201. Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Child Enteric Protozoan Infections in Rural Bangladesh: A Cluster-Randomized Controlled Trial.
- Author
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Lin, Audrie, Ercumen, Ayse, Benjamin-Chung, Jade, Arnold, Benjamin F, Das, Shimul, Haque, Rashidul, Ashraf, Sania, Parvez, Sarker M, Unicomb, Leanne, Rahman, Mahbubur, Hubbard, Alan E, Stewart, Christine P, Colford, John M, and Luby, Stephen P
- Subjects
Feces ,Humans ,Intestinal Diseases ,Parasitic ,Cryptosporidiosis ,Giardiasis ,Protozoan Infections ,Entamoebiasis ,Water ,Prevalence ,Cluster Analysis ,Sanitation ,Nutritional Status ,Adolescent ,Adult ,Middle Aged ,Child ,Child ,Preschool ,Pregnant Women ,Rural Population ,Bangladesh ,Female ,Male ,Young Adult ,Hand Disinfection ,Emerging Infectious Diseases ,Prevention ,Nutrition ,Clinical Research ,Foodborne Illness ,Digestive Diseases ,Pediatric ,Clinical Trials and Supportive Activities ,Infectious Diseases ,Vaccine Related ,Aetiology ,2.2 Factors relating to the physical environment ,Infection ,Clean Water and Sanitation ,water ,sanitation ,hygiene ,nutrition ,Giardia ,Biological Sciences ,Medical and Health Sciences ,Microbiology - Abstract
Background:We evaluated effects of individual and combined water, sanitation, handwashing (WSH), and nutritional interventions on protozoan infections in children. Methods:We randomized geographical clusters of pregnant women in rural Bangladesh into chlorinated drinking water, hygienic sanitation, handwashing, nutrition, combined WSH, nutrition plus WSH (N+WSH), or control arms. Participants were not masked. After approximately 2.5 years of intervention, we measured Giardia, Cryptosporidium, and Entamoeba histolytica prevalence and infection intensity by multiplex real-time polymerase chain reaction of child stool. Analysis was intention-to-treat. Results:Between May 2012 and July 2013, we randomized 5551 pregnant women. At follow-up, among 4102 available women, we enrolled 6694 children into the protozoan assessment. We analyzed stool from 5933 children (aged ~31 months) for protozoan infections. Compared with 35.5% prevalence among controls, Giardia infection prevalence was lower in the sanitation (26.5%; prevalence ratio [PR], 0.75 [95% confidence interval {CI}, .64-.88]), handwashing (28.2%; PR, 0.80 [95% CI, .66-.96]), WSH (29.7%; PR, 0.83 [95% CI, .72-.96]), and N+WSH (26.7%; PR, 0.75 [95% CI, .64-.88]) arms. Water and nutrition interventions had no effect. Low prevalence of E. histolytica and Cryptosporidium (
- Published
- 2018