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Swarthout JM, Mureithi M, Mboya J, Arnold BF, Wolfe MK, Dentz HN, Lin A, Arnold CD, Rao G, Stewart CP, Clasen T, Colford JM, Null C, Pickering AJ. Addressing Fecal Contamination in Rural Kenyan Households: The Roles of Environmental Interventions and Animal Ownership. Environ Sci Technol 2024. [PMID: 38760010 DOI: 10.1021/acs.est.3c09419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Combined water, sanitation, and handwashing (WSH) interventions could reduce fecal contamination along more transmission pathways than single interventions alone. We measured Escherichia coli levels in 3909 drinking water samples, 2691 child hand rinses, and 2422 toy ball rinses collected from households enrolled in a 2-year cluster-randomized controlled trial evaluating single and combined WSH interventions. Water treatment with chlorine reduced E. coli in drinking water. A combined WSH intervention improved water quality by the same magnitude but did not affect E. coli levels on hands or toys. One potential explanation for the limited impact of the sanitation intervention (upgraded latrines) is failure to address dog and livestock fecal contamination. Small ruminant (goat or sheep) ownership was associated with increased E. coli levels in stored water and on child hands. Cattle and poultry ownership was protective against child stunting, and domesticated animal ownership was not associated with child diarrhea. Our findings do not support restricting household animal ownership to prevent child diarrheal disease or stunting but do support calls for WSH infrastructure that can more effectively reduce household fecal contamination.
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Affiliation(s)
- Jenna M Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | | | - John Mboya
- Innovations for Poverty Action, Nairobi 00200, Kenya
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California 94720, United States
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, Department of Ophthalmology and Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California 94158, United States
| | - Marlene K Wolfe
- Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia 30322, United States
| | - Holly N Dentz
- Institute for Global Nutrition, University of California, Davis, Davis, California 95616, United States
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, California 95064, United States
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, Davis, California 95616, United States
| | - Gouthami Rao
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States
| | - Christine P Stewart
- Institute for Global Nutrition, University of California, Davis, Davis, California 95616, United States
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Emory University, Atlanta, Georgia 30322, United States
| | - John M Colford
- School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California 94720, United States
| | - Clair Null
- Mathematica, Washington, District of Columbia 20002, United States
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California 94720, United States
- Chan Zuckerberg Biohub San Francisco, San Francisco, California 94158, United States
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Lu D, Kalantar KL, Chu VT, Glascock AL, Guerrero ES, Bernick N, Butcher X, Ewing K, Fahsbender E, Holmes O, Hoops E, Jones AE, Lim R, McCanny S, Reynoso L, Rosario K, Tang J, Valenzuela O, Mourani PM, Pickering AJ, Raphenya AR, Alcock BP, McArthur AG, Langelier CR. Simultaneous detection of pathogens and antimicrobial resistance genes with the open source, cloud-based, CZ ID pipeline. bioRxiv 2024:2024.04.12.589250. [PMID: 38645206 PMCID: PMC11030322 DOI: 10.1101/2024.04.12.589250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Antimicrobial resistant (AMR) pathogens represent urgent threats to human health, and their surveillance is of paramount importance. Metagenomic next generation sequencing (mNGS) has revolutionized such efforts, but remains challenging due to the lack of open-access bioinformatics tools capable of simultaneously analyzing both microbial and AMR gene sequences. To address this need, we developed the Chan Zuckerberg ID (CZ ID) AMR module, an open-access, cloud-based workflow designed to integrate detection of both microbes and AMR genes in mNGS and whole-genome sequencing (WGS) data. It leverages the Comprehensive Antibiotic Resistance Database and associated Resistance Gene Identifier software, and works synergistically with the CZ ID short-read mNGS module to enable broad detection of both microbes and AMR genes. We highlight diverse applications of the AMR module through analysis of both publicly available and newly generated mNGS and WGS data from four clinical cohort studies and an environmental surveillance project. Through genomic investigations of bacterial sepsis and pneumonia cases, hospital outbreaks, and wastewater surveillance data, we gain a deeper understanding of infectious agents and their resistomes, highlighting the value of integrating microbial identification and AMR profiling for both research and public health. We leverage additional functionalities of the CZ ID mNGS platform to couple resistome profiling with the assessment of phylogenetic relationships between nosocomial pathogens, and further demonstrate the potential to capture the longitudinal dynamics of pathogen and AMR genes in hospital acquired bacterial infections. In sum, the new AMR module advances the capabilities of the open-access CZ ID microbial bioinformatics platform by integrating pathogen detection and AMR profiling from mNGS and WGS data. Its development represents a critical step toward democratizing pathogen genomic analysis and supporting collaborative efforts to combat the growing threat of AMR.
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Affiliation(s)
- Dan Lu
- Chan Zuckerberg Initiative, Redwood City, CA, USA
| | | | - Victoria T. Chu
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Nina Bernick
- Chan Zuckerberg Initiative, Redwood City, CA, USA
| | | | - Kirsty Ewing
- Chan Zuckerberg Initiative, Redwood City, CA, USA
| | | | | | - Erin Hoops
- Chan Zuckerberg Initiative, Redwood City, CA, USA
| | - Ann E. Jones
- Chan Zuckerberg Initiative, Redwood City, CA, USA
| | - Ryan Lim
- Chan Zuckerberg Initiative, Redwood City, CA, USA
| | | | | | | | | | | | - Peter M. Mourani
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children’s, Little Rock, AR, USA
| | - Amy J. Pickering
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- University of California, Berkeley, Berkeley, CA, USA
| | - Amogelang R. Raphenya
- Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | - Brian P. Alcock
- Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | - Andrew G. McArthur
- Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | - Charles R. Langelier
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
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Contreras JD, Islam M, Mertens A, Pickering AJ, Arnold BF, Benjamin-Chung J, Hubbard AE, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Improved Child Feces Management Mediates Reductions in Childhood Diarrhea from an On-Site Sanitation Intervention: Causal Mediation Analysis of a Cluster-Randomized Trial in Rural Bangladesh. J Epidemiol Glob Health 2024:10.1007/s44197-024-00210-y. [PMID: 38507184 DOI: 10.1007/s44197-024-00210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The WASH benefits Bangladesh trial multi-component sanitation intervention reduced diarrheal disease among children < 5 years. Intervention components included latrine upgrades, child feces management tools, and behavioral promotion. It remains unclear which components most impacted diarrhea. METHODS We conducted mediation analysis within a subset of households (n = 720) from the sanitation and control arms. Potential mediators were categorized into indicators of latrine quality, latrine use practices, and feces management practices. We estimated average causal mediation effects (ACME) as prevalence differences (PD), defined as the intervention's effect on diarrhea through its effect on the mediator. RESULTS The intervention improved all indicators compared to controls. We found significant mediation through multiple latrine use and feces management practice indicators. The strongest mediators during monsoon seasons were reduced open defecation among children aged < 3 and 3-8 years, and increased disposal of child feces into latrines. The strongest mediators during dry seasons were access to a flush/pour-flush latrine, reduced open defecation among children aged 3-8 years, and increased disposal of child feces into latrines. Individual mediation effects were small (PD = 0.5-2 percentage points) compared to the overall intervention effect but collectively describe significant mediation pathways. DISCUSSION The effect of the WASH Benefits Bangladesh sanitation intervention on diarrheal disease was mediated through improved child feces management and reduced child open defecation. Although the intervention significantly improved latrine quality, relatively high latrine quality at baseline may have limited benefits from additional improvements. Targeting safe child feces management may increase the health benefits of rural sanitation interventions.
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Affiliation(s)
- Jesse D Contreras
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48103, USA
| | - Mahfuza Islam
- Department of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, CA, 94720, USA
- Chan Zuckerberg Biohub, San Francisco, CA, 94158, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Jade Benjamin-Chung
- Chan Zuckerberg Biohub, San Francisco, CA, 94158, USA
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, 94304, USA
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Mahbubur Rahman
- Environmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Leanne Unicomb
- Environmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, 1212, Bangladesh
| | - Stephen P Luby
- Woods Institute for the Environment, Stanford University, Stanford, CA, 94305, USA
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27695, USA.
- Jordan Hall Addition 2225, Raleigh, NC, 27606, USA.
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Mertens A, Arnold BF, Benjamin-Chung J, Boehm AB, Brown J, Capone D, Clasen T, Fuhrmeister ER, Grembi JA, Holcomb D, Knee J, Kwong LH, Lin A, Luby SP, Nala R, Nelson K, Njenga SM, Null C, Pickering AJ, Rahman M, Reese HE, Steinbaum L, Stewart JR, Thilakaratne R, Cumming O, Colford JM, Ercumen A. Is detection of enteropathogens and human or animal faecal markers in the environment associated with subsequent child enteric infections and growth: an individual participant data meta-analysis. Lancet Glob Health 2024; 12:e433-e444. [PMID: 38365415 PMCID: PMC10882208 DOI: 10.1016/s2214-109x(23)00563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Quantifying contributions of environmental faecal contamination to child diarrhoea and growth faltering can illuminate causal mechanisms behind modest health benefits in recent water, sanitation, and hygiene (WASH) trials. We aimed to assess associations between environmental detection of enteropathogens and human or animal microbial source tracking markers (MSTM) and subsequent child health outcomes. METHODS In this individual participant data meta-analysis we searched we searched PubMed, Embase, CAB Direct Global Health, Agricultural and Environmental Science Database, Web of Science, and Scopus for WASH intervention studies with a prospective design and concurrent control that measured enteropathogens or MSTM in environmental samples, or both, and subsequently measured enteric infections, diarrhoea, or height-for-age Z-scores (HAZ) in children younger than 5 years. We excluded studies that only measured faecal indicator bacteria. The initial search was done on Jan 19, 2021, and updated on March 22, 2023. One reviewer (AM) screened abstracts, and two independent reviewers (AM and RT) examined the full texts of short-listed articles. All included studies include at least one author that also contributed as an author to the present Article. Our primary outcomes were the 7-day prevalence of caregiver-reported diarrhoea and HAZ in children. For specific enteropathogens in the environment, primary outcomes also included subsequent child infection with the same pathogen ascertained by stool testing. We estimated associations using covariate-adjusted regressions and pooled estimates across studies. FINDINGS Data from nine published reports from five interventions studies, which included 8603 children (4302 girls and 4301 boys), were included in the meta-analysis. Environmental pathogen detection was associated with increased infection prevalence with the same pathogen and lower HAZ (ΔHAZ -0·09 [95% CI -0·17 to -0·01]) but not diarrhoea (prevalence ratio 1·22 [95% CI 0·95 to 1·58]), except during wet seasons. Detection of MSTM was not associated with diarrhoea (no pooled estimate) or HAZ (ΔHAZ -0·01 [-0·13 to 0·11] for human markers and ΔHAZ -0·02 [-0·24 to 0·21] for animal markers). Soil, children's hands, and stored drinking water were major transmission pathways. INTERPRETATION Our findings support a causal chain from pathogens in the environment to infection to growth faltering, indicating that the lack of WASH intervention effects on child growth might stem from insufficient reductions in environmental pathogen prevalence. Studies measuring enteropathogens in the environment should subsequently measure the same pathogens in stool to further examine theories of change between WASH, faecal contamination, and health. Given that environmental pathogen detection was predictive of infection, programmes targeting specific pathogens (eg, vaccinations and elimination efforts) can environmentally monitor the pathogens of interest for population-level surveillance instead of collecting individual biospecimens. FUNDING The Bill & Melinda Gates Foundation and the UK Foreign and Commonwealth Development Office.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology, University of California, Berkeley, CA, USA; Division of Biostatistics, University of California, Berkeley, CA, USA.
| | - Benjamin F Arnold
- Francis I Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Alexandria B Boehm
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Joe Brown
- Department of Environmental Science and Engineering, University of North Carolina, Gillings School of Global Public Health, Michael Hooker Research Center, Chapel Hill, NC, USA
| | - Drew Capone
- Department of Environmental and Occupational Health, Indiana University, Bloomington, IN, USA
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Erica R Fuhrmeister
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | | | - David Holcomb
- Department of Environmental Science and Engineering, University of North Carolina, Gillings School of Global Public Health, Michael Hooker Research Center, Chapel Hill, NC, USA
| | - Jackie Knee
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - Laura H Kwong
- Division of Environmental Health Sciences, University of California, Berkeley, CA, USA
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Rassul Nala
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Kara Nelson
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | | | | | - Amy J Pickering
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, Dhaka, Bangladesh
| | - Heather E Reese
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren Steinbaum
- California Department of Toxic Substances Control, Sacramento, CA, USA
| | - Jill R Stewart
- Department of Environmental Science and Engineering, University of North Carolina, Gillings School of Global Public Health, Michael Hooker Research Center, Chapel Hill, NC, USA
| | | | - Oliver Cumming
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - John M Colford
- Division of Epidemiology, University of California, Berkeley, CA, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
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Arnold BF, Rerolle F, Tedijanto C, Njenga SM, Rahman M, Ercumen A, Mertens A, Pickering AJ, Lin A, Arnold CD, Das K, Stewart CP, Null C, Luby SP, Colford JM, Hubbard AE, Benjamin-Chung J. Geographic pair matching in large-scale cluster randomized trials. Nat Commun 2024; 15:1069. [PMID: 38316755 PMCID: PMC10844220 DOI: 10.1038/s41467-024-45152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Cluster randomized trials are often used to study large-scale public health interventions. In large trials, even small improvements in statistical efficiency can have profound impacts on the required sample size and cost. Location integrates many socio-demographic and environmental characteristics into a single, readily available feature. Here we show that pair matching by geographic location leads to substantial gains in statistical efficiency for 14 child health outcomes that span growth, development, and infectious disease through a re-analysis of two large-scale trials of nutritional and environmental interventions in Bangladesh and Kenya. Relative efficiencies from pair matching are ≥1.1 for all outcomes and regularly exceed 2.0, meaning an unmatched trial would need to enroll at least twice as many clusters to achieve the same level of precision as the geographically pair matched design. We also show that geographically pair matched designs enable estimation of fine-scale, spatially varying effect heterogeneity under minimal assumptions. Our results demonstrate broad, substantial benefits of geographic pair matching in large-scale, cluster randomized trials.
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Affiliation(s)
- Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
| | - Francois Rerolle
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Christine Tedijanto
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
| | - Andrew Mertens
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Audrie Lin
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, CA, USA
| | - Kishor Das
- CURAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | | | | | - Stephen P Luby
- Infectious diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - John M Colford
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Jade Benjamin-Chung
- Chan Zuckerberg Biohub, San Francisco, CA, USA
- Department of Epidemiology and Population Health, Stanford University, CA, USA
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Nadimpalli ML, Rojas Salvatierra L, Chakraborty S, Swarthout JM, Cabrera LZ, Pickering AJ, Calderon M, Saito M, Gilman RH, Pajuelo MJ. Effects of breastfeeding on children's gut colonization with multidrug-resistant Enterobacterales in peri-urban Lima, Peru. Gut Microbes 2024; 16:2309681. [PMID: 38300753 PMCID: PMC10841006 DOI: 10.1080/19490976.2024.2309681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Abstract
Children living in low-resource settings are frequently gut-colonized with multidrug-resistant bacteria. We explored whether breastfeeding may protect against children's incident gut colonization with extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-Ec) and Klebsiella, Enterobacter, or Citrobacter spp. (ESBL-KEC). We screened 937 monthly stool samples collected from 112 children aged 1-16 months during a 2016-19 prospective cohort study of enteric infections in peri-urban Lima. We used 52,816 daily surveys to examine how exposures to breastfeeding in the 30 days prior to a stool sample were associated with children's risks of incident gut-colonization, controlling for antibiotic use and other covariates. We sequenced 78 ESBL-Ec from 47 children to explore their diversity. Gut-colonization with ESBL-Ec was increasingly prevalent as children aged, approaching 75% by 16 months, while ESBL-KEC prevalence fluctuated between 18% and 36%. Through 6 months of age, exclusively providing human milk in the 30 days prior to a stool sample did not reduce children's risk of incident gut-colonization with ESBL-Ec or ESBL-KEC. From 6 to 16 months of age, every 3 additional days of breastfeeding in the prior 30 days was associated with 6% lower risk of incident ESBL-Ec gut-colonization (95% CI: 0.90, 0.98, p = .003). No effects were observed on incident ESBL-KEC colonization. We detected highly diverse ESBL-Ec among children and few differences between children who were predominantly breastfed (mean age: 4.1 months) versus older children (10.8 months). Continued breastfeeding after 6 months conferred protection against children's incident gut colonization with ESBL-Ec in this setting. Policies supporting continued breastfeeding should be considered in efforts to combat antibiotic resistance.
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Affiliation(s)
- Maya L. Nadimpalli
- Gangarosa Department of Environmental Health, Emory Rollins School of Public Health, Atlanta, GA, USA
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR), Tufts University, Boston, MA, USA
| | - Luismarcelo Rojas Salvatierra
- Laboratorio de Microbiología Molecular, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Subhra Chakraborty
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jenna M. Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Lilia Z. Cabrera
- Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
| | - Amy J. Pickering
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR), Tufts University, Boston, MA, USA
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Blum Center for Developing Economies, University of California, Berkeley, CA, USA
| | - Maritza Calderon
- Laboratorio de Microbiología Molecular, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Robert H. Gilman
- Laboratorio de Microbiología Molecular, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Monica J. Pajuelo
- Laboratorio de Microbiología Molecular, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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7
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Harris AR, Daly SW, Pickering AJ, Mrisho M, Harris M, Davis J. Safe Today, Unsafe Tomorrow: Tanzanian Households Experience Variability in Drinking Water Quality. Environ Sci Technol 2023; 57:17481-17489. [PMID: 37922469 DOI: 10.1021/acs.est.3c05275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
Measuring Escherichia coli in a single-grab sample of stored drinking water is often used to characterize drinking water quality. However, if water quality exhibits variability temporally, then one-time measurement schemes may be insufficient to adequately characterize the quality of water that people consume. This study uses longitudinal data collected from 193 households in peri-urban Tanzania to assess variability in stored water quality and to characterize uncertainty with different data collection schemes. Households were visited 5 times over the course of a year. At each visit, information was collected on water management practices, and a sample of stored drinking water was collected for E. coli enumeration. Water quality was poor for households, with 80% having highly contaminated (>100 CFU per 100 mL) water during at least one visit. There was substantial variability of water quality for households, with only 3% of households having the same category (low, medium, or high) of water quality for all five visits. These data suggest a single sample would inaccurately characterize a household's drinking water quality over the course of a year and lead to misestimates of population level access to safe drinking water.
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Affiliation(s)
- Angela R Harris
- Civil, Construction, and Environmental Engineering, North Carolina State University, 915 Partners Way, Campus Box 7908, Raleigh, North Carolina 27606, United States
| | - Sean W Daly
- Civil, Construction, and Environmental Engineering, North Carolina State University, 915 Partners Way, Campus Box 7908, Raleigh, North Carolina 27606, United States
| | - Amy J Pickering
- Civil and Environmental Engineering, University California Berkeley, Berkeley, California 94720, United States
| | | | - Michael Harris
- Civil and Environmental Engineering, University California Berkeley, Berkeley, California 94720, United States
| | - Jennifer Davis
- Environmental Engineering & Science, Department of Civil and Environmental Engineering, Stanford University, Stanford, California 94305, United States
- Woods Institute for the Environment, Stanford University, Stanford, California 94305, United States
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8
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Nadimpalli ML, Stegger M, Viau R, Yith V, de Lauzanne A, Sem N, Borand L, Huynh BT, Brisse S, Passet V, Overballe-Petersen S, Aziz M, Gouali M, Jacobs J, Phe T, Hungate BA, Leshyk VO, Pickering AJ, Gravey F, Liu CM, Johnson TJ, Hello SL, Price LB. Plugging the leaks: antibiotic resistance at human-animal interfaces in low-resource settings. Front Ecol Environ 2023; 21:428-434. [PMID: 38464945 PMCID: PMC10923528 DOI: 10.1002/fee.2639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Antibiotic resistance is one of the greatest public health challenges of our time. International efforts to curb resistance have largely focused on drug development and limiting unnecessary antibiotic use. However, in areas where water, sanitation, and hygiene infrastructure is lacking, we propose that bacterial flow between humans and animals can exacerbate the emergence and spread of resistant pathogens. Here, we describe the consequences of poor environmental controls by comparing mobile resistance elements among Escherichia coli recovered from humans and meat in Cambodia, a middle-income country with substantial human-animal connectivity and unregulated antibiotic use. We identified identical mobile resistance elements and a conserved transposon region that were widely dispersed in both humans and animals, a phenomenon rarely observed in high-income settings. Our findings indicate that plugging leaks at human-animal interfaces should be a critical part of addressing antibiotic resistance in low- and especially middle-income countries.
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Affiliation(s)
- Maya L Nadimpalli
- Gangarosa Department of Environmental Health, Emory Rollins School of Public Health, Atlanta, GA
- Stuart B Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, MA
| | - Marc Stegger
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
- Antimicrobial Resistance and Infectious Diseases Laboratory, Harry Butler Institute, Murdoch University, Perth, Australia
| | - Roberto Viau
- Stuart B Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, MA
- Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA
| | - Vuthy Yith
- Laboratory of Environment and Food Safety, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Agathe de Lauzanne
- Epidemiology and Public Health Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Nita Sem
- Laboratory of Environment and Food Safety, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Laurence Borand
- Epidemiology and Public Health Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Bich-tram Huynh
- Université Paris-Saclay, UVSQ, Inserm, Anti-Infective Evasion and Pharmacoepidemiology Team, CESP, Montigny le Bretonneux, France
- UMR 1181, Inserm, University of Versailles Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Virginie Passet
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | | | - Maliha Aziz
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Malika Gouali
- Laboratory of Environment and Food Safety, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
- Enteric Bacterial Pathogens Unit, Institut Pasteur, Paris, France
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Thong Phe
- Sihanouk Hospital Center for Hope, Phnom Penh, Cambodia
| | - Bruce A Hungate
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ
- Center for Ecosystem Science and Society, Northern Arizona University, Flagstaff, AZ
| | - Victor O Leshyk
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ
- Center for Ecosystem Science and Society, Northern Arizona University, Flagstaff, AZ
| | - Amy J Pickering
- Stuart B Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, MA
- Department of Civil and Environmental Engineering, University of California–Berkeley, Berkeley, CA
| | - François Gravey
- Université de Caen Normandie, Université de Rouen Normandie, Inserm, DYNAMICURE UMR 1311, CHU Caen, Caen, France
- Department of Bacteriology, CHU Caen, Caen, France
| | - Cindy M Liu
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Timothy J Johnson
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St Paul, MN
| | - Simon Le Hello
- Enteric Bacterial Pathogens Unit, Institut Pasteur, Paris, France
- Université de Caen Normandie, Université de Rouen Normandie, Inserm, DYNAMICURE UMR 1311, CHU Caen, Caen, France
- Department of Bacteriology, CHU Caen, Caen, France
| | - Lance B Price
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
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Amato HK, Loayza F, Salinas L, Paredes D, Garcia D, Sarzosa S, Saraiva-Garcia C, Johnson TJ, Pickering AJ, Riley LW, Trueba G, Graham JP. Risk factors for extended-spectrum beta-lactamase (ESBL)-producing E. coli carriage among children in a food animal-producing region of Ecuador: A repeated measures observational study. PLoS Med 2023; 20:e1004299. [PMID: 37831716 PMCID: PMC10621961 DOI: 10.1371/journal.pmed.1004299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/02/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The spread of antibiotic-resistant bacteria may be driven by human-animal-environment interactions, especially in regions with limited restrictions on antibiotic use, widespread food animal production, and free-roaming domestic animals. In this study, we aimed to identify risk factors related to commercial food animal production, small-scale or "backyard" food animal production, domestic animal ownership, and practices related to animal handling, waste disposal, and antibiotic use in Ecuadorian communities. METHODS AND FINDINGS We conducted a repeated measures study from 2018 to 2021 in 7 semirural parishes of Quito, Ecuador to identify determinants of third-generation cephalosporin-resistant E. coli (3GCR-EC) and extended-spectrum beta-lactamase E. coli (ESBL-EC) in children. We collected 1,699 fecal samples from 600 children and 1,871 domestic animal fecal samples from 376 of the same households at up to 5 time points per household over the 3-year study period. We used multivariable log-binomial regression models to estimate relative risks (RR) of 3GCR-EC and ESBL-EC carriage, adjusting for child sex and age, caregiver education, household wealth, and recent child antibiotic use. Risk factors for 3GCR-EC included living within 5 km of more than 5 commercial food animal operations (RR: 1.26; 95% confidence interval (CI): 1.10, 1.45; p-value: 0.001), household pig ownership (RR: 1.23; 95% CI: 1.02, 1.48; p-value: 0.030) and child pet contact (RR: 1.23; 95% CI: 1.09, 1.39; p-value: 0.001). Risk factors for ESBL-EC were dog ownership (RR: 1.35; 95% CI: 1.00, 1.83; p-value: 0.053), child pet contact (RR: 1.54; 95% CI: 1.10, 2.16; p-value: 0.012), and placing animal feces on household land/crops (RR: 1.63; 95% CI: 1.09, 2.46; p-value: 0.019). The primary limitations of this study are the use of proxy and self-reported exposure measures and the use of a single beta-lactamase drug (ceftazidime with clavulanic acid) in combination disk diffusion tests for ESBL confirmation, potentially underestimating phenotypic ESBL production among cephalosporin-resistant E. coli isolates. To improve ESBL determination, it is recommended to use 2 combination disk diffusion tests (ceftazidime with clavulanic acid and cefotaxime with clavulanic acid) for ESBL confirmatory testing. Future studies should also characterize transmission pathways by assessing antibiotic resistance in commercial food animals and environmental reservoirs. CONCLUSIONS In this study, we observed an increase in enteric colonization of antibiotic-resistant bacteria among children with exposures to domestic animals and their waste in the household environment and children living in areas with a higher density of commercial food animal production operations.
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Affiliation(s)
- Heather K. Amato
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, California, United States of America
| | - Fernanda Loayza
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Liseth Salinas
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Diana Paredes
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Daniela Garcia
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Soledad Sarzosa
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Carlos Saraiva-Garcia
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Timothy J. Johnson
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, Minnesota, United States of America
- Mid Central Research & Outreach Center, Willmar, Minnesota, United States of America
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, California, United States of America
- Blum Center for Developing Economies, University of California, Berkeley, California, United States of America
| | - Lee W. Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Gabriel Trueba
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Jay P. Graham
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, California, United States of America
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Amato HK, Loayza F, Salinas L, Paredes D, García D, Sarzosa S, Saraiva-Garcia C, Johnson TJ, Pickering AJ, Riley LW, Trueba G, Graham JP. Leveraging the COVID-19 pandemic as a natural experiment to assess changes in antibiotic use and antibiotic-resistant E. coli carriage in semi-rural Ecuador. Sci Rep 2023; 13:14854. [PMID: 37684276 PMCID: PMC10491794 DOI: 10.1038/s41598-023-39532-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/26/2023] [Indexed: 09/10/2023] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has had significant impacts on health systems, population dynamics, public health awareness, and antibiotic stewardship, which could affect antibiotic resistant bacteria (ARB) emergence and transmission. In this study, we aimed to compare knowledge, attitudes, and practices (KAP) of antibiotic use and ARB carriage in Ecuadorian communities before versus after the COVID-19 pandemic began. We leveraged data collected for a repeated measures observational study of third-generation cephalosporin-resistant E. coli (3GCR-EC) carriage among children in semi-rural communities in Quito, Ecuador between July 2018 and September 2021. We included 241 households that participated in surveys and child stool sample collection in 2019, before the pandemic, and in 2021, after the pandemic began. We estimated adjusted Prevalence Ratios (aPR) and 95% Confidence Intervals (CI) using logistic and Poisson regression models. Child antibiotic use in the last 3 months declined from 17% pre-pandemic to 5% in 2021 (aPR: 0.30; 95% CI 0.15, 0.61) and 3GCR-EC carriage among children declined from 40 to 23% (aPR: 0.48; 95% CI 0.32, 0.73). Multi-drug resistance declined from 86 to 70% (aPR: 0.32; 95% CI 0.13; 0.79), the average number of antibiotic resistance genes (ARGs) per 3GCR-EC isolate declined from 9.9 to 7.8 (aPR of 0.79; 95% CI 0.65, 0.96), and the diversity of ARGs was lower in 2021. In the context of Ecuador, where COVID-19 prevention and control measures were strictly enforced after its major cities experienced some of the world's the highest mortality rates from SARS-CoV-2 infections, antibiotic use and ARB carriage declined in semi-rural communities of Quito from 2019 to 2021.
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Affiliation(s)
- Heather K Amato
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, CA, USA.
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA.
| | - Fernanda Loayza
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Liseth Salinas
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Diana Paredes
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Daniela García
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Soledad Sarzosa
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Carlos Saraiva-Garcia
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Timothy J Johnson
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
- Blum Center for Developing Economies, University of California, Berkeley, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Gabriel Trueba
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Jay P Graham
- Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, CA, USA
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11
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Crider YS, Ray I, Pickering AJ. Response to "Comment on 'Adoption of Point-of-Use Chlorination for Household Drinking Water Treatment: A Systematic Review'". Environ Health Perspect 2023; 131:98003. [PMID: 37751323 PMCID: PMC10521912 DOI: 10.1289/ehp13870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Yoshika S. Crider
- Energy & Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
- Division of Epidemiology & Biostatistics, UC Berkeley, Berkeley, California, USA
- King Center on Global Development, Stanford University, Stanford, California, USA
| | - Isha Ray
- Energy & Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, UC Berkeley, Berkeley, California, USA
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12
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Fuhrmeister ER, Harvey AP, Nadimpalli ML, Gallandat K, Ambelu A, Arnold BF, Brown J, Cumming O, Earl AM, Kang G, Kariuki S, Levy K, Pinto Jimenez CE, Swarthout JM, Trueba G, Tsukayama P, Worby CJ, Pickering AJ. Evaluating the relationship between community water and sanitation access and the global burden of antibiotic resistance: an ecological study. Lancet Microbe 2023; 4:e591-e600. [PMID: 37399829 PMCID: PMC10393780 DOI: 10.1016/s2666-5247(23)00137-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/22/2023] [Accepted: 04/24/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Antibiotic resistance is a leading cause of death, with the highest burden occurring in low-resource settings. There is little evidence on the potential for water, sanitation, and hygiene (WASH) access to reduce antibiotic resistance in humans. We aimed to determine the relationship between the burden of antibiotic resistance in humans and community access to drinking water and sanitation. METHODS In this ecological study, we linked publicly available, geospatially tagged human faecal metagenomes (from the US National Center for Biotechnology Information Sequence Read Archive) with georeferenced household survey datasets that reported access to drinking water sources and sanitation facility types. We used generalised linear models with robust SEs to estimate the relationship between the abundance of antibiotic resistance genes (ARGs) in human faecal metagenomes and community-level coverage of improved drinking water and sanitation within a defined radii of faecal metagenome coordinates. FINDINGS We identified 1589 metagenomes from 26 countries. The mean abundance of ARGs, in units of log10 ARG fragments per kilobase per million mapped reads classified as bacteria, was highest in Africa compared with Europe (p=0·014), North America (p=0·0032), and the Western Pacific (p=0·011), and second highest in South-East Asia compared with Europe (p=0·047) and North America (p=0·014). Increased access to improved water and sanitation was associated with lower ARG abundance (effect estimate -0·22, [95% CI -0·39 to -0·05]) and the association was stronger in urban (-0·32 [-0·63 to 0·00]) than in rural (-0·16 [-0·38 to 0·07]) areas. INTERPRETATION Although additional studies to investigate causal effects are needed, increasing access to water and sanitation could be an effective strategy to curb the proliferation of antibiotic resistance in low-income and middle-income countries. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Erica R Fuhrmeister
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Abigail P Harvey
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
| | - Maya L Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA; Gangarosa Department of Environmental Health, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - Karin Gallandat
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Argaw Ambelu
- Water and Health Division, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Ashlee M Earl
- Infectious Disease & Microbiome Program, Broad Institute, Cambridge, MA, USA
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Chris E Pinto Jimenez
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jenna M Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Gabriel Trueba
- Institutito de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Pablo Tsukayama
- Laboratorio de Genómica Microbiana, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Colin J Worby
- Infectious Disease & Microbiome Program, Broad Institute, Cambridge, MA, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA.
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13
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Powers JE, Mureithi M, Mboya J, Campolo J, Swarthout JM, Pajka J, Null C, Pickering AJ. Effects of High Temperature and Heavy Precipitation on Drinking Water Quality and Child Hand Contamination Levels in Rural Kenya. Environ Sci Technol 2023; 57:6975-6988. [PMID: 37071701 PMCID: PMC10157894 DOI: 10.1021/acs.est.2c07284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Climate change may impact human health through the influence of weather on environmental transmission of diarrhea. Previous studies have found that high temperatures and heavy precipitation are associated with increased diarrhea prevalence, but the underlying causal mechanisms have not been tested and validated. We linked measurements of Escherichia coli in source water (n = 1673), stored drinking water (n = 9692), and hand rinses from children <2 years old (n = 2634) with publicly available gridded temperature and precipitation data (at ≤0.2 degree spatial resolution and daily temporal resolution) by the GPS coordinates and date of sample collection. Measurements were collected over a 3-year period across a 2500 km2 area in rural Kenya. In drinking water sources, high 7-day temperature was associated with a 0.16 increase in log10 E. coli levels (p < 0.001, 95% CI: 0.07, 0.24), while heavy 7-day total precipitation was associated with a 0.29 increase in log10 E. coli levels (p < 0.001, 95% CI: 0.13, 0.44). In household stored drinking water, heavy 7-day precipitation was associated with a 0.079 increase in log10 E. coli levels (p = 0.042, 95% CI: 0.07, 0.24). Heavy precipitation did not increase E. coli levels among respondents who treated their water, suggesting that water treatment can mitigate effects on water quality. On child hands, high 7-day temperature was associated with a 0.39 decrease in log10 E. coli levels (p < 0.001, 95% CI: -0.52, -0.27). Our findings provide insight on how climate change could impact environmental transmission of bacterial pathogens in Kenya. We suggest water treatment is especially important after heavy precipitation (particularly when preceded by dry periods) and high temperatures.
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Affiliation(s)
- Julie E Powers
- University of California, Berkeley, Berkeley, California 94704, United States
| | - Maryanne Mureithi
- Innovations for Poverty Action, Sandalwood Lane, Nairobi 00500, Kenya
| | - John Mboya
- Innovations for Poverty Action, Sandalwood Lane, Nairobi 00500, Kenya
| | - Jake Campolo
- Farmers Business Network, San Carlos, California 94070, United States
| | | | - Joseph Pajka
- Tufts University, Medford, Massachusetts 02155, United States
| | - Clair Null
- Mathematica, Washington, D.C. 20002, United States
| | - Amy J Pickering
- University of California, Berkeley, Berkeley, California 94704, United States
- Chan Zuckerberg Biohub, San Francisco, California 94158, United States
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14
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Pinto Jimenez CE, Keestra S, Tandon P, Cumming O, Pickering AJ, Moodley A, Chandler CIR. Biosecurity and water, sanitation, and hygiene (WASH) interventions in animal agricultural settings for reducing infection burden, antibiotic use, and antibiotic resistance: a One Health systematic review. Lancet Planet Health 2023; 7:e418-e434. [PMID: 37164518 DOI: 10.1016/s2542-5196(23)00049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 05/12/2023]
Abstract
Prevention and control of infections across the One Health spectrum is essential for improving antibiotic use and addressing the emergence and spread of antibiotic resistance. Evidence for how best to manage these risks in agricultural communities-45% of households globally-has not been systematically assembled. This systematic review identifies and summarises evidence from on-farm biosecurity and water, sanitation, and hygiene (WASH) interventions with the potential to directly or indirectly reduce infections and antibiotic resistance in animal agricultural settings. We searched 17 scientific databases (including Web of Science, PubMed, and regional databases) and grey literature from database inception to Dec 31, 2019 for articles that assessed biosecurity or WASH interventions measuring our outcomes of interest; namely, infection burden, microbial loads, antibiotic use, and antibiotic resistance in animals, humans, or the environment. Risk of bias was assessed with the Systematic Review Centre for Laboratory Animal Experimentation tool, Risk of Bias in Non-Randomized Studies of Interventions, and the Appraisal tool for Cross-Sectional Studies, although no studies were excluded as a result. Due to the heterogeneity of interventions found, we conducted a narrative synthesis. The protocol was pre-registered with PROSPERO (CRD42020162345). Of the 20 672 publications screened, 104 were included in this systematic review. 64 studies were conducted in high-income countries, 24 studies in upper-middle-income countries, 13 studies in lower-middle-income countries, two in low-income countries, and one included both upper-middle-income countries and lower-middle-income countries. 48 interventions focused on livestock (mainly pigs), 43 poultry (mainly chickens), one on livestock and poultry, and 12 on aquaculture farms. 68 of 104 interventions took place on intensive farms, 22 in experimental settings, and ten in smallholder or subsistence farms. Positive outcomes were reported for ten of 23 water studies, 17 of 35 hygiene studies, 15 of 24 sanitation studies, all three air-quality studies, and 11 of 17 other biosecurity-related interventions. In total, 18 of 26 studies reported reduced infection or diseases, 37 of 71 studies reported reduced microbial loads, four of five studies reported reduced antibiotic use, and seven of 20 studies reported reduced antibiotic resistance. Overall, risk of bias was high in 28 of 57 studies with positive interventions and 17 of 30 studies with negative or neutral interventions. Farm-management interventions successfully reduced antibiotic use by up to 57%. Manure-oriented interventions reduced antibiotic resistance genes or antibiotic-resistant bacteria in animal waste by up to 99%. This systematic review highlights the challenges of preventing and controlling infections and antimicrobial resistance, even in well resourced agricultural settings. Most of the evidence emerges from studies that focus on the farm itself, rather than targeting agricultural communities or the broader social, economic, and policy environment that could affect their outcomes. WASH and biosecurity interventions could complement each other when addressing antimicrobial resistance in the human, animal, and environmental interface.
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Affiliation(s)
- Chris E Pinto Jimenez
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK; Agriculture and Infectious Disease Group, London School of Hygiene & Tropical Medicine, London, UK.
| | - Sarai Keestra
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Agriculture and Infectious Disease Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Pranav Tandon
- Global Health Office, McMaster University, Hamilton, ON, Canada
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California Berkeley, CA, USA
| | | | - Clare I R Chandler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK
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15
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Mertens A, Arnold BF, Benjamin-Chung J, Boehm AB, Brown J, Capone D, Clasen T, Fuhrmeister E, Grembi JA, Holcomb D, Knee J, Kwong LH, Lin A, Luby SP, Nala R, Nelson K, Njenga SM, Null C, Pickering AJ, Rahman M, Reese HE, Steinbaum L, Stewart J, Thilakaratne R, Cumming O, Colford JM, Ercumen A. Effects of water, sanitation, and hygiene interventions on detection of enteropathogens and host-specific faecal markers in the environment: a systematic review and individual participant data meta-analysis. Lancet Planet Health 2023; 7:e197-e208. [PMID: 36889861 PMCID: PMC10009758 DOI: 10.1016/s2542-5196(23)00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Water, sanitation, and hygiene (WASH) improvements are promoted to reduce diarrhoea in low-income countries. However, trials from the past 5 years have found mixed effects of household-level and community-level WASH interventions on child health. Measuring pathogens and host-specific faecal markers in the environment can help investigate causal pathways between WASH and health by quantifying whether and by how much interventions reduce environmental exposure to enteric pathogens and faecal contamination from human and different animal sources. We aimed to assess the effects of WASH interventions on enteropathogens and microbial source tracking (MST) markers in environmental samples. METHODS We did a systematic review and individual participant data meta-analysis, which included searches from Jan 1, 2000, to Jan 5, 2023, from PubMed, Embase, CAB Direct Global Health, Agricultural and Environmental Science Database, Web of Science, and Scopus, of prospective studies with water, sanitation, or hygiene interventions and concurrent control group that measured pathogens or MST markers in environmental samples and measured child anthropometry, diarrhoea, or pathogen-specific infections. We used covariate-adjusted regression models with robust standard errors to estimate study-specific intervention effects and pooled effect estimates across studies using random-effects models. FINDINGS Few trials have measured the effect of sanitation interventions on pathogens and MST markers in the environment and they mostly focused on onsite sanitation. We extracted individual participant data on nine environmental assessments from five eligible trials. Environmental sampling included drinking water, hand rinses, soil, and flies. Interventions were consistently associated with reduced pathogen detection in the environment but effect estimates in most individual studies could not be distinguished from chance. Pooled across studies, we found a small reduction in the prevalence of any pathogen in any sample type (pooled prevalence ratio [PR] 0·94 [95% CI 0·90-0·99]). Interventions had no effect on the prevalence of MST markers from humans (pooled PR 1·00 [95% CI 0·88-1·13]) or animals (pooled PR 1·00 [95% CI 0·97-1·03]). INTERPRETATION The small effect of these sanitation interventions on pathogen detection and absence of effects on human or animal faecal markers are consistent with the small or null health effects previously reported in these trials. Our findings suggest that the basic sanitation interventions implemented in these studies did not contain human waste and did not adequately reduce exposure to enteropathogens in the environment. FUNDING Bill and Melinda Gates Foundation and the UK Foreign and Commonwealth Development Office.
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Affiliation(s)
- Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA.
| | - Benjamin F Arnold
- Francis I Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Alexandria B Boehm
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Joe Brown
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, Michael Hooker Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Drew Capone
- Department of Environmental and Occupational Health, Indiana University Bloomington, Bloomington, IN, USA
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, NE, Atlanta, GA, USA
| | - Erica Fuhrmeister
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | | | - David Holcomb
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, Michael Hooker Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jackie Knee
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - Laura H Kwong
- Division of Environmental Health Sciences, University of California, Berkeley, CA, USA
| | - Audrie Lin
- Department of Biobehavioral Health, Pennsylvania State University, PA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Rassul Nala
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Kara Nelson
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | | | | | - Amy J Pickering
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, Dhaka, Bangladesh
| | - Heather E Reese
- Department of Environmental Health, Rollins School of Public Health, Emory University, NE, Atlanta, GA, USA
| | - Lauren Steinbaum
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Jill Stewart
- Department of Environmental Science and Engineering, Gillings School of Global Public Health, Michael Hooker Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ruwan Thilakaratne
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Tropical Medicine & Hygiene, London, UK
| | - John M Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
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16
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Pinto Jimenez CE, Keestra SM, Tandon P, Pickering AJ, Moodley A, Cumming O, Chandler CIR. One Health WASH: an AMR-smart integrative approach to preventing and controlling infection in farming communities. BMJ Glob Health 2023; 8:bmjgh-2022-011263. [PMID: 36882219 PMCID: PMC10008318 DOI: 10.1136/bmjgh-2022-011263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/27/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
- Chris E Pinto Jimenez
- Global Health and Development Department, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarai M Keestra
- Global Health and Development Department, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Pranav Tandon
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California Berkeley, Berkeley, California, USA
| | - Arshnee Moodley
- CGIAR AMR Hub, International Livestock Research Institute, Nairobi, Kenya.,Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare I R Chandler
- Global Health and Development Department, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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17
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Crider YS, Tsuchiya M, Mukundwa M, Ray I, Pickering AJ. Adoption of Point-of-Use Chlorination for Household Drinking Water Treatment: A Systematic Review. Environ Health Perspect 2023; 131:16001. [PMID: 36715546 PMCID: PMC9885856 DOI: 10.1289/ehp10839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Centralized chlorination of urban piped water supplies has historically contributed to major reductions in waterborne illness. In locations without effective centralized water treatment, point-of-use (POU) chlorination for households is widely promoted to improve drinking water quality and health. Realizing these health benefits requires correct, consistent, and sustained product use, but real-world evaluations have often observed low levels of use. To our knowledge, no prior reviews exist on adoption of chlorine POU products. OBJECTIVES Our objectives were to identify which indicators of adoption are most often used in chlorine POU studies, summarize levels of adoption observed, understand how adoption changes over time, and determine how adoption is affected by frequency of contact between participants and study staff. METHODS We conducted a systematic review of household POU chlorination interventions or programs from 1990 through 2021 that reported a quantitative measure of adoption, were conducted in low- and middle-income countries, included data collection at households, and reported the intervention start date. RESULTS We identified 36 studies of household drinking water chlorination products that met prespecified eligibility criteria and extracted data from 46 chlorine intervention groups with a variety of chlorine POU products and locations. There was no consensus definition of adoption of household water treatment; the most common indicator was the proportion of household stored water samples with free chlorine residual > 0.1 or 0.2 mg / L . Among studies that reported either free or total chlorine-confirmed adoption of chlorine POU products, use was highly variable (across all chlorine intervention groups at the last time point measured in each study; range: 1.5%-100%; sample size-weighted median = 47 % ; unweighted median = 58 % ). The median follow-up duration among intervention groups was 3 months. On average, adoption declined over time and was positively associated with frequency of contact between respondents and study staff. DISCUSSION Although prior research has shown that POU chlorine products improve health when correctly and consistently used, a reliance on individual adoption for effective treatment is unlikely to lead to the widespread public health benefits historically associated with pressurized, centralized treatment of piped water supplies. https://doi.org/10.1289/EHP10839.
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Affiliation(s)
- Yoshika S. Crider
- Energy and Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
- Division of Epidemiology and Biostatistics, UC Berkeley, Berkeley, California, USA
- King Center on Global Development, Stanford University, Stanford, California, USA
| | - Miki Tsuchiya
- Master of Development Practice Program, UC Berkeley, Berkeley, California, USA
| | - Magnifique Mukundwa
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley (UC Berkeley), Berkeley, California, USA
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, UC Berkeley, Berkeley, California, USA
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18
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Bliss SS, Abraha EA, Fuhrmeister ER, Pickering AJ, Bascom-Slack CA. Learning and STEM identity gains from an online module on sequencing-based surveillance of antimicrobial resistance in the environment: An analysis of the PARE-Seq curriculum. PLoS One 2023; 18:e0282412. [PMID: 36897842 PMCID: PMC10004520 DOI: 10.1371/journal.pone.0282412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
COVID-19 necessitated the rapid transition to online learning, challenging the ability of Science, Technology, Engineering, and Math (STEM) professors to offer laboratory experiences to their students. As a result, many instructors sought online alternatives. In addition, recent literature supports the capacity of online curricula to empower students of historically underrepresented identities in STEM fields. Here, we present PARE-Seq, a virtual bioinformatics activity highlighting approaches to antimicrobial resistance (AMR) research. Following curricular development and assessment tool validation, pre- and post-assessments of 101 undergraduates from 4 institutions revealed that students experienced both significant learning gains and increases in STEM identity, but with small effect sizes. Learning gains were marginally modified by gender, race/ethnicity, and number of extracurricular work hours per week. Students with more extracurricular work hours had significantly lower increase in STEM identity score after course completion. Female-identifying students saw greater learning gains than male-identifying, and though not statistically significant, students identifying as an underrepresented minority reported larger increases in STEM identity score. These findings demonstrate that even short course-based interventions have potential to yield learning gains and improve STEM identity. Online curricula like PARE-Seq can equip STEM instructors to utilize research-driven resources that improve outcomes for all students, but support must be prioritized for students working outside of school.
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Affiliation(s)
- Scarlet S. Bliss
- Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Medford, Massachusetts, United States of America
- Center for Science Education, Department of Medical Education, Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Eve A. Abraha
- Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Medford, Massachusetts, United States of America
| | - Erica R. Fuhrmeister
- Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Medford, Massachusetts, United States of America
| | - Amy J. Pickering
- Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Medford, Massachusetts, United States of America
| | - Carol A. Bascom-Slack
- Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Medford, Massachusetts, United States of America
- Center for Science Education, Department of Medical Education, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
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19
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Swarthout JM, Chan EMG, Garcia D, Nadimpalli ML, Pickering AJ. Human Colonization with Antibiotic-Resistant Bacteria from Nonoccupational Exposure to Domesticated Animals in Low- and Middle-Income Countries: A Critical Review. Environ Sci Technol 2022; 56:14875-14890. [PMID: 35947446 DOI: 10.1021/acs.est.2c01494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Data on community-acquired antibiotic-resistant bacterial infections are particularly sparse in low- and middle-income countries (LMICs). Limited surveillance and oversight of antibiotic use in food-producing animals, inadequate access to safe drinking water, and insufficient sanitation and hygiene infrastructure in LMICs could exacerbate the risk of zoonotic antibiotic resistance transmission. This critical review compiles evidence of zoonotic exchange of antibiotic-resistant bacteria (ARB) or antibiotic resistance genes (ARGs) within households and backyard farms in LMICs, as well as assesses transmission mechanisms, risk factors, and environmental transmission pathways. Overall, substantial evidence exists for exchange of antibiotic resistance between domesticated animals and in-contact humans. Whole bacteria transmission and horizontal gene transfer between humans and animals were demonstrated within and between households and backyard farms. Further, we identified water, soil, and animal food products as environmental transmission pathways for exchange of ARB and ARGs between animals and humans, although directionality of transmission is poorly understood. Herein we propose study designs, methods, and topical considerations for priority incorporation into future One Health research to inform effective interventions and policies to disrupt zoonotic antibiotic resistance exchange in low-income communities.
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Affiliation(s)
- Jenna M Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Elana M G Chan
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Denise Garcia
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California 94720, United States
| | - Maya L Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, Massachusetts 02111, United States
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California 94720, United States
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, Massachusetts 02111, United States
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20
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Montealegre MC, Greenwood EE, Teichmann L, Nadimpalli ML, Caduff L, Swarthout JM, Nydegger T, Sultana S, Islam MA, Lanza VF, Luby SP, Pickering AJ, Julian TR. Drinking Water Chlorination Impact on Fecal Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Bangladeshi Children in a Double-Blind, Cluster-Randomized Controlled Trial. Environ Health Perspect 2022; 130:117702. [PMID: 36416733 PMCID: PMC9683094 DOI: 10.1289/ehp11359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Affiliation(s)
| | - Esther E. Greenwood
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Lisa Teichmann
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Maya L. Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, Massachusetts, USA
| | - Lea Caduff
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Jenna M. Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - Tabea Nydegger
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Sonia Sultana
- Enteric and Food Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammad Aminul Islam
- Enteric and Food Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Val F. Lanza
- Bioinformatics Unit IRYCIS, Madrid, Spain
- CIBERINFEC, Madrid, Spain
| | - Stephen P. Luby
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California, USA
| | - Timothy R. Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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21
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Dewey KG, Arnold CD, Wessells KR, Prado EL, Abbeddou S, Adu-Afarwuah S, Ali H, Arnold BF, Ashorn P, Ashorn U, Ashraf S, Becquey E, Brown KH, Christian P, Colford JM, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Humphrey JH, Huybregts L, Iannottie LL, Jannat K, Lartey A, Port AL, Leroy JL, Luby SP, Maleta K, Matias SL, Mbuya MNN, Mridha MK, Nkhoma M, Null C, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Prendergast AJ, Ruel M, Shaikh S, Weber AM, Wolff P, Zongrone A, Stewart CP. Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2022; 116:1314-1333. [PMID: 36045000 DOI: 10.1093/ajcn/nqac232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. OBJECTIVE We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3). METHODS We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models. We used random effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. RESULTS SQ-LNS provision led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation. CONCLUSIONS Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. Registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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Affiliation(s)
- Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, 9000Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Gaibandha-5700, Bangladesh
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sania Ashraf
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA.,Helen Keller International, New York, NY, USA
| | - Parul Christian
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jean H Humphrey
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | | | - Kaniz Jannat
- School of Health Sciences, Western Sydney University, NSW, Australia
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Agnes Le Port
- Montpellier Interdisciplinary center on Sustainable Agri-food systems (MoISA), French National Research Institute for Sustainable Development (IRD), Montpellier, France
| | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Kenneth Maleta
- Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh.,Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh
| | - Minyanga Nkhoma
- Department of Nutrition and Dietetics, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Bangladesh
| | - Harriet Okronipa
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Jean-Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, CA, USA
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, 1201 I Street NW, Washington, DC, 20005, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Gaibandha-5700, Bangladesh
| | - Ann M Weber
- School of Public Health, Division of Epidemiology, University of Nevada, Reno, USA
| | | | | | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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22
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Contreras JD, Islam M, Mertens A, Pickering AJ, Kwong LH, Arnold BF, Benjamin-Chung J, Hubbard AE, Alam M, Sen D, Islam S, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Influence of community-level sanitation coverage and population density on environmental fecal contamination and child health in a longitudinal cohort in rural Bangladesh. Int J Hyg Environ Health 2022; 245:114031. [PMID: 36058111 PMCID: PMC9489923 DOI: 10.1016/j.ijheh.2022.114031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/15/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
Background Household-level sanitation interventions have had limited effects on child health or environmental contamination, potentially due to low community coverage. Higher community-level coverage with safely managed sanitation can reduce opportunities for disease transmission. Methods We estimated associations between community sanitation coverage, environmental fecal contamination, and child health among 360 compounds in the control arm of the WASH Benefits trial in rural Bangladesh (NCT01590095). In each compound, we enumerated E. coli in environmental samples and recorded the 7-day prevalence of caregiver-reported diarrheal disease and acute respiratory infections (ARI) in children under five. We observed indicators of latrine access and quality among all neighboring compounds within 100 m of study compounds. We defined community coverage as the proportion of neighboring compounds with (1) at least one latrine, and (2) exclusively hygienic latrines (improved facility observed to safely contain feces), within both 50 m and 100 m of study compounds. We assessed effect modification by population density and season. Results Adjusted for confounders, study compounds surrounded by 100% coverage of at least one latrine per compound within 50 m had slightly lower log10E. coli counts in stored water (Δlog = −0.13, 95% CI -0.26, −0.01), child hand rinses (Δlog = −0.13, 95% CI -0.24, −0.02), and caregiver hand rinses (Δlog = −0.16, 95% CI -0.29, −0.03) and marginally lower prevalence of diarrheal disease (prevalence ratio [PR] = 0.82, 95% CI 0.64, 1.04) and ARI (PR = 0.84, 95% CI 0.69, 1.03) compared to compounds surrounded by <100% coverage. Effects were similar but less pronounced at 100 m. At higher population densities, community latrine coverage was associated with larger reductions in E. coli on child and caregiver hands and prevalence of diarrheal disease. Coverage with exclusively hygienic latrines was not associated with any outcome. Conclusion Higher community sanitation coverage was associated with reduced fecal contamination and improved child health, with stronger effects at highly local scales (50m) and at high population densities. Our findings indicate that the relationship between community sanitation coverage, environmental contamination, and child health varies by definition of coverage, distance, and population density. This work highlights significant uncertainty around how to best measure sanitation coverage and the expected health effects of increasing sanitation coverage using a specific metric. Better understanding of community-level sanitation access is needed to inform policy for implementing sanitation systems that effectively protect community health.
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Affiliation(s)
- Jesse D Contreras
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, 27695, United States
| | - Mahfuza Islam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Laura H Kwong
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, 94158, United States
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, 94304, United States
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Mahfuja Alam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Debashis Sen
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Sharmin Islam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, 1212, Bangladesh
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, 94305, United States
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, 94720, United States
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, 27695, United States.
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23
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Contreras JD, Islam M, Mertens A, Pickering AJ, Arnold BF, Benjamin-Chung J, Hubbard AE, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh. PLoS Med 2022; 19:e1004041. [PMID: 35939520 PMCID: PMC9394830 DOI: 10.1371/journal.pmed.1004041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/22/2022] [Accepted: 06/02/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diarrhea and acute respiratory infection (ARI) are leading causes of death in children. The WASH Benefits Bangladesh trial implemented a multicomponent sanitation intervention that led to a 39% reduction in the prevalence of diarrhea among children and a 25% reduction for ARI, measured 1 to 2 years after intervention implementation. We measured longer-term intervention effects on these outcomes between 1 to 3.5 years after intervention implementation, including periods with differing intensity of behavioral promotion. METHODS AND FINDINGS WASH Benefits Bangladesh was a cluster-randomized controlled trial of water, sanitation, hygiene, and nutrition interventions (NCT01590095). The sanitation intervention included provision of or upgrades to improved latrines, sani-scoops for feces removal, children's potties, and in-person behavioral promotion. Promotion was intensive up to 2 years after intervention initiation, decreased in intensity between years 2 to 3, and stopped after 3 years. Access to and reported use of latrines was high in both arms, and latrine quality was significantly improved by the intervention, while use of child feces management tools was low. We enrolled a random subset of households from the sanitation and control arms into a longitudinal substudy, which measured child health with quarterly visits between 1 to 3.5 years after intervention implementation. The study period therefore included approximately 1 year of high-intensity promotion, 1 year of low-intensity promotion, and 6 months with no promotion. We assessed intervention effects on diarrhea and ARI prevalence among children <5 years through intention-to-treat analysis using generalized linear models with robust standard errors. Masking was not possible during data collection, but data analysis was masked. We enrolled 720 households (360 per arm) from the parent trial and made 9,800 child observations between June 2014 and December 2016. Over the entire study period, diarrheal prevalence was lower among children in the sanitation arm (11.9%) compared to the control arm (14.5%) (prevalence ratio [PR] = 0.81, 95% CI 0.66, 1.00, p = 0.05; prevalence difference [PD] = -0.027, 95% CI -0.053, 0, p = 0.05). ARI prevalence did not differ between sanitation (21.3%) and control (22.7%) arms (PR = 0.93, 95% CI 0.82, 1.05, p = 0.23; PD = -0.016, 95% CI -0.043, 0.010, p = 0.23). There were no significant differences in intervention effects between periods with high-intensity versus low-intensity/no promotion. Study limitations include use of caregiver-reported symptoms to define health outcomes and limited data collected after promotion ceased. CONCLUSIONS The observed effect of the WASH Benefits Bangladesh sanitation intervention on diarrhea in children appeared to be sustained for at least 3.5 years after implementation, including 1.5 years after heavy promotion ceased. Existing latrine access was high in the study setting, suggesting that improving on-site latrine quality can deliver health benefits when latrine use practices are in place. Further work is needed to understand how latrine adoption can be achieved and sustained in settings with low existing access and how sanitation programs can adopt transformative approaches of excreta management, including safe disposal of child and animal feces, to generate a hygienic home environment. TRIAL REGISTRATION ClinicalTrials.gov; NCT01590095; https://clinicaltrials.gov/ct2/show/NCT01590095.
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Affiliation(s)
- Jesse D. Contreras
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Mahfuza Islam
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, University of California, Berkeley, California, United States of America
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, California, United States of America
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, United States of America
| | - Alan E. Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Stephen P. Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, United States of America
| | - John M. Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, United States of America
- * E-mail:
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24
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Lindmark M, Cherukumilli K, Crider YS, Marcenac P, Lozier M, Voth-Gaeddert L, Lantagne DS, Mihelcic JR, Zhang QM, Just C, Pickering AJ. Passive In-Line Chlorination for Drinking Water Disinfection: A Critical Review. Environ Sci Technol 2022; 56:9164-9181. [PMID: 35700262 PMCID: PMC9261193 DOI: 10.1021/acs.est.1c08580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
The world is not on track to meet Sustainable Development Goal 6.1 to provide universal access to safely managed drinking water by 2030. Removal of priority microbial contaminants by disinfection is one aspect of ensuring water is safely managed. Passive chlorination (also called in-line chlorination) represents one approach to disinfecting drinking water before or at the point of collection (POC), without requiring daily user input or electricity. In contrast to manual household chlorination methods typically implemented at the point of use (POU), passive chlorinators can reduce the user burden for chlorine dosing and enable treatment at scales ranging from communities to small municipalities. In this review, we synthesized evidence from 27 evaluations of passive chlorinators (in 19 articles, 3 NGO reports, and 5 theses) conducted across 16 countries in communities, schools, health care facilities, and refugee camps. Of the 27 passive chlorinators we identified, the majority (22/27) were solid tablet or granular chlorine dosers, and the remaining devices were liquid chlorine dosers. We identified the following research priorities to address existing barriers to scaled deployment of passive chlorinators: (i) strengthening local chlorine supply chains through decentralized liquid chlorine production, (ii) validating context-specific business models and financial sustainability, (iii) leveraging remote monitoring and sensing tools to monitor real-time chlorine levels and potential system failures, and (iv) designing handpump-compatible passive chlorinators to serve the many communities reliant on handpumps as a primary drinking water source. We also propose a set of reporting indicators for future studies to facilitate standardized evaluations of the technical performance and financial sustainability of passive chlorinators. In addition, we discuss the limitations of chlorine-based disinfection and recognize the importance of addressing chemical contamination in drinking water supplies. Passive chlorinators deployed and managed at-scale have the potential to elevate the quality of existing accessible and available water services to meet "safely managed" requirements.
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Affiliation(s)
- Megan Lindmark
- Department
of Civil and Environmental Engineering, University of Iowa, Iowa City, Iowa 52242-1396, United States
| | - Katya Cherukumilli
- Department
of Civil and Environmental Engineering, University of California Berkeley, Berkeley, California 94720-2284, United States
| | - Yoshika S. Crider
- Energy
& Resources Group, University of California
Berkeley, Berkeley, California 94720-2284, United States
- Division
of Epidemiology & Biostatistics, University
of California Berkeley, Berkeley, California 94720-2284, United States
- King
Center on Global Development, Stanford University, Stanford, California 94305-2004, United States
| | - Perrine Marcenac
- National
Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, United States
| | - Matthew Lozier
- National
Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, United States
| | - Lee Voth-Gaeddert
- National
Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, United States
- SAMRC/WITS
Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, 2050, South Africa
| | - Daniele S. Lantagne
- Tufts
University School of Engineering, Medford, Massachusetts 02155-1012, United States
| | - James R. Mihelcic
- Department
of Civil and Environmental Engineering, University of South Florida, Tampa, Florida 33620-5350, United States
| | - Qianjin Marina Zhang
- Lichtenberger
Engineering Library, University of Iowa, Iowa City, Iowa 52242-1396, United States
| | - Craig Just
- Department
of Civil and Environmental Engineering, University of Iowa, Iowa City, Iowa 52242-1396, United States
| | - Amy J. Pickering
- Department
of Civil and Environmental Engineering, University of California Berkeley, Berkeley, California 94720-2284, United States
- Blum
Center for Developing Economies, University
of California Berkeley, Berkeley, California 94720-2284, United States
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25
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Zhu K, Suttner B, Knee J, Capone D, Moe CL, Stauber CE, Konstantinidis KT, Wallach TE, Pickering AJ, Brown J. Elevated Fecal Mitochondrial DNA from Symptomatic Norovirus Infections Suggests Potential Health Relevance of Human Mitochondrial DNA in Fecal Source Tracking. Environ Sci Technol Lett 2022; 9:543-550. [PMID: 35719858 PMCID: PMC9202355 DOI: 10.1021/acs.estlett.2c00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
An end goal of fecal source tracking (FST) is to provide information on risk of transmission of waterborne illnesses associated with fecal contamination. Ideally, concentrations of FST markers in ambient waters would reflect exposure risk. Human mtDNA is an FST marker that is exclusively human in origin and may be elevated in feces of individuals experiencing gastrointestinal inflammation. In this study, we examined whether human mtDNA is elevated in fecal samples from individuals with symptomatic norovirus infections using samples from the United States (US), Mozambique, and Bangladesh. We quantified hCYTB484 (human mtDNA) and HF183/BacR287 (human-associated Bacteroides) FST markers using droplet digital polymerase chain reaction. We observed the greatest difference in concentrations of hCYTB484 when comparing samples from individuals with symptomatic norovirus infections versus individuals without norovirus infections or diarrhea symptoms: log10 increase of 1.42 in US samples (3,820% increase, p-value = 0.062), 0.49 in Mozambique (308% increase, p-value = 0.061), and 0.86 in Bangladesh (648% increase, p-value = 0.035). We did not observe any trends in concentrations of HF183/BacR287 in the same samples. These results suggest concentrations of fecal mtDNA may increase during symptomatic norovirus infection and that mtDNA in environmental samples may represent an unambiguously human source-tracking marker that correlates with enteric pathogen exposure risk.
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Affiliation(s)
- Kevin
J. Zhu
- School
of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Brittany Suttner
- School
of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Jackie Knee
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, London WC1E 7HT,United Kingdom
| | - Drew Capone
- Department
of Environmental Sciences and Engineering, Gillings School of Global
Public Health, University of North Carolina
at Chapel Hill, Chapel
Hill, North Carolina 27599, United States
| | - Christine L. Moe
- Center
for Global Safe Water, Sanitation, and Hygiene, Rollins School of
Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Christine E. Stauber
- Department
of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia 30302, United States
| | - Kostas T. Konstantinidis
- School
of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Thomas E. Wallach
- Division
of Pediatric Gastroenterology, SUNY Downstate
Health Sciences University, Brooklyn, New York 11203, United States
| | - Amy J. Pickering
- Department
of Civil and Environmental Engineering, University of California, Berkeley, California 94720, United States
| | - Joe Brown
- Department
of Environmental Sciences and Engineering, Gillings School of Global
Public Health, University of North Carolina
at Chapel Hill, Chapel
Hill, North Carolina 27599, United States
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26
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Nadimpalli ML, Lanza VF, Montealegre MC, Sultana S, Fuhrmeister ER, Worby CJ, Teichmann L, Caduff L, Swarthout JM, Crider YS, Earl AM, Brown J, Luby SP, Islam MA, Julian TR, Pickering AJ. Drinking water chlorination has minor effects on the intestinal flora and resistomes of Bangladeshi children. Nat Microbiol 2022; 7:620-629. [PMID: 35422497 PMCID: PMC9249080 DOI: 10.1038/s41564-022-01101-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/24/2022] [Indexed: 02/07/2023]
Abstract
Healthy development of the gut microbiome provides long-term health benefits. Children raised in countries with high infectious disease burdens are frequently exposed to diarrhoeal pathogens and antibiotics, which perturb gut microbiome assembly. A recent cluster-randomized trial leveraging >4,000 child observations in Dhaka, Bangladesh, found that automated water chlorination of shared taps effectively reduced child diarrhoea and antibiotic use. In this substudy, we leveraged stool samples collected from 130 children 1 year after chlorine doser installation to examine differences between treatment and control children's gut microbiota. Water chlorination was associated with increased abundance of several bacterial genera previously linked to improved gut health; however, we observed no effects on the overall richness or diversity of taxa. Several clinically relevant antibiotic resistance genes were relatively more abundant in the gut microbiome of treatment children, possibly due to increases in Enterobacteriaceae. While further studies on the long-term health impacts of drinking chlorinated water would be valuable, we conclude that access to chlorinated water did not substantially impact child gut microbiome development in this setting, supporting the use of chlorination to increase global access to safe drinking water.
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Affiliation(s)
- Maya L. Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA,Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR), Tufts University, Boston, MA, USA
| | - Val F. Lanza
- Bioinformatics Unit, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain,Network Research Center for Infectious Diseases (CIBERINFEC), Spain
| | | | - Sonia Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Erica R. Fuhrmeister
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Colin J. Worby
- Infectious Disease & Microbiome Program, Broad Institute, Cambridge, MA
| | - Lisa Teichmann
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Lea Caduff
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Jenna M. Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Yoshika S. Crider
- Energy and Resources Group, University of California Berkeley, Berkeley, CA, USA,King Center on Global Development, Stanford University, Stanford, CA, USA
| | - Ashlee M. Earl
- Infectious Disease & Microbiome Program, Broad Institute, Cambridge, MA
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Stephen P. Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Mohammad Aminul Islam
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland,Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Timothy R. Julian
- Network Research Center for Infectious Diseases (CIBERINFEC), Spain,Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
| | - Amy J. Pickering
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR), Tufts University, Boston, MA, USA,Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA,Blum Center for Developing Economies, University of California, Berkeley, CA, USA,Correspondence and requests for materials should be addressed to Dr. Amy Pickering () and Dr. Tim Julian ()
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27
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van Dijk LR, Walker BJ, Straub TJ, Worby CJ, Grote A, Schreiber HL, Anyansi C, Pickering AJ, Hultgren SJ, Manson AL, Abeel T, Earl AM. StrainGE: a toolkit to track and characterize low-abundance strains in complex microbial communities. Genome Biol 2022; 23:74. [PMID: 35255937 PMCID: PMC8900328 DOI: 10.1186/s13059-022-02630-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/09/2022] [Indexed: 01/21/2023] Open
Abstract
Human-associated microbial communities comprise not only complex mixtures of bacterial species, but also mixtures of conspecific strains, the implications of which are mostly unknown since strain level dynamics are underexplored due to the difficulties of studying them. We introduce the Strain Genome Explorer (StrainGE) toolkit, which deconvolves strain mixtures and characterizes component strains at the nucleotide level from short-read metagenomic sequencing with higher sensitivity and resolution than other tools. StrainGE is able to identify strains at 0.1x coverage and detect variants for multiple conspecific strains within a sample from coverages as low as 0.5x.
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Affiliation(s)
- Lucas R. van Dijk
- grid.66859.340000 0004 0546 1623Infectious Disease & Microbiome Program, Broad Institute, 415 Main Street, Cambridge, MA 02142 USA ,grid.5292.c0000 0001 2097 4740Delft Bioinformatics Lab, Delft University of Technology, Van Mourik Broekmanweg 6, Delft, 2628 XE The Netherlands
| | - Bruce J. Walker
- grid.66859.340000 0004 0546 1623Infectious Disease & Microbiome Program, Broad Institute, 415 Main Street, Cambridge, MA 02142 USA ,Applied Invention, Cambridge, MA USA
| | - Timothy J. Straub
- grid.66859.340000 0004 0546 1623Infectious Disease & Microbiome Program, Broad Institute, 415 Main Street, Cambridge, MA 02142 USA ,grid.38142.3c000000041936754XDepartment of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Colin J. Worby
- grid.66859.340000 0004 0546 1623Infectious Disease & Microbiome Program, Broad Institute, 415 Main Street, Cambridge, MA 02142 USA
| | - Alexandra Grote
- grid.66859.340000 0004 0546 1623Infectious Disease & Microbiome Program, Broad Institute, 415 Main Street, Cambridge, MA 02142 USA
| | - Henry L. Schreiber
- grid.4367.60000 0001 2355 7002Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110 USA ,grid.4367.60000 0001 2355 7002Center for Women’s Infectious Disease Research (CWIDR), Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Christine Anyansi
- grid.5292.c0000 0001 2097 4740Delft Bioinformatics Lab, Delft University of Technology, Van Mourik Broekmanweg 6, Delft, 2628 XE The Netherlands
| | - Amy J. Pickering
- grid.47840.3f0000 0001 2181 7878Department of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, CA 94720 USA ,grid.429997.80000 0004 1936 7531Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR), Tufts University, Boston, MA USA
| | - Scott J. Hultgren
- grid.4367.60000 0001 2355 7002Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110 USA ,grid.4367.60000 0001 2355 7002Center for Women’s Infectious Disease Research (CWIDR), Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Abigail L. Manson
- grid.66859.340000 0004 0546 1623Infectious Disease & Microbiome Program, Broad Institute, 415 Main Street, Cambridge, MA 02142 USA
| | - Thomas Abeel
- grid.66859.340000 0004 0546 1623Infectious Disease & Microbiome Program, Broad Institute, 415 Main Street, Cambridge, MA 02142 USA ,grid.5292.c0000 0001 2097 4740Delft Bioinformatics Lab, Delft University of Technology, Van Mourik Broekmanweg 6, Delft, 2628 XE The Netherlands
| | - Ashlee M. Earl
- grid.66859.340000 0004 0546 1623Infectious Disease & Microbiome Program, Broad Institute, 415 Main Street, Cambridge, MA 02142 USA
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28
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Dewey KG, Wessells KR, Arnold CD, Prado EL, Abbeddou S, Adu-Afarwuah S, Ali H, Arnold BF, Ashorn P, Ashorn U, Ashraf S, Becquey E, Bendabenda J, Brown KH, Christian P, Colford JM, Dulience SJL, Fernald LCH, Galasso E, Hallamaa L, Hess SY, Humphrey JH, Huybregts L, Iannotti LL, Jannat K, Lartey A, Le Port A, Leroy JL, Luby SP, Maleta K, Matias SL, Mbuya MNN, Mridha MK, Nkhoma M, Null C, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Prendergast AJ, Ruel M, Shaikh S, Weber AM, Wolff P, Zongrone A, Stewart CP. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child growth: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2021; 114:15S-42S. [PMID: 34590672 PMCID: PMC8560308 DOI: 10.1093/ajcn/nqab278] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child stunting and wasting. Identification of subgroups who benefit most from SQ-LNSs may facilitate program design. OBJECTIVES We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child growth outcomes. METHODS We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 37,066). We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. RESULTS SQ-LNS provision decreased stunting (length-for-age z score < -2) by 12% (relative reduction), wasting [weight-for-length (WLZ) z score < -2] by 14%, low midupper arm circumference (MUAC) (<125 mm or MUAC-for-age z score < -2) by 18%, acute malnutrition (WLZ < -2 or MUAC < 125 mm) by 14%, underweight (weight-for-age z score < -2) by 13%, and small head size (head circumference-for-age z score < -2) by 9%. Effects of SQ-LNSs generally did not differ by study-level characteristics including region, stunting burden, malaria prevalence, sanitation, water quality, duration of supplementation, frequency of contact, or average compliance with SQ-LNS. Effects of SQ-LNSs on stunting, wasting, low MUAC, and small head size were greater among girls than among boys; effects on stunting, underweight, and low MUAC were greater among later-born (than among firstborn) children; and effects on wasting and acute malnutrition were greater among children in households with improved (as opposed to unimproved) sanitation. CONCLUSIONS The positive impact of SQ-LNSs on growth is apparent across a variety of study-level contexts. Policy-makers and program planners should consider including SQ-LNSs in packages of interventions to prevent both stunting and wasting.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.
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Affiliation(s)
- Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Hasmot Ali
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Bangladesh
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sania Ashraf
- Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, PA, USA
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Jaden Bendabenda
- Department of Nutrition and Food Safety, WHO, Geneva, Switzerland
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
- Helen Keller International, New York, NY, USA
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jean H Humphrey
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Kaniz Jannat
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Minyanga Nkhoma
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Harriet Okronipa
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Marie Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Saijuddin Shaikh
- The JiVitA Project of Johns Hopkins University, Bangladesh, Paschimpara, Bangladesh
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | | | | | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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Prado EL, Arnold CD, Wessells KR, Stewart CP, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn U, Ashorn P, Becquey E, Brown KH, Chandna J, Christian P, Dentz HN, Dulience SJL, Fernald LC, Galasso E, Hallamaa L, Hess SY, Huybregts L, Iannotti LL, Jimenez EY, Kohl P, Lartey A, Le Port A, Luby SP, Maleta K, Matchado A, Matias SL, Mridha MK, Ntozini R, Null C, Ocansey ME, Parvez SM, Phuka J, Pickering AJ, Prendergast AJ, Shamim AA, Siddiqui Z, Tofail F, Weber AM, Wu L, Dewey KG. Small-quantity lipid-based nutrient supplements for children age 6-24 months: a systematic review and individual participant data meta-analysis of effects on developmental outcomes and effect modifiers. Am J Clin Nutr 2021; 114:43S-67S. [PMID: 34590116 PMCID: PMC8560311 DOI: 10.1093/ajcn/nqab277] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Small-quantity (SQ) lipid-based nutrient supplements (LNSs) provide many nutrients needed for brain development. OBJECTIVES We aimed to generate pooled estimates of the effect of SQ-LNSs on developmental outcomes (language, social-emotional, motor, and executive function), and to identify study-level and individual-level modifiers of these effects. METHODS We conducted a 2-stage meta-analysis of individual participant data from 14 intervention against control group comparisons in 13 randomized trials of SQ-LNSs provided to children age 6-24 mo (total n = 30,024). RESULTS In 11-13 intervention against control group comparisons (n = 23,588-24,561), SQ-LNSs increased mean language (mean difference: 0.07 SD; 95% CI: 0.04, 0.10 SD), social-emotional (0.08; 0.05, 0.11 SD), and motor scores (0.08; 95% CI: 0.05, 0.11 SD) and reduced the prevalence of children in the lowest decile of these scores by 16% (prevalence ratio: 0.84; 95% CI: 0.76, 0.92), 19% (0.81; 95% CI: 0.74, 0.89), and 16% (0.84; 95% CI: 0.76, 0.92), respectively. SQ-LNSs also increased the prevalence of children walking without support at 12 mo by 9% (1.09; 95% CI: 1.05, 1.14). Effects of SQ-LNSs on language, social-emotional, and motor outcomes were larger among study populations with a higher stunting burden (≥35%) (mean difference: 0.11-0.13 SD; 8-9 comparisons). At the individual level, greater effects of SQ-LNSs were found on language among children who were acutely malnourished (mean difference: 0.31) at baseline; on language (0.12), motor (0.11), and executive function (0.06) among children in households with lower socioeconomic status; and on motor development among later-born children (0.11), children of older mothers (0.10), and children of mothers with lower education (0.11). CONCLUSIONS Child SQ-LNSs can be expected to result in modest developmental gains, which would be analogous to 1-1.5 IQ points on an IQ test, particularly in populations with a high child stunting burden. Certain groups of children who experience higher-risk environments have greater potential to benefit from SQ-LNSs in developmental outcomes.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020159971.
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Affiliation(s)
- Elizabeth L Prado
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Charles D Arnold
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - K Ryan Wessells
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Christine P Stewart
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Kenneth H Brown
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
- Helen Keller International, New York, NY, USA
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly N Dentz
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Lotta Hallamaa
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonja Y Hess
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Lora L Iannotti
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Elizabeth Y Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Patricia Kohl
- Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Andrew Matchado
- Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | | | - Sarker M Parvez
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - John Phuka
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Abu A Shamim
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Zakia Siddiqui
- Healthy Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | - Lee S F Wu
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Institute for Global Nutrition & Department of Nutrition, University of California Davis, Davis, CA, USA
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30
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Wessells KR, Arnold CD, Stewart CP, Prado EL, Abbeddou S, Adu-Afarwuah S, Arnold BF, Ashorn P, Ashorn U, Becquey E, Brown KH, Byrd KA, Campbell RK, Christian P, Fernald L, Fan YM, Galasso E, Hess SY, Huybregts L, Jorgensen JM, Kiprotich M, Kortekangas E, Lartey A, Le Port A, Leroy JL, Lin A, Maleta K, Matias SL, Mbuya M, Mridha MK, Mutasa K, Naser AM, Paul RR, Okronipa H, Ouédraogo JB, Pickering AJ, Rahman M, Schulze K, Smith LE, Weber AM, Zongrone A, Dewey KG. Characteristics that modify the effect of small-quantity lipid-based nutrient supplementation on child anemia and micronutrient status: an individual participant data meta-analysis of randomized controlled trials. Am J Clin Nutr 2021; 114:68S-94S. [PMID: 34590114 PMCID: PMC8560313 DOI: 10.1093/ajcn/nqab276] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/04/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Small-quantity lipid-based nutrient supplements (SQ-LNSs) have been shown to reduce the prevalence of child anemia and iron deficiency, but effects on other micronutrients are less well known. Identifying subgroups who benefit most from SQ-LNSs could support improved program design. OBJECTIVES We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes. METHODS We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers. RESULTS SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP < 0.70 µmol/L), with little evidence of effect modification by individual-level characteristics. CONCLUSIONS SQ-LNSs can substantially reduce the prevalence of anemia, iron deficiency, and IDA among children across a range of individual, population, and study design characteristics. Policy-makers and program planners should consider SQ-LNSs within intervention packages to prevent anemia and iron deficiency.This trial was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663.
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Affiliation(s)
| | - Charles D Arnold
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Christine P Stewart
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Elizabeth L Prado
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Souheila Abbeddou
- Public Health Nutrition, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Ulla Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Elodie Becquey
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Kenneth H Brown
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA,Helen Keller International, New York, NY, USA
| | | | - Rebecca K Campbell
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Parul Christian
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Yue-Mei Fan
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Sonja Y Hess
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Lieven Huybregts
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Josh M Jorgensen
- Nutrition Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Emma Kortekangas
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anna Lartey
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | | | - Jef L Leroy
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, USA
| | - Audrie Lin
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Susana L Matias
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Mduduzi N N Mbuya
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe,Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Abu M Naser
- International Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh,Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rina R Paul
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Harriet Okronipa
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Mahbubur Rahman
- International Center for Diarrheal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Kerry Schulze
- Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura E Smith
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Ann M Weber
- Division of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | | | - Kathryn G Dewey
- Institute for Global Nutrition and Department of Nutrition, University of California, Davis, Davis, CA, USA
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Smith DW, Sultana S, Crider YS, Islam SA, Swarthout JM, Goddard FGB, Rabbani A, Luby SP, Pickering AJ, Davis J. Effective Demand for In-Line Chlorination Bundled with Rental Housing in Dhaka, Bangladesh. Environ Sci Technol 2021; 55:12471-12482. [PMID: 34498866 DOI: 10.1021/acs.est.1c01308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Delivering safe water in cities of lower- and middle-income countries remains elusive even where there is a piped supply. Passive, in-line chlorination upstream of the point of water collection reduces child diarrhea without the behavior change required for point-of-use water treatment products or manual chlorine dispensers. We conducted a price experiment to measure effective demand (willingness and ability to pay) for an in-line chlorination service using tablet chlorinators among 196 landlords of rental housing properties in Dhaka, Bangladesh. We offered a 12-month subscription using Becker-DeGroot-Marschak auctions with real money payments. The service consistently delivered chlorinated water and satisfied tenants. Landlords' effective demand for in-line chlorination was similar to or greater than that for point-of-use treatment products and manual chlorine dispensers previously documented among Dhaka households. Over the service period, landlords renting to low-income households had lower effective demand than those renting to middle-income households despite similar initial rates of payment across both groups. Making in-line chlorination financially viable for the lowest-income consumers would likely require service cost reductions, subsidies, or both. Our findings suggest that even revealed preference experiments may overestimate the effective demand needed to sustain water supply improvements, especially in low-income populations, if they only measure demand once.
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Affiliation(s)
- Daniel W Smith
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Sonia Sultana
- Environmental Interventions Unit, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Yoshika S Crider
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Syed Anjerul Islam
- Environmental Interventions Unit, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Jenna M Swarthout
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Frederick G B Goddard
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Atonu Rabbani
- Department of Economics, University of Dhaka, Dhaka 1000, Bangladesh
- BRAC James P. Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka 1212, Bangladesh
| | - Stephen P Luby
- Stanford Woods Institute for the Environment, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
| | - Amy J Pickering
- Department of Civil & Environmental Engineering, Davis Hall, University of California, Berkeley, Berkeley, California 94720, United States
| | - Jennifer Davis
- Department of Civil & Environmental Engineering, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
- Stanford Woods Institute for the Environment, Stanford University, Y2E2 Building, 473 Via Ortega, Stanford, California 94305, United States
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32
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Contreras JD, Islam M, Mertens A, Pickering AJ, Kwong LH, Arnold BF, Benjamin-Chung J, Hubbard AE, Alam M, Sen D, Islam S, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Longitudinal Effects of a Sanitation Intervention on Environmental Fecal Contamination in a Cluster-Randomized Controlled Trial in Rural Bangladesh. Environ Sci Technol 2021; 55:8169-8179. [PMID: 34086447 PMCID: PMC8213058 DOI: 10.1021/acs.est.1c01114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 05/06/2023]
Abstract
Household latrine access generally is not associated with reduced fecal contamination in the environment, but its long-term effectiveness has not been measured. We conducted an environmental assessment nested within the WASH Benefits Bangladesh randomized controlled trial (NCT01590095). We quantified E. coli and fecal coliforms in samples of stored drinking water, child hands, mother hands, soil, and food among a random sample of households from the sanitation and control arms of the trial. Samples were collected during eight quarterly visits approximately 1-3.5 years after intervention initiation. Overall, there were no substantial differences in environmental fecal contamination between households enrolled in the sanitation and control arms. Statistically significant reductions were found in stored water and child hands after pooling across sampling rounds, but the effects were small and not consistent across rounds. In addition, we assessed potential effect modification of intervention effects by follow-up time, season, wealth, community-level latrine density and coverage, population density, and domestic animal ownership. While the intervention had statistically significant effects within some subgroups, there were no consistent patterns of effect modification. Our findings support a growing consensus that on-site latrines are insufficient to prevent fecal contamination in the rural household environment.
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Affiliation(s)
- Jesse D. Contreras
- Department
of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Mahfuza Islam
- Environmental
Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Andrew Mertens
- Division
of Epidemiology and Biostatistics, School
of Public Health, University of California, Berkeley, California 94720, United States
| | - Amy J. Pickering
- Department
of Civil and Environmental Engineering, University of California, Berkeley, California 94720, United States
| | - Laura H. Kwong
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
| | - Benjamin F. Arnold
- Francis I.
Proctor Foundation, University of California, San Francisco, California 94143, United States
| | - Jade Benjamin-Chung
- Division
of Epidemiology and Biostatistics, School
of Public Health, University of California, Berkeley, California 94720, United States
| | - Alan E. Hubbard
- Division
of Epidemiology and Biostatistics, School
of Public Health, University of California, Berkeley, California 94720, United States
| | - Mahfuja Alam
- Environmental
Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Debashis Sen
- Environmental
Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Sharmin Islam
- Environmental
Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Mahbubur Rahman
- Environmental
Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Leanne Unicomb
- Environmental
Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Stephen P. Luby
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
| | - John M. Colford
- Division
of Epidemiology and Biostatistics, School
of Public Health, University of California, Berkeley, California 94720, United States
| | - Ayse Ercumen
- Department
of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina 27695, United States
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Benjamin-Chung J, Crider YS, Mertens A, Ercumen A, Pickering AJ, Lin A, Steinbaum L, Swarthout J, Rahman M, Parvez SM, Haque R, Njenga SM, Kihara J, Null C, Luby SP, Colford JM, Arnold BF. Household finished flooring and soil-transmitted helminth and Giardia infections among children in rural Bangladesh and Kenya: a prospective cohort study. Lancet Glob Health 2021; 9:e301-e308. [PMID: 33607029 PMCID: PMC7900607 DOI: 10.1016/s2214-109x(20)30523-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Soil-transmitted helminths and Giardia duodenalis are responsible for a large burden of disease globally. In low-resource settings, household finished floors (eg, concrete floors) might reduce transmission of soil-transmitted helminths and G duodenalis. METHODS In a prospective cohort of children nested within two randomised trials in rural Bangladesh and Kenya, we estimated associations between household finished flooring and soil-transmitted helminths and G duodenalis prevalence. In 2015-16, we collected stool samples from children aged 2-16 years in rural Bangladesh and Kenya. We detected soil-transmitted helminth infection using quantitative PCR (qPCR; Bangladesh n=2800; Kenya n=3094), and G duodenalis using qPCR in Bangladesh (n=6894) and ELISA in Kenya (n=8899). We estimated adjusted prevalence ratios (aPRs) using log-linear models adjusted for potential confounders. FINDINGS 7187 (92·2%) of 7795 children in Bangladesh and 9077 (93·7%) of 9686 children in Kenya provided stool specimens that were analysed by qPCR. At enrolment, 691 (10%) households in Bangladesh and 471 (5%) households in Kenya had finished floors. In both countries, household finished flooring was associated with lower Ascaris lumbricoides prevalence (Bangladesh aPR 0·33, 95% CI 0·14-0·78; Kenya 0·62, 0·39-0·98) and any soil-transmitted helminths (Bangladesh 0·73, 0·52-1·01; Kenya 0·57, 0·37-0·88). Household finished floors were also associated with lower Necator americanus prevalence in Bangladesh (0·52, 0·29-0·94) and G duodenalis prevalence in both countries (Bangladesh 0·78, 0·64-0·95; Kenya 0·82, 0·70-0·97). INTERPRETATION In low-resource settings, living in households with finished floors over a 2-year period was associated with lower prevalence of G duodenalis and some soil-transmitted helminths in children. FUNDING Bill & Melinda Gates Foundation and Task Force for Global Health.
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Affiliation(s)
- Jade Benjamin-Chung
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
| | - Yoshika S Crider
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA; Energy & Resources Group, University of California, Berkeley, Berkeley, CA, USA
| | - Andrew Mertens
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
| | - Amy J Pickering
- Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Audrie Lin
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | | | - Jenna Swarthout
- Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sarker M Parvez
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jimmy Kihara
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Clair Null
- Center for International Policy Research and Evaluation, Mathematica Policy Research, Washington, DC, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - John M Colford
- Division of Epidemiology & Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, San Francisco, CA, USA; Department of Ophthalmology, University of California, San Francisco, CA, USA
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34
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Harvey AP, Fuhrmeister ER, Cantrell ME, Pitol AK, Swarthout JM, Powers JE, Nadimpalli ML, Julian TR, Pickering AJ. Longitudinal Monitoring of SARS-CoV-2 RNA on High-Touch Surfaces in a Community Setting. Environ Sci Technol Lett 2021; 8:168-175. [PMID: 34192125 PMCID: PMC7927285 DOI: 10.1021/acs.estlett.0c00875] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 05/19/2023]
Abstract
Environmental surveillance of surface contamination is an unexplored tool for understanding transmission of SARS-CoV-2 in community settings. We conducted longitudinal swab sampling of high-touch non-porous surfaces in a Massachusetts town during a COVID-19 outbreak from April to June 2020. Twenty-nine of 348 (8.3%) surface samples were positive for SARS-CoV-2 RNA, including crosswalk buttons, trash can handles, and door handles of essential business entrances (grocery store, liquor store, bank, and gas station). The estimated risk of infection from touching a contaminated surface was low (less than 5 in 10,000) by quantitative microbial risk assessment, suggesting fomites play a minimal role in SARS-CoV-2 community transmission. The weekly percentage of positive samples (out of n = 33 unique surfaces per week) best predicted variation in city-level COVID-19 cases with a 7-day lead time. Environmental surveillance of SARS-CoV-2 RNA on high-touch surfaces may be a useful tool to provide early warning of COVID-19 case trends.
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Affiliation(s)
- Abigail P. Harvey
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | | | - Molly E. Cantrell
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | - Ana K. Pitol
- Department of Civil and Environmental Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Jenna M. Swarthout
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | - Julie E. Powers
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | - Maya L. Nadimpalli
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | - Timothy R. Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dubendorf CH-8600, Switzerland
- Swiss Tropical and Public Health Institute, Basel CH-4051, Switzerland
- University of Basel, Basel CH-4055, Switzerland
| | - Amy J. Pickering
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
- Department of Civil and Environmental Engineering, University of California, Berkeley, 94720
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35
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Kwong LH, Ercumen A, Pickering AJ, Unicomb L, Davis J, Leckie JO, Luby SP. Soil ingestion among young children in rural Bangladesh. J Expo Sci Environ Epidemiol 2021; 31:82-93. [PMID: 31673039 PMCID: PMC7722350 DOI: 10.1038/s41370-019-0177-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 08/18/2019] [Accepted: 08/28/2019] [Indexed: 05/19/2023]
Abstract
Ingestion of soil and dust is a pathway of children's exposure to several environmental contaminants, including lead, pesticides, and fecal contamination. Empirically based estimates of central tendency for soil consumption by children in high-income countries range from 9 to 135 dry mg/day. Using a Monte Carlo simulation, we modeled the mass of soil directly and indirectly ingested per day by rural Bangladeshi children and identified the parameters that influence the mass ingested. We combined data from observations of direct and indirect ingestion among children with measurements of soil mass on the children's hands, mother's hands, and objects to quantify soil ingestion/day. Estimated geometric mean soil ingestion was 162 dry mg/day for children 3-5 months, 224 dry mg/day for children 6-11 months, 234 dry mg/day for children 12-23 months, 168 dry mg/day for children 24-35 months, and 178 dry mg/day for children 36-47 months old. Across all age groups, children placing their hands in their mouths accounted for 46-78% of total ingestion and mouthing objects contributed 8-12%. Direct ingestion of soil accounted for nearly 40% of soil ingested among children 6-23 months old. Sensitivity analyses identified that the parameters most affecting the estimates were the load of soil on the child's hand, the frequency of hand-to-mouth contacts while not eating, and, for children 6-23 months old, the frequency of direct soil ingestion. In a rural, low-income setting, children's soil consumption was substantially more than the estimates for children in high-income countries. Further characterizing soil ingestion of children in low-income contexts would improve assessments of the risks they face from soil-associated contaminants.
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Affiliation(s)
- Laura H Kwong
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA.
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jennifer Davis
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - James O Leckie
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Stephen P Luby
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
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36
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Fuhrmeister ER, Larson JR, Kleinschmit AJ, Kirby JE, Pickering AJ, Bascom-Slack CA. Combating Antimicrobial Resistance Through Student-Driven Research and Environmental Surveillance. Front Microbiol 2021; 12:577821. [PMID: 33679626 PMCID: PMC7931799 DOI: 10.3389/fmicb.2021.577821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/14/2021] [Indexed: 11/13/2022] Open
Abstract
Emerging resistance to all classes of antimicrobials is one of the defining crises of the 21st century. Many advances in modern medicine, such as routine surgeries, are predicated on sustaining patients with antimicrobials during a period when their immune systems alone cannot clear infection. The development of new antimicrobials has not kept pace with the antimicrobial resistance (AR) threat. AR bacteria have been documented in various environments, such as drinking and surface water, food, sewage, and soil, yet surveillance and sampling has largely been from infected patients. The prevalence and diversity of AR bacteria in the environment, and the risks they pose to humans are not well understood. There is consensus that environmental surveillance is an important first step in forecasting and targeting efforts to prevent spread and transmission of AR microbes. However, efforts to date have been limited. The Prevalence of Antibiotic Resistance in the Environment (PARE) is a classroom-based project that engages students around the globe in systematic environmental AR surveillance with the goal of identifying areas where prevalence is high. The format of PARE, designed as short classroom research modules, lowers common barriers for institutional participation in course-based research. PARE brings real-world microbiology into the classroom by educating students about the pressing public health issue of AR, while empowering them to be partners in the solution. In turn, the PARE project provides impactful data to inform our understanding of the spread of AR in the environment through global real-time surveillance.
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Affiliation(s)
- Erica R. Fuhrmeister
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, United States
| | - Jennifer R. Larson
- Department of Biological and Environmental Sciences, Capital University, Columbus, OH, United States
| | - Adam J. Kleinschmit
- Department of Natural and Applied Sciences, University of Dubuque, Dubuque, IA, United States
| | - James E. Kirby
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Amy J. Pickering
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, United States
| | - Carol A. Bascom-Slack
- Department of Medical Education, Tufts University School of Medicine, Boston, MA, United States
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37
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Nadimpalli ML, Bourke CD, Robertson RC, Delarocque-Astagneau E, Manges AR, Pickering AJ. Can breastfeeding protect against antimicrobial resistance? BMC Med 2020; 18:392. [PMID: 33317529 PMCID: PMC7737306 DOI: 10.1186/s12916-020-01862-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/19/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The proportion of infections among young children that are antimicrobial-resistant is increasing across the globe. Newborns may be colonized with enteric antimicrobial-resistant pathogens early in life, which is a risk factor for infection-related morbidity and mortality. Breastfeeding is actively promoted worldwide for its beneficial impacts on newborn health and gut health. However, the role of breastfeeding and human milk components in mitigating young children's carriage of antimicrobial-resistant pathogens and antibiotic resistance genes has not been comprehensively explored. MAIN BODY Here, we review how the act of breastfeeding, early breastfeeding, and/or human milk components, such as the milk microbiota, secretory IgA, human milk oligosaccharides, antimicrobial peptides, and microRNA -bearing extracellular vesicles, could play a role in preventing the establishment of antimicrobial-resistant pathogens in young children's developing gut microbiomes. We describe findings from recent human studies that support this concept. CONCLUSION Given the projected rise in global morbidity and mortality that will stem from antimicrobial-resistant infections, identifying behavioral or nutritional interventions that could decrease children's susceptibility to colonization with antimicrobial-resistant pathogens may be one strategy for protecting their health. We suggest that breastfeeding and human milk supplements deserve greater attention as potential preventive measures in the global effort to combat antimicrobial resistance, particularly in low- and middle-income settings.
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Affiliation(s)
- Maya L Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Science & Engineering Complex, Anderson Hall, Room 204, 200 College Avenue, Medford, MA, USA. .,Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR), Tufts University, Boston, MA, USA.
| | - Claire D Bourke
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK.,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Ruairi C Robertson
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Elisabeth Delarocque-Astagneau
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team Anti-infective Evasion and Pharmacoepidemiology, 78180 Montigny, France.,AP-HP, GHU Paris Saclay University, Raymond Poincaré Hospital, Epidemiology and Public Health Department, 92380 Garches, France
| | - Amee R Manges
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Science & Engineering Complex, Anderson Hall, Room 204, 200 College Avenue, Medford, MA, USA.,Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR), Tufts University, Boston, MA, USA
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38
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Fuhrmeister ER, Ercumen A, Grembi JA, Islam M, Pickering AJ, Nelson KL. Shared bacterial communities between soil, stored drinking water, and hands in rural Bangladeshi households. Water Res X 2020; 9:100056. [PMID: 32529181 PMCID: PMC7276488 DOI: 10.1016/j.wroa.2020.100056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 05/24/2023]
Abstract
Understanding household-level transmission pathways of fecal pathogens can provide insight for developing effective strategies to reduce diarrheal illness in low- and middle-income countries. We applied whole bacterial community analysis to investigate pathways of bacterial transmission in 50 rural Bangladeshi households. SourceTracker was used to quantify the shared microbial community in household reservoirs (stored drinking water, soil, and hands) and estimate the percentage of fecal-associated bacteria from child and mothers' feces in these reservoirs. Among the reservoirs studied, most bacterial transfer occurred between mothers' and children's hands and between mothers' hands and stored water. The relative percentage of human fecal-associated bacteria in all household reservoirs was low. We also quantified the number of identical amplicon sequence variants within and between individual households to assess bacterial community exchange in the domestic environment. Intra-household sharing of bacteria between mothers' and children's hands and between hands and soil was significantly greater than inter-household sharing.
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Affiliation(s)
- Erica R. Fuhrmeister
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, 94720, United States
| | - Ayse Ercumen
- School of Public Health, University of California, Berkeley, CA, 94720, United States
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27607, United States
| | - Jessica A. Grembi
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, 94305, United States
| | - Mahfuza Islam
- Environmental Intervention Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, 1212, Bangladesh
| | - Amy J. Pickering
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02153, United States
| | - Kara L. Nelson
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, 94720, United States
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39
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Kwong LH, Ercumen A, Pickering AJ, Arsenault JE, Islam M, Parvez SM, Unicomb L, Rahman M, Davis J, Luby SP. Ingestion of Fecal Bacteria along Multiple Pathways by Young Children in Rural Bangladesh Participating in a Cluster-Randomized Trial of Water, Sanitation, and Hygiene Interventions (WASH Benefits). Environ Sci Technol 2020; 54:13828-13838. [PMID: 33078615 PMCID: PMC7643345 DOI: 10.1021/acs.est.0c02606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Quantifying the contribution of individual exposure pathways to a child's total ingestion of fecal matter could help prioritize interventions to reduce environmental enteropathy and diarrhea. This study used data on fecal contamination of drinking water, food, soil, hands, and objects and second-by-second data on children's contacts with these environmental reservoirs in rural Bangladesh to assess the relative contribution of different pathways to children's ingestion of fecal indicator bacteria and if ingestion decreased with the water, sanitation, and hygiene interventions implemented in the WASH Benefits Trial. Our model estimated that rural Bangladeshi children <36 months old consume 3.6-4.9 log10 most probable number E. coli/day. Among children <6 months, placing objects in the mouth accounted for 60% of E. coli ingested. For children 6-35 months old, mouthing their own hands, direct soil ingestion, and ingestion of contaminated food were the primary pathways of E. coli ingestion. The amount of E. coli ingested by children and the predominant pathways of E. coli ingestion were unchanged by the water, sanitation, and hygiene interventions. These results highlight contaminated soil, children's hands, food, and objects as primary pathways of E. coli ingestion and emphasize the value of intervening along these pathways.
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Affiliation(s)
- Laura H. Kwong
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
| | - Ayse Ercumen
- Department
of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Amy J. Pickering
- Department
of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Joanne E. Arsenault
- Program
in International Community Nutrition, University
of California, Davis, California 95616, United States
| | - Mahfuza Islam
- International
Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh
| | - Sarker M Parvez
- International
Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh
| | - Leanne Unicomb
- International
Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh
| | - Mahbubur Rahman
- International
Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh
| | - Jennifer Davis
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
- Department
of Civil and Environmental Engineering, Stanford University, Stanford, California 94305, United States
| | - Stephen P. Luby
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
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40
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Poulin C, Peletz R, Ercumen A, Pickering AJ, Marshall K, Boehm AB, Khush R, Delaire C. What Environmental Factors Influence the Concentration of Fecal Indicator Bacteria in Groundwater? Insights from Explanatory Modeling in Uganda and Bangladesh. Environ Sci Technol 2020; 54:13566-13578. [PMID: 32975935 DOI: 10.1021/acs.est.0c02567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Information about microbial water quality is critical for managing water safety and protecting public health. In low-income countries, monitoring all drinking water supplies is impractical because financial resources and capacity are insufficient. Data sets derived from satellite imagery, census, and hydrological models provide an opportunity to examine relationships between a suite of environmental risk factors and microbial water quality over large geographical scales. We investigated the relationships between groundwater fecal contamination and different environmental parameters in Uganda and Bangladesh. In Uganda, groundwater contamination was associated with high population density (p < 0.001; OR = 1.27), high cropland coverage (p < 0.001; OR = 1.47), high average monthly precipitation (p < 0.001; OR = 1.14), and high surface runoff (p < 0.001; OR = 1.37), while low groundwater contamination was more likely in areas further from cities (p < 0.001; OR = 0.66) and with higher forest coverage (p < 0.001; OR = 0.70). In Bangladesh, contamination was associated with higher weekly precipitation (p < 0.001; OR = 1.44) and higher livestock density (p = 0.05; OR = 1.11), while low contamination was associated with low forest coverage (p < 0.001; OR = 1.23) and high cropland coverage (p < 0.001; OR = 0.80). We developed a groundwater contamination index for each country to help decision-makers identify areas where groundwater is most prone to fecal contamination and prioritize monitoring activities. Our approach demonstrates how to harness satellite-derived data to guide water safety management.
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Affiliation(s)
- Chloé Poulin
- The Aquaya Institute, PO Box 21862, Nairobi, Kenya
| | | | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Amy J Pickering
- Civil and Environmental Engineering, Tufts University, Medford, Massachusetts 02153, United States
| | | | - Alexandria B Boehm
- Department of Civil and Environmental Engineering, Stanford University, Stanford California 94305-4020, United States
| | - Ranjiv Khush
- The Aquaya Institute, PO Box 21862, Nairobi, Kenya
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Harvey AP, Fuhrmeister ER, Cantrell M, Pitol AK, Swarthout JM, Powers JE, Nadimpalli ML, Julian TR, Pickering AJ. Longitudinal monitoring of SARS-CoV-2 RNA on high-touch surfaces in a community setting. medRxiv 2020:2020.10.27.20220905. [PMID: 33140065 PMCID: PMC7605577 DOI: 10.1101/2020.10.27.20220905] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Environmental surveillance of surface contamination is an unexplored tool for understanding transmission of SARS-CoV-2 in community settings. We conducted longitudinal swab sampling of high-touch non-porous surfaces in a Massachusetts town during a COVID-19 outbreak from April to June 2020. Twenty-nine of 348 (8.3 %) surface samples were positive for SARS-CoV-2, including crosswalk buttons, trash can handles, and door handles of essential business entrances (grocery store, liquor store, bank, and gas station). The estimated risk of infection from touching a contaminated surface was low (less than 5 in 10,000), suggesting fomites play a minimal role in SARS-CoV-2 community transmission. The weekly percentage of positive samples (out of n=33 unique surfaces per week) best predicted variation in city-level COVID-19 cases using a 7-day lead time. Environmental surveillance of SARS-CoV-2 RNA on high-touch surfaces could be a useful tool to provide early warning of COVID-19 case trends.
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Affiliation(s)
- Abigail P. Harvey
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | | | - Molly Cantrell
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | - Ana K. Pitol
- Department of Civil and Environmental Engineering, Imperial College London, United Kingdom
| | - Jenna M. Swarthout
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | - Julie E. Powers
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | - Maya L. Nadimpalli
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
| | - Timothy R. Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dubendorf CH-8600, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Amy J. Pickering
- Civil and Environmental Engineering, Tufts University, Medford, MA, 02155
- Department of Civil and Environmental Engineering, University of California, Berkeley
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Goddard FB, Ban R, Barr DB, Brown J, Cannon J, Colford JM, Eisenberg JNS, Ercumen A, Petach H, Freeman MC, Levy K, Luby SP, Moe C, Pickering AJ, Sarnat JA, Stewart J, Thomas E, Taniuchi M, Clasen T. Measuring Environmental Exposure to Enteric Pathogens in Low-Income Settings: Review and Recommendations of an Interdisciplinary Working Group. Environ Sci Technol 2020; 54:11673-11691. [PMID: 32813503 PMCID: PMC7547864 DOI: 10.1021/acs.est.0c02421] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 05/06/2023]
Abstract
Infections with enteric pathogens impose a heavy disease burden, especially among young children in low-income countries. Recent findings from randomized controlled trials of water, sanitation, and hygiene interventions have raised questions about current methods for assessing environmental exposure to enteric pathogens. Approaches for estimating sources and doses of exposure suffer from a number of shortcomings, including reliance on imperfect indicators of fecal contamination instead of actual pathogens and estimating exposure indirectly from imprecise measurements of pathogens in the environment and human interaction therewith. These shortcomings limit the potential for effective surveillance of exposures, identification of important sources and modes of transmission, and evaluation of the effectiveness of interventions. In this review, we summarize current and emerging approaches used to characterize enteric pathogen hazards in different environmental media as well as human interaction with those media (external measures of exposure), and review methods that measure human infection with enteric pathogens as a proxy for past exposure (internal measures of exposure). We draw from lessons learned in other areas of environmental health to highlight how external and internal measures of exposure can be used to more comprehensively assess exposure. We conclude by recommending strategies for advancing enteric pathogen exposure assessments.
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Affiliation(s)
- Frederick
G. B. Goddard
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Radu Ban
- Bill and
Melinda Gates Foundation, Seattle, Washington 98109, United States
| | - Dana Boyd Barr
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Joe Brown
- School of
Civil and Environmental Engineering, Georgia
Institute of Technology, Atlanta, Georgia 30332, United States
| | - Jennifer Cannon
- Centers
for Disease Control and Prevention Foundation, Atlanta, Georgia 30308, United States
| | - John M. Colford
- Division
of Epidemiology and Biostatistics, School of Public Health, University of California−Berkeley, Berkeley, California 94720, United States
| | - Joseph N. S. Eisenberg
- Department
of Epidemiology, University of Michigan
School of Public Health, Ann Arbor, Michigan 48109, United States
| | - Ayse Ercumen
- Department
of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Helen Petach
- U.S. Agency
for International Development, Washington, DC 20004, United States
| | - Matthew C. Freeman
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Karen Levy
- Department
of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington 98105, United States
| | - Stephen P. Luby
- Division
of Infectious Diseases and Geographic Medicine, Stanford University, California 94305, United States
| | - Christine Moe
- Center
for
Global Safe Water, Sanitation and Hygiene, Rollins School of Public
Health, Emory University, Atlanta, Georgia 30322, United States
| | - Amy J. Pickering
- Department
of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Jeremy A. Sarnat
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Jill Stewart
- Department
of Environmental Sciences and Engineering, Gillings School of Global
Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, United States
| | - Evan Thomas
- Mortenson
Center in Global Engineering, University
of Colorado Boulder, Boulder, Colorado 80303, United States
| | - Mami Taniuchi
- Division
of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia 22903, United States
| | - Thomas Clasen
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
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Affiliation(s)
- Maya L Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA; Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, MA, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02155, USA; Center for Integrated Management of Antimicrobial Resistance, Tufts University, Boston, MA, USA.
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Goddard FGB, Pickering AJ, Ercumen A, Brown J, Chang HH, Clasen T. Faecal contamination of the environment and child health: a systematic review and individual participant data meta-analysis. Lancet Planet Health 2020; 4:e405-e415. [PMID: 32918886 PMCID: PMC7653404 DOI: 10.1016/s2542-5196(20)30195-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Exposure to faecal contamination is believed to be associated with child diarrhoea and possibly stunting; however, few studies have explicitly measured the association between faecal contamination and health. We aimed to assess individual participant data (IPD) across multiple trials and observational studies to quantify the relationship for common faecal-oral transmission pathways. METHODS We did a systematic review and meta-analysis of IPD from studies identified in an electronic search of PubMed, Web of Science, and Embase on May 21, 2018. The search was done in English, but full texts published in French, Portuguese, and Spanish were also reviewed. Eligible studies quantified (1) household-level faecal indicator bacteria concentrations along common faecal-oral transmission pathways of drinking water, soil, or food, on children's hands or fomites, or fly densities in food preparation areas; and (2) individual-level diarrhoea or linear growth measures for children younger than 5 years in low-income and middle-income countries. For the diarrhoea analysis, all definitions of diarrhoea were eligible but studies were excluded if they used a recall period longer than 7 days. For the linear growth analysis (using height-for-age Z scores [HAZ]), cross-sectional studies were excluded, because of the absence of longitudinal environmental contamination data measured before the growth outcomes. We used multilevel generalised mixed-effects models to estimate the odds ratio (OR) for diarrhoea and the difference in HAZ scores for individual studies associated with a 1-log10 higher measure of faecal contamination. Estimates from each study were combined under a random-effects meta-analysis framework. The study protocol was pre-registered with PROSPERO (CRD42018102114). FINDINGS From 72 eligible studies, we included IPD for 20 studies in the meta-analyses, totalling 54 225 diarrhoea or linear growth observations matched to faecal indicator bacteria concentrations in drinking water, and a further 35 010 observations with faecal contamination data for the other transmission pathways. Child diarrhoea was associated with 1-log10 higher faecal indicator bacteria concentrations in drinking water (OR 1·09, 95% CI 1·04 to 1·13; p=0·0002, I2=34%, 95% CI 0 to 62) and on children's hands (1·11, 1·02 to 1·22; p=0·021, I2=0%, 0 to 71). Lower HAZ scores were associated with 1-log10 higher median faecal indicator bacteria concentrations in drinking water (HAZ -0·04, 95% CI -0·06 to -0·01; p=0·0054; I2=19%, 95% CI 0 to 63) and on fomites (-0·06, -0·12 to 0·00; p=0·044, I2=57%, 0 to 90). INTERPRETATION Although summary measures from individual studies often report little or no effect of measured faecal contamination on child health, this multi-study IPD analysis indicates that household faecal indicator bacteria concentrations are associated with important adverse health outcomes in young children. Improved direct measures of exposure and enteric pathogens could help to better characterise the relationship and inform intervention design in future studies. FUNDING None.
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Affiliation(s)
- Frederick G B Goddard
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Pickering AJ, Davis J. Correction to Freshwater Availability and Water Fetching Distance Affect Child Health in Sub-Saharan Africa. Environ Sci Technol 2020; 54:9143. [PMID: 32633493 DOI: 10.1021/acs.est.0c03980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Islam M, Rahman M, Unicomb L, Kafi MAH, Rahman M, Alam M, Sen D, Islam S, Pickering AJ, Hubbard AE, Luby SP, Arnold BF, Colford JM, Ercumen A. Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea. PLoS One 2020; 15:e0236163. [PMID: 32687513 PMCID: PMC7371197 DOI: 10.1371/journal.pone.0236163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
Child open defecation is common in low-income countries and can lead to fecal exposure in the domestic environment. We assessed associations between child feces management practices vs. measures of contamination and child diarrhea among households with children <5 years in rural Bangladesh. We visited 360 households quarterly and recorded caregiver-reported diarrhea prevalence, and defecation and feces disposal practices for children <5 years. We examined caregiver and child hands for visible dirt and enumerated E. coli in child and caregiver hand rinse and stored drinking water samples. Safe child defecation (in latrine/potty) and safe feces disposal (in latrine) was reported by 21% and 23% of households, respectively. Controlling for potential confounders, households reporting unsafe child defecation had higher E. coli prevalence on child hands (prevalence ratio [PR] = 1.12, 1.04-1.20) and in stored water (PR = 1.12,1.03-1.21). Similarly, households reporting unsafe feces disposal had higher E. coli prevalence on child hands (PR = 1.11, 1.02-1.21) and in stored water (PR = 1.10, 1.03-1.18). Effects on E. coli levels were similar. Children in households with unsafe defecation and feces disposal had higher diarrhea prevalence but the associations were not statistically significant. Our findings suggest that unsafe child feces management may present a source of fecal exposure for young children.
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Affiliation(s)
- Mahfuza Islam
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Leanne Unicomb
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | | | - Mostafizur Rahman
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Mahfuja Alam
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Debashis Sen
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Sharmin Islam
- Environmental Intervention Unit, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Amy J. Pickering
- Civil and Environmental Engineering, Tufts University, Medford, MA, United States of America
| | - Alan E. Hubbard
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, United States of America
| | - Stephen P. Luby
- Woods Institute for the Environment, Stanford University, Stanford, CA, United States of America
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, United States of America
| | - John M. Colford
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, United States of America
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, United States of America
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47
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Bivins A, North D, Ahmad A, Ahmed W, Alm E, Been F, Bhattacharya P, Bijlsma L, Boehm AB, Brown J, Buttiglieri G, Calabro V, Carducci A, Castiglioni S, Cetecioglu Gurol Z, Chakraborty S, Costa F, Curcio S, de los Reyes FL, Delgado Vela J, Farkas K, Fernandez-Casi X, Gerba C, Gerrity D, Girones R, Gonzalez R, Haramoto E, Harris A, Holden PA, Islam MT, Jones DL, Kasprzyk-Hordern B, Kitajima M, Kotlarz N, Kumar M, Kuroda K, La Rosa G, Malpei F, Mautus M, McLellan SL, Medema G, Meschke JS, Mueller J, Newton RJ, Nilsson D, Noble RT, van Nuijs A, Peccia J, Perkins TA, Pickering AJ, Rose J, Sanchez G, Smith A, Stadler L, Stauber C, Thomas K, van der Voorn T, Wigginton K, Zhu K, Bibby K. Wastewater-Based Epidemiology: Global Collaborative to Maximize Contributions in the Fight Against COVID-19. Environ Sci Technol 2020; 54:7754-7757. [PMID: 32530639 PMCID: PMC7299382 DOI: 10.1021/acs.est.0c02388] [Citation(s) in RCA: 263] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 05/10/2023]
Affiliation(s)
- Aaron Bivins
- Department of Civil and Environmental
Engineering and Earth Sciences, University of Notre
Dame, 156 Fitzpatrick Hall, Notre Dame, Indiana
46556, United States
| | - Devin North
- Department of Civil and Environmental
Engineering and Earth Sciences, University of Notre
Dame, 156 Fitzpatrick Hall, Notre Dame, Indiana
46556, United States
| | - Arslan Ahmad
- Department of Sustainable Development,
Environmental Science and Engineering, KTH Royal
Institute of Technology, Teknikringen 10B,
SE-10044 Stockholm, Sweden
- KWR Water Research
Institute, Groningenhaven 7 3433 PE Nieuwegein,
The Netherlands
| | - Warish Ahmed
- CSIRO Land and Water,
Ecosciences Precinct, 41 Boggo Road, Dutton Park,
Queensland 4102, Australia
| | - Eric Alm
- Department of Biological Engineering,
Massachusetts Institute of
Technology, 21 Ames St, Cambridge, Massachusetts 02142,
United States
| | - Frederic Been
- KWR Water Research Institute,
Water Quality and Heath, Groningenhaven 7 3433 PE
Nieuwegein, The Netherlands
| | - Prosun Bhattacharya
- Department of Sustainable Development,
Environmental Science and Engineering, KTH Royal
Institute of Technology, Teknikringen 10B,
SE-10044 Stockholm, Sweden
- KWR Water Research
Institute, Groningenhaven 7 3433 PE Nieuwegein,
The Netherlands
| | - Lubertus Bijlsma
- Analytical Chemistry in Public Health
and the Environment, University Jaume I,
Av. Vicent Sos Baynat, s/n 12071 Castellón de la Plana,
Spain
| | - Alexandria B. Boehm
- Department of Civil and Environmental
Engineering, Stanford University, 473 Via
Ortega, Stanford, California 94305, United
States
| | - Joe Brown
- School of Civil and Environmental
Engineering, Georgia Institute of
Technology, 311 Ferst Drive, Atlanta, Georgia
30332, United States
| | - Gianluigi Buttiglieri
- Catalan Institute for
Water Research (ICRA), Emili Grahit 101, E-17003
Girona, Spain
| | - Vincenza Calabro
- Laboratory of Transport Phenomena &
Biotechnology, Department of Computer Engineering, Modeling,
Electronics and Systems, University of
Calabria, Via P. Bucci, Cubo 42/a 87036 Rende,
Cosenza, Italy
| | - Annalaura Carducci
- Department of Biology,
University of Pisa, Via Volta 4 bis,
13 56126 Pisa, Italy
| | - Sara Castiglioni
- Department of Environmental Health
Sciences, Instituto di Richerche Farmacologiche Mario
Negri IRCCS, Via Mario Negri, 2, 20156 Milan,
Italy
| | - Zeynep Cetecioglu Gurol
- Department of Chemical Engineering,
KTH Royal Institute of Technology,
Teknikringen 42, SE-11428 Stockholm, Sweden
| | - Sudip Chakraborty
- Laboratory of Transport Phenomena &
Biotechnology, Department of Computer Engineering, Modeling,
Electronics and Systems, University of
Calabria, Via P. Bucci, Cubo 42/a 87036 Rende,
Cosenza, Italy
| | - Federico Costa
- Instituto de Saúde Coletiva,
Universidade Federal da Bahia,
Salvador, Bahia, Brazil. 40110-040
| | - Stefano Curcio
- Laboratory of Transport Phenomena &
Biotechnology, Department of Computer Engineering, Modeling,
Electronics and Systems, University of
Calabria, Via P. Bucci, Cubo 42/a 87036 Rende,
Cosenza, Italy
| | - Francis L. de los Reyes
- Department of Civil, Construction,
and Environmental Engineering, North Carolina State
University, 2501 Stinson Dr, Raleigh, North
Carolina 27607, United States
| | - Jeseth Delgado Vela
- Department of Civil and Environmental
Engineering, Howard University, 2300 Sixth
Street, NW #1026, Washington, D.C. 20059, United
States
| | - Kata Farkas
- School of Ocean Sciences,
Bangor University, Menai Bridge,
Anglesey, LL59 5AB, U.K.
| | - Xavier Fernandez-Casi
- Laboratory of Environmental
Chemistry, School of Architecture, Civil and Environmental Engineering
(ENAC), École Polytechnique Fédérale
de Lausanne (EPFL), CH-1015, Lausanne,
Switzerland
| | - Charles Gerba
- Department of Environmental Science,
University of Arizona, 2959 W Calle
Agua Nueva, Tucson, Arizona 85745, United
States
| | - Daniel Gerrity
- Applied Research and Development
Center, Southern Nevada Water Authority,
100 S City Pkwy Suite 700, Las Vegas, Nevada 89106, United
States
| | - Rosina Girones
- Department of Genetics, Microbiology
and Statistics, University of Barcelona,
Diagonal, 643 08028 Barcelona, Spain
| | - Raul Gonzalez
- Hampton Roads Sanitation
District, 1434 Air Rail Ave, Virginia Beach,
Virginia 23455, United States
| | - Eiji Haramoto
- Interdisciplinary Center for River
Basin Environment, University of Yamanashi,
4-3-11 Takeda, Kofu, Yamanashi 400-8511,
Japan
| | - Angela Harris
- Department of Civil, Construction,
and Environmental Engineering, North Carolina State
University, 2501 Stinson Dr, Raleigh, North
Carolina 27607, United States
| | - Patricia A. Holden
- Bren School of Environmental Science
& Management, University of California,
3508 Bren Hall, Santa Barbara, California 93106, United
States
| | - Md. Tahmidul Islam
- Department of Sustainable Development,
Environmental Science and Engineering, KTH Royal
Institute of Technology, Teknikringen 10B,
SE-10044 Stockholm, Sweden
| | - Davey L. Jones
- School of Natural Sciences,
Bangor University, Gwynedd, Wales
LL57 2UW, United Kingdom
| | | | - Masaaki Kitajima
- Division of Environmental
Engineering, Hokkaido University, North 13
West 8, Kita-ku, Sapporo, Hokkaido 060-8628,
Japan
| | - Nadine Kotlarz
- Department of Biological Sciences,
North Carolina State University,
Raleigh, North Carolina 27695, United States
| | - Manish Kumar
- Discipline of Earth Science,
Indian Institute of Technology,
Gandhinagar, Gujarat 382 355, India
| | - Keisuke Kuroda
- Department of Environmental &
Civil Engineering, Toyama Prefectural
University, 5180 Kurokawa, Imizu-city, Toyama
9390398 Japan
| | - Giuseppina La Rosa
- Department of Environment and Health,
Italian National Institute of Health,
Viale Regina Elena, 299, 00161, Roma RM,
Italy
| | - Francesca Malpei
- Dipartimento di Ingegneria Civile e
Ambientale, Politecnico di Milano, Piazza
Leonardo da Vinci, 32, 20133 Milano MI, Italy
| | - Mariana Mautus
- Biobot Analytics,
LLC, Somerville, Massachusetts 02143,
United States
| | - Sandra L. McLellan
- School of Freshwater Sciences,
University of Wisconsin-Milwaukee,
600 E Greenfield Ave, Milwaukee, Wisconsin 53204, United
States
| | - Gertjan Medema
- KWR Water Research Institute,
Water Quality and Heath, Groningenhaven 7 3433 PE
Nieuwegein, The Netherlands
- Delft University of
Technology, Stevinweg 1, 2628 CN Delft,
The Netherlands
- Michigan State
University, Natural Resources, 1405 S Harrison Rd,
East Lansing, Michigan 48823, United States
| | - John Scott Meschke
- Dept. Environmental and Occupational
Health Sciences, School of Public Health, University of
Washington, Seattle Washington 98105-6099,
United States
| | - Jochen Mueller
- Queensland Alliance for Environmental
Health Sciences (QAEHS), University of
Queensland, 20 Cornwall Street, Brisbane,
Queensland 4102 Australia
| | - Ryan J. Newton
- School of Freshwater Sciences,
University of Wisconsin-Milwaukee,
600 E Greenfield Ave, Milwaukee, Wisconsin 53204, United
States
| | - David Nilsson
- Department of Sustainable Development,
Environmental Science and Engineering, KTH Royal
Institute of Technology, Teknikringen 10B,
SE-10044 Stockholm, Sweden
| | - Rachel T. Noble
- UNC Chapel Hill
Institute of Marine Sciences, Morehead City, North
Carolina 28557, United States
| | - Alexander van Nuijs
- Toxicological Centre,
University of Antwerp,
Universiteitsplein 1, 2610 Wilrijk,
België
| | - Jordan Peccia
- Department of Chemical and
Environmental Engineering, Yale University,
17 Hillhouse Avenue, New Haven, Connecticut 06520-8292,
United States
| | - T. Alex Perkins
- Department of Biological Sciences and
Eck Institute for Global Health, University of Notre
Dame, Notre Dame, Indiana 46556, United
States
| | - Amy J. Pickering
- Civil and Environmental Engineering,
Tufts University, Medford,
Massachusetts 02155, United States
| | - Joan Rose
- Department of Fisheries and Wildlife,
Michigan State University, East
Lansing, Michigan 48824, United States
| | - Gloria Sanchez
- Institute of
Agrochemistry and Food Technology (IATA-CSIC),
Catedratico Agustin Escardino Benlloch, 7 46980 Paterna −
Valencia, Spain
| | - Adam Smith
- Astani Department of Civil and
Environmental Engineering, University of Southern
California, 3620 S Vermont Ave, Los Angeles,
California 90089, United States
| | - Lauren Stadler
- Department of Civil and Environmental
Engineering, Rice University, 6100 Main St,
Houston, Texas 77005, United States
| | - Christine Stauber
- School of Public Health,
Georgia State University, 100
Piedmont Avenue, NE Atlanta, Georgia 30302, United
States
| | - Kevin Thomas
- Queensland Alliance for Environmental
Health Sciences (QAEHS), University of
Queensland, 20 Cornwall Street, Brisbane,
Queensland 4102 Australia
| | - Tom van der Voorn
- Institute of Environmental Systems
Research, University of Osnabrück,
Barbarastr. 12, D49069, Osnabrück,
Germany
| | - Krista Wigginton
- Department of Civil and Environmental
Engineering, University of Michigan, 1351
Beal Avenue, EWRE 181 Ann Arbor, Michigan 48109-2125, United
States
| | - Kevin Zhu
- School of Civil and Environmental
Engineering, Georgia Institute of
Technology, 311 Ferst Drive, Atlanta, Georgia
30332, United States
| | - Kyle Bibby
- Department of Civil and Environmental
Engineering and Earth Sciences, University of Notre
Dame, 156 Fitzpatrick Hall, Notre Dame, Indiana
46556, United States
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48
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Kwong LH, Ercumen A, Pickering AJ, Unicomb L, Davis J, Luby SP. Correction to: Age-related changes to environmental exposure: variation in the frequency that young children place hands and objects in their mouths. J Expo Sci Environ Epidemiol 2020; 30:769-772. [PMID: 31455796 DOI: 10.1038/s41370-019-0160-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Laura H Kwong
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA.
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jennifer Davis
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
| | - Stephen P Luby
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
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Pickering AJ, Crider Y, Sultana S, Swarthout J, Goddard FG, Anjerul Islam S, Sen S, Ayyagari R, Luby SP. Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial. Lancet Glob Health 2020; 7:e1247-e1256. [PMID: 31402005 DOI: 10.1016/s2214-109x(19)30315-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/22/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Previous blinded trials of household water treatment interventions in low-income settings have failed to detect a reduction in child diarrhoea. Technological advances have enabled the development of automated in-line chlorine dosers that can disinfect drinking water without electricity, while also allowing users to continue their typical water collection practices. We aimed to evaluate the effect of installing novel passive chlorination devices at shared water points on child diarrhoea prevalence in low-income, densely populated communities in urban Bangladesh. METHODS In this double-blind cluster-randomised controlled trial, 100 shared water points (clusters) in two low-income urban communities in Bangladesh were randomly assigned (1:1) to have their drinking water automatically chlorinated at the point of collection by a solid tablet chlorine doser (intervention group) or to be treated by a visually identical doser that supplied vitamin C (active control group). The trial followed an open cohort design; all children younger than 5 years residing in households accessing enrolled water points were measured every 2-3 months during a 14-month follow-up period (children could migrate into or out of the cluster). The primary outcome was caregiver-reported child diarrhoea (≥3 loose or watery stools in a 24-h period [WHO criteria]) with a 1-week recall, including all available childhood observations in the analyses. This trial is registered with ClinicalTrials.gov, number NCT02606981, and is completed. FINDINGS Between July 5, 2015, and Nov 11, 2015, 100 water points with 920 eligible households were enrolled into the study and randomly assigned to the treatment (50 water points; 517 children at baseline; 2073 child observations included in the primary analysis) or control groups (50; 519; 2154). Children in the treatment group had less WHO-defined diarrhoea than did children in the control group (control 216 [10·0%] of 2154; treatment 156 [7·5%] of 2073; prevalence ratio 0·77, 95% CI 0·65-0·91). Drinking water at the point of collection at treatment taps had detectable free chlorine residual 83% (mean 0·37 ppm) of the time compared with 0% at control taps (0·00 ppm). INTERPRETATION Passive chlorination at the point of collection could be an effective and scalable strategy in low-income urban settings for reducing child diarrhoea and for achieving global progress towards Sustainable Development Goal 6.1 to attain universal access to safe and affordable drinking water. Targeting a low chlorine residual (<0·5 ppm) in treated water can increase taste acceptability of chlorinated drinking water while still reducing the risk of diarrhoea. FUNDING The World Bank.
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Affiliation(s)
- Amy J Pickering
- Civil and Environmental Engineering, Tufts University, Medford, MA, USA; Civil and Environmental Engineering, Stanford University, Stanford, CA, USA.
| | - Yoshika Crider
- Civil and Environmental Engineering, Stanford University, Stanford, CA, USA; Energy and Resources Group, University of California Berkeley, Berkeley, CA, USA
| | - Sonia Sultana
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jenna Swarthout
- Civil and Environmental Engineering, Tufts University, Medford, MA, USA; Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Frederick Gb Goddard
- Civil and Environmental Engineering, Stanford University, Stanford, CA, USA; Emory University, Atlanta, GA, USA
| | - Syed Anjerul Islam
- Civil and Environmental Engineering, Tufts University, Medford, MA, USA; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shreyan Sen
- Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Raga Ayyagari
- Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Stephen P Luby
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
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50
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Nadimpalli ML, Marks SJ, Montealegre MC, Gilman RH, Pajuelo MJ, Saito M, Tsukayama P, Njenga SM, Kiiru J, Swarthout J, Islam MA, Julian TR, Pickering AJ. Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. Nat Microbiol 2020; 5:787-795. [PMID: 32467623 DOI: 10.1038/s41564-020-0722-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/07/2020] [Indexed: 12/24/2022]
Abstract
Antimicrobial resistance (AMR) is a growing public health challenge that is expected to disproportionately burden lower- and middle-income countries (LMICs) in the coming decades. Although the contributions of human and veterinary antibiotic misuse to this crisis are well-recognized, environmental transmission (via water, soil or food contaminated with human and animal faeces) has been given less attention as a global driver of AMR, especially in urban informal settlements in LMICs-commonly known as 'shanty towns' or 'slums'. These settlements may be unique hotspots for environmental AMR transmission given: (1) the high density of humans, livestock and vermin living in close proximity; (2) frequent antibiotic misuse; and (3) insufficient drinking water, drainage and sanitation infrastructure. Here, we highlight the need for strategies to disrupt environmental AMR transmission in urban informal settlements. We propose that water and waste infrastructure improvements tailored to these settings should be evaluated for their effectiveness in limiting environmental AMR dissemination, lowering the community-level burden of antimicrobial-resistant infections and preventing antibiotic misuse. We also suggest that additional research is directed towards developing economic and legal incentives for evaluating and implementing water and waste infrastructure in these settings. Given that almost 90% of urban population growth will occur in regions predicted to be most burdened by the AMR crisis, there is an urgent need to build effective, evidence-based policies that could influence massive investments in the built urban environment in LMICs over the next few decades.
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Affiliation(s)
- Maya L Nadimpalli
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.,Center for Integrated Management of Antimicrobial Resistance (CIMAR), Tufts University, Boston, MA, USA
| | - Sara J Marks
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | | | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.,Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Monica J Pajuelo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.,Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Pablo Tsukayama
- Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Instituto de Medicina Tropical 'Alexander von Humboldt', Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Jenna Swarthout
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.,International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Timothy R Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA. .,Center for Integrated Management of Antimicrobial Resistance (CIMAR), Tufts University, Boston, MA, USA.
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