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Associations between household-level exposures and all-cause diarrhea and pathogen-specific enteric infections in children enrolled in five sentinel surveillance studies

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dc.contributor.author Colston, J.M.
dc.contributor.author Faruque, A.S.G.
dc.contributor.author Jahangir Hossain, M.
dc.contributor.author Saha, D.
dc.contributor.author Kanungo, S.
dc.contributor.author Mandomando, I.
dc.contributor.author Imran Nisar, M.
dc.contributor.author Zaidi, A.K.M.
dc.contributor.author Omore, R.
dc.contributor.author Breiman, R.F.
dc.contributor.author Sow, S.O.
dc.contributor.author Roose, A.
dc.contributor.author Levine, M.M.
dc.contributor.author Kotloff, K.L.
dc.contributor.author Ahmed, T.
dc.contributor.author Bessong, P.
dc.contributor.author Bhutta, Z.
dc.contributor.author Mduma, E.
dc.contributor.author Yori, P.P.
dc.contributor.author Shrestha, P.S.
dc.contributor.author Olortegui, M.P.
dc.contributor.author Kang, G.
dc.contributor.author Lima, A.A.M.
dc.contributor.author Humphrey, J.
dc.contributor.author Prendergast, A.
dc.contributor.author Schiaffino Salazar, Francesca
dc.contributor.author Zaitchik, B.F.
dc.contributor.author Kosek, M.N.
dc.date.accessioned 2020-12-14T16:06:17Z
dc.date.available 2020-12-14T16:06:17Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8689
dc.description.abstract Diarrheal disease remains a major cause of childhood mortality and morbidity causing poor health and economic outcomes. In low-resource settings, young children are exposed to numerous risk factors for enteric pathogen transmission within their dwellings, though the relative importance of different transmission pathways varies by pathogen species. The objective of this analysis was to model associations between five household-level risk factors—water, sanitation, flooring, caregiver education, and crowding—and infection status for endemic enteric pathogens in children in five surveillance studies. Data were combined from 22 sites in which a total of 58,000 stool samples were tested for 16 specific enteropathogens using qPCR. Risk ratios for pathogen-and taxon-specific infection status were modeled using generalized linear models along with hazard ratios for all-cause diarrhea in proportional hazard models, with the five household-level variables as primary exposures adjusting for covariates. Improved drinking water sources conferred a 17% reduction in diarrhea risk; however, the direction of its association with particular pathogens was inconsistent. Improved sanitation was associated with a 9% reduction in diarrhea risk with protective effects across pathogen species and taxa of around 10–20% risk reduction. A 9% reduction in diarrhea risk was observed in subjects with covered floors, which were also associated with decreases in risk for zoonotic enteropathogens. Caregiver education and household crowding showed more modest, inconclusive results. Combining data from diverse sites, this analysis quantified associations between five household-level exposures on risk of specific enteric infections, effects which differed by pathogen species but were broadly consistent with hypothesized transmission mechanisms. Such estimates may be used within expanded water, sanitation, and hygiene (WASH) programs to target interventions to the particular pathogen profiles of individual communities and prioritize resources. en_US
dc.language.iso eng
dc.publisher MDPI
dc.relation.ispartofseries International Journal of Environmental Research and Public Health
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject enteropathogens en_US
dc.subject water en_US
dc.subject sanitation and hygiene en_US
dc.subject child health en_US
dc.subject diarrheal disease en_US
dc.subject zoonoses en_US
dc.title Associations between household-level exposures and all-cause diarrhea and pathogen-specific enteric infections in children enrolled in five sentinel surveillance studies en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.3390/ijerph17218078
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.05
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#1.05.08
dc.relation.issn 1660-4601


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