sampling ,EVALUATION research ,RANDOMIZED controlled trials - Abstract
Background: Researchers typically report more on the impact of public health interventions and less on the degree to which interventions were followed implementation fidelity. We developed and measured fidelity indicators for the WASH Benefits Bangladesh study, a large-scale efficacy trial, in order to identify gaps between intended and actual implementation.Methods: Community health workers (CHWs) delivered individual and combined water, sanitation, handwashing (WSH) and child nutrition interventions to 4169 enrolled households in geographically matched clusters. Households received free enabling technologies (insulated water storage container; sani-scoop, potty, double-pit, pour-flush latrine; handwashing station, soapy-water storage bottle), and supplies (chlorine tablets, lipid-based nutrient supplements, laundry detergent sachets) integrated with parallel behavior-change promotion. Behavioral objectives were drinking treated, safely stored water, safe feces disposal, handwashing with soap at key times, and age-appropriate nutrition behaviors. We administered monthly surveys and spot-checks to households from randomly selected clusters for 6 months early in the trial. If any fidelity measures fell below set benchmarks, a rapid response mechanism was triggered.Results: In the first 3 months, functional water seals were detected in 33% (14/42) of latrines in the sanitation only arm; 35% (14/40) for the combined WSH arm; and 60% (34/57) for the combined WSH and Nutrition arm, all falling below the pre-set benchmark of 80%. Other fidelity indicators met the 65 to 80% uptake benchmarks. Rapid qualitative investigations determined that households concurrently used their own latrines with broken water seals in parallel with those provided by the trial. In consultation with the households, we closed pre-existing latrines without water seals, increased the CHWs' visit frequency to encourage correct maintenance of latrines with water seals, and discouraged water-seal removal or breakage. At the sixth assessment, 86% (51/59) of households were in sanitation only; 92% (72/78) in the combined WSH; and 93% (71/76) in the combined WSH and Nutrition arms had latrines with functional water seals.Conclusions: An intensive implementation fidelity monitoring and rapid response system proved beneficial for this efficacy trial. To implement a routine program at scale requires further research into an adaptation of fidelity monitoring that supports program effectiveness.Trial Registration: WASH Benefits Bangladesh: ClinicalTrials.gov, ID: NCT01590095 . Registered on 30 April 2012. [ABSTRACT FROM AUTHOR]- Published
- 2018
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8. WASH Benefits Bangladesh trial: management structure for achieving high coverage in an efficacy trial.
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Unicomb, Leanne, Begum, Farzana, Leontsini, Elli, Rahman, Mahbubur, Ashraf, Sania, Naser, Abu Mohd, Nizame, Fosiul A., Jannat, Kaniz, Hussain, Faruqe, Parvez, Sarker Masud, Arman, Shaila, Mobashara, Moshammot, Luby, Stephen P., and Winch, Peter J.
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SANITATION ,ORAL hygiene ,COMMUNITY health workers ,HAND washing ,NUTRITION ,COMPARATIVE studies ,ENVIRONMENTAL monitoring ,FAMILIES ,HEALTH behavior ,HYGIENE ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,EVALUATION research ,RANDOMIZED controlled trials ,EVALUATION of human services programs - Abstract
Background: Water, sanitation, and hygiene (WASH) efficacy trials deliver interventions to the target population under optimal conditions to estimate their effects on outcomes of interest, to inform subsequent selection for inclusion in routine programs. A systematic and intensive approach to intervention delivery is required to achieve the high-level uptake necessary to measure efficacy. We describe the intervention delivery system adopted in the WASH Benefits Bangladesh study, as part of a three-paper series on WASH Benefits Intervention Delivery and Performance.Methods: Community Health Workers (CHWs) delivered individual and combined WASH and nutrition interventions to 4169 enrolled households in geographically matched clusters. Households were provided with free enabling technologies and supplies, integrated with parallel behaviour-change promotion. Behavioural objectives were drinking treated, safely stored water, safe feces disposal, handwashing with soap at key times, and age-appropriate nutrition behaviours (birth to 24 months). The intervention delivery system built on lessons learned from prior WASH intervention effectiveness, implementation, and formative research studies. We recruited local CHWs, residents of the study villages, through transparent merit-based selection methods, and consultation with community leaders. CHW supervisors received training on direct intervention delivery, then trained their assigned CHWs. CHWs in turn used the technologies in their own homes. Each CHW counseled six to eight intervention households spread across a 0.2-2.2-km radius, with a 1:12 supervisor-to-CHW ratio. CHWs met monthly with supervisor-trainers to exchange experiences and adapt technology and behaviour-change approaches to evolving conditions. Intervention uptake was tracked through fidelity measures, with a priori benchmarks necessary for an efficacy study.Results: Sufficient levels of uptake were attained by the fourth intervention assessment month and sustained throughout the intervention period. Periodic internal CHW monitoring resulted in discontinuation of a small number of low performers.Conclusions: The intensive intervention delivery system required for an efficacy trial differs in many respects from the system for a routine program. To implement a routine program at scale requires further research on how to optimize the supervisor-to-CHW-to-intervention household ratios, as well as other program costs without compromising program effectiveness.Trial Registration: ClinicalTrials.gov, ID: NCC01590095 . Registered on 2 May 2012. [ABSTRACT FROM AUTHOR]- Published
- 2018
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