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Gutema FD, Cumming O, Mumma J, Simiyu S, Attitwa E, Okoth B, Denge J, Sewell D, Baker KK. Enterococcus contamination of infant foods and implications for exposure to foodborne pathogens in peri-urban neighbourhoods of Kisumu, Kenya. Epidemiol Infect 2024; 152:e23. [PMID: 38264955 PMCID: PMC10894905 DOI: 10.1017/s0950268824000062] [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] [Indexed: 01/25/2024] Open
Abstract
We collected infant food samples from 714 households in Kisumu, Kenya, and estimated the prevalence and concentration of Enterococcus, an indicator of food hygiene conditions. In a subset of 212 households, we quantified the change in concentration in stored food between a morning and afternoon feeding time. In addition, household socioeconomic characteristics and hygiene practices of the caregivers were documented. The prevalence of Enterococcus in infant foods was 50% (95% confidence interval: 46.1 - 53.4), and the mean log10 colony-forming units (CFUs) was 1.1 (SD + 1.4). No risk factors were significantly associated with the prevalence and concentration of Enterococcus in infant foods. The mean log10 CFU of Enterococcus concentration was 0.47 in the morning and 0.73 in the afternoon foods with a 0.64 log10 mean increase in matched samples during storage. Although no factors were statistically associated with the prevalence and the concentration of Enterococcus in infant foods, household flooring type was significantly associated with an increase in concentration during storage, with finished floors leading to 1.5 times higher odds of concentration increase compared to unfinished floors. Our study revealed high prevalence but low concentration of Enterococcus in infant food in low-income Kisumu households, although concentrations increased during storage implying potential increases in risk of exposure to foodborne pathogens over a day. Further studies aiming at investigating contamination of infant foods with pathogenic organisms and identifying effective mitigation measures are required to ensure infant food safety.
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Affiliation(s)
- Fanta D Gutema
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA
- Department of Microbiology, Immunology and Veterinary Public health, Addis Ababa University, Bishoftu, Ethiopia
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Mumma
- Center of Research, Great Lakes University of Kisumu, Kisumu, Kenya
| | - Sheillah Simiyu
- Center of Research, Great Lakes University of Kisumu, Kisumu, Kenya
- African Population and Health Research Center, Nairobi, Kenya
| | - Edwin Attitwa
- Center of Research, Great Lakes University of Kisumu, Kisumu, Kenya
| | - Bonphace Okoth
- Center of Research, Great Lakes University of Kisumu, Kisumu, Kenya
| | - John Denge
- Center of Research, Great Lakes University of Kisumu, Kisumu, Kenya
| | - Daniel Sewell
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Kelly K Baker
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA
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Baker KK, Simiyu S, Busienei P, Gutema FD, Okoth B, Agira J, Amondi CS, Ziraba A, Kapanka AG, Osinuga A, Ouma C, Sewell DK, Gaire S, Tumwebaze IK, Mberu B. Protocol for the PATHOME study: a cohort study on urban societal development and the ecology of enteric disease transmission among infants, domestic animals and the environment. BMJ Open 2023; 13:e076067. [PMID: 38000826 PMCID: PMC10680014 DOI: 10.1136/bmjopen-2023-076067] [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: 05/26/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Global morbidity from enteric infections and diarrhoea remains high in children in low-income and middle-income countries, despite significant investment over recent decades in health systems and water and sanitation infrastructure. Other types of societal development may be required to reduce disease burden. Ecological research on the influence of household and neighbourhood societal development on pathogen transmission dynamics between humans, animals and the environment could identify more effective strategies for preventing enteric infections. METHODS AND ANALYSIS The 'enteric pathome'-that is, the communities of viral, bacterial and parasitic pathogens transmitted from human and animal faeces through the environment is taxonomically complex in high burden settings. This integrated cohort-exposure assessment study leverages natural socioeconomic spectrums of development to study how pathome complexity is influenced by household and neighbourhood infrastructure and hygiene conditions. We are enrolling under 12-month-old children in low-income and middle-income neighbourhoods of two Kenyan cities (Nairobi and Kisumu) into a 'short-cohort' study involving repeat testing of child faeces for enteric pathogens. A mid-study exposure assessment documenting infrastructural, behavioural, spatial, climate, environmental and zoonotic factors characterises pathogen exposure pathways in household and neighbourhood settings. These data will be used to inform and validate statistical and agent-based models (ABM) that identify individual or combined intervention strategies for reducing multipathogen transmission between humans, animals and environment in urban Kenya. ETHICS AND DISSEMINATION The protocols for human subjects' research were approved by Institutional Review Boards at the University of Iowa (ID-202004606) and AMREF Health Africa (ID-ESRC P887/2020), and a national permit was obtained from the Kenya National Commission for Science Technology and Innovation (ID# P/21/8441). The study was registered on Clinicaltrials.gov (Identifier: NCT05322655) and is in pre-results stage. Protocols for research on animals were approved by the University of Iowa Animal Care and Use Committee (ID 0042302).
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Affiliation(s)
- Kelly K Baker
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Sheillah Simiyu
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Phylis Busienei
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Fanta D Gutema
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Bonphace Okoth
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - John Agira
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Christine S Amondi
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Abdhalah Ziraba
- Division of Health and Wellbeing, African Population and Health Research Center, Nairobi, Kenya
| | - Alexis G Kapanka
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Abisola Osinuga
- Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Daniel K Sewell
- Department of Biostatistics, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Sabin Gaire
- Department of Biostatistics, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Innocent K Tumwebaze
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
| | - Blessing Mberu
- Division of Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya
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Tsai K, Nonnenmann MW, Rohlman D, Baker KK. Development of Shortened Enrichment Methods for Detection of Salmonella Typhimurium Spiked in Milk. ACS Food Sci Technol 2023; 3:831-837. [PMID: 37228389 PMCID: PMC10204049 DOI: 10.1021/acsfoodscitech.2c00310] [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: 10/01/2022] [Revised: 03/25/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023]
Abstract
Rapid and accurate testing of pathogenic Salmonella enterica in dairy products could reduce the risk of exposure to the bacterial pathogens for consumers. This study aimed to reduce the assessment time needed for enteric bacteria recovery and quantification in food using the natural growth properties of Salmonella enterica Typhimurium (S. Typhimurium) in cow's milk and efficiently using rapid PCR methods. Over 5 h of 37 °C enrichment, culture and PCR methods measured increases in the non-heat-treated S. Typhimurium concentration at similar rates, with an average increase of 2.7 log10 CFU/mL between the start of enrichment and 5 h. In contrast, no bacteria were recovered by culture after S. Typhimurium in milk received heat treatment, and the number of gene copies of heat-treated Salmonella detected by PCR did not increase with the enrichment time. Thus, comparing culture and PCR data over just 5 h of enrichment time can detect and differentiate between replicating bacteria and dead bacteria.
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Affiliation(s)
- Kevin Tsai
- Department
of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa 52246, United States
| | - Matthew W Nonnenmann
- Department
of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, Nebraska 69198, United States
| | - Diane Rohlman
- Department
of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa 52246, United States
| | - Kelly K. Baker
- Department
of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa 52246, United States
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Simiyu S, Aseyo E, Anderson J, Cumming O, Baker KK, Dreibelbis R, Mumma JAO. A Mixed Methods Process Evaluation of a Food Hygiene Intervention in Low-Income Informal Neighbourhoods of Kisumu, Kenya. Matern Child Health J 2022; 27:824-836. [PMID: 36352283 PMCID: PMC10115704 DOI: 10.1007/s10995-022-03548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Diarrhoea is a leading cause of infant mortality with the main transmission pathways being unsafe water and contaminated food, surfaces and hands. The 'Safe Start' trial evaluated a food hygiene intervention implemented in a peri-urban settlement of Kisumu, Kenya, with the aim of reducing diarrhoeagenic enteric infections among infants. Four food hygiene behaviours were targeted: handwashing with soap before preparation and feeding, boiling infant food before feeding, storing infant food in sealed containers, and exclusive use of designated utensils during feeding. METHODS A process evaluation of the intervention was guided by a theory of change describing the hypothesised implementation and receipt of the intervention, mechanisms of change, and the context. These were assessed by qualitative and quantitative data that included debriefing sessions with the delivery teams and Community Health Volunteers (CHVs), and structured observations during food preparation. RESULTS The intervention achieved high coverage and fidelity with over 90% of 814 eligible caregivers participating in the intervention. Caregivers in the intervention arm demonstrated an understanding of the intervention messages, and had 1.38 (95% CI: 1.02-1.87) times the odds of washing hands before food preparation and 3.5 (95% CI: 1.91-6.56) times the odds of using a feeding utensil compared to caregivers in the control group. Contextual factors, especially the movement of caregivers within and outside the study area and time constraints faced by caregivers influenced uptake of some intervention behaviours. CONCLUSION Future interventions should seek to explicitly target contextual factors such as secondary caregivers and promote food hygiene interventions as independent of each other.
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Affiliation(s)
- Sheillah Simiyu
- African Population and Health Research Center, Manga Close, Off Kirawa Road, P.O Box 10787- 00100, Nairobi, Kenya.
| | - Evalyne Aseyo
- Great Lakes University of Kisumu, P.O Box 2224-40100, Kisumu, Kenya
| | - John Anderson
- Independent Research Consultant, 78702, Austin, TX, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Kelly K Baker
- Department of Occupational and Environmental Health College of Public Health, University of Iowa, 52333, Iowa City, IA, USA
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
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Baker KK, Mumma JAO, Simiyu S, Sewell D, Tsai K, Anderson JD, MacDougall A, Dreibelbis R, Cumming O. Environmental and behavioural exposure pathways associated with diarrhoea and enteric pathogen detection in 5-month-old, periurban Kenyan infants: a cross-sectional study. BMJ Open 2022; 12:e059878. [PMID: 36316067 PMCID: PMC9628658 DOI: 10.1136/bmjopen-2021-059878] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to test whether household environmental hygiene and behavioural conditions moderated associations between diarrhoea and enteric pathogen detection in infants 5 months of age in Kenya and pathogen sources, including latrine access, domestic animal co-habitation and public food sources. DESIGN Cross-sectional study utilising enrolment survey data of households participating in the Safe Start cluster-randomised controlled trial . SETTING Kisumu, Kenya. PARTICIPANTS A total of 898 caregivers with 5-month (22 week ± 1 week) aged infants were enrolled in the study and completed the enrolment survey. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes were (1) caregiver-reported 7-day diarrhoea prevalence and (2) count of types of enteric viruses, bacteria and parasites in infant stool. Exposures and effect modifiers included water access and treatment, cohabitation with domestic animals, sanitation access, handwashing practices, supplemental feeding, access to refrigeration and flooring. RESULTS Reported handwashing after handling animals (adjusted odds ratio (aOR)=0.20; 95% CI=0.06 to 0.50) and before eating (aOR=0.44; 95% CI=0.26 to 0.73) were strongly associated with lower risk of caregiver-reported diarrhoea, while cohabitation with animals (aOR=1.54; 95% CI=1.01 to 2.34) living in a household with vinyl-covered dirt floors (aOR=0.60; 95% CI=0.45 to 0.87) were strongly associated with pathogen codetection in infants. Caregiver handwashing after child (p=0.02) or self-defecation (p=0.03) moderated the relationship between shared sanitation access and infant exposure to pathogens, specifically private latrine access was protective against pathogen exposure of infants in households, where caregivers washed hands after defecation. In the absence of handwashing, access to private sanitation posed no benefits over shared latrines for protecting infants from exposure. CONCLUSION Our evidence highlights eliminating animal cohabitation and improving flooring, postdefecation and food-related handwashing, and safety and use of cow milk sources as interventions to prevent enteric pathogen exposure of young infants in Kenya. TRIAL REGISTRATION NUMBER NCT03468114.
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Affiliation(s)
- Kelly K Baker
- Department of Occupational and Environmental Health, The University of Iowa, Iowa City, Iowa, USA
| | | | - Sheillah Simiyu
- African Population and Health Research Center, Nairobi, Kenya
| | - Daniel Sewell
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | - Kevin Tsai
- Department of Occupational and Environmental Health, The University of Iowa, Iowa City, Iowa, USA
| | | | - Amy MacDougall
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Hoffmann V, Simiyu S, Sewell DK, Tsai K, Cumming O, Mumma J, Baker KK. Milk Product Safety and Household Food Hygiene Influence Bacterial Contamination of Infant Food in Peri-Urban Kenya. Front Public Health 2022; 9:772892. [PMID: 35211451 PMCID: PMC8861079 DOI: 10.3389/fpubh.2021.772892] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/20/2021] [Indexed: 11/27/2022] Open
Abstract
Background Milk is a common infant food in peri-urban Kenya that can transmit diarrhea-causing enteric pathogens. Little is known about how contamination of milk at point of purchase and household handling of milk-based infant foods contribute to infant exposure to enteric pathogens. Objective To compare the prevalence and concentrations of bacterial indicator organisms and enteric pathogens in unpackaged, fresh pasteurized, and ultra-high temperature (UHT) treated milk at purchase and assess the influence of the type of milk used to prepare infant food on contamination of this food. Methods Paired samples of purchased milk and infant food prepared with this milk were obtained from 188 households in low-income neighborhoods in Kisumu, Kenya. Samples were cultured on selective media to isolate Salmonella enterica, Shigella spp., Klebsiella aerogenes, Proteus spp., and Escherichia coli, with pathogens validated by PCR. Probability of detection of these bacteria was compared by milk product treatment and packaging method, and between milk at point of purchase vs. food at point of infant consumption. Results Unpackaged milk was most contaminated at point of purchase, but bacterial contamination was also present in pasteurized and UHT milk at purchase. Presence of bacteria in UHT and fresh pasteurized milk at purchase predicted presence of the same bacteria type in infant food. Prevalence of bacterial contamination and concentration level for bacterial indicators generally increased between point of purchase and consumption in UHT and fresh pasteurized milk-based food but decreased in unpackaged milk-based food. Prevalence of the four fecal bacteria were similar in infant foods prepared with each type of milk. Conclusion Both pre-market contamination and post-purchase handling influence the likelihood of infants ingesting foods contaminated by diarrheal pathogens.
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Affiliation(s)
- Vivian Hoffmann
- Markets Trade and Institutions Division, International Food Policy Research Institute, Washington, DC, United States
| | | | - Daniel K Sewell
- Department of Biostatistics, University of Iowa, Iowa City, IA, United States
| | - Kevin Tsai
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Mumma
- Department of Community Nutrition, Great Lakes University of Kisumu, Kisumu, Kenya
| | - Kelly K Baker
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States
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Kontowicz E, Brown G, Torner J, Carrel M, Baker KK, Petersen CA. Inclusion of environmentally themed search terms improves Elastic net regression nowcasts of regional Lyme disease rates. PLoS One 2022; 17:e0251165. [PMID: 35271589 PMCID: PMC8912246 DOI: 10.1371/journal.pone.0251165] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022] Open
Abstract
Lyme disease is the most widely reported vector-borne disease in the United States. 95% of confirmed human cases are reported in the Northeast and upper Midwest (25,778 total confirmed cases from Northeast and upper Midwest / 27,203 total US confirmed cases). Human cases typically occur in the spring and summer months when an infected nymph Ixodid tick takes a blood meal. Current federal surveillance strategies report data on an annual basis, leading to nearly a year lag in national data reporting. These lags in reporting make it difficult for public health agencies to assess and plan for the current burden of Lyme disease. Implementation of a nowcasting model, using historical data to predict current trends, provides a means for public health agencies to evaluate current Lyme disease burden and make timely priority-based budgeting decisions. The objective of the study was to develop and compare the performance of nowcasting models using free data from Google Trends and Centers of Disease Control and Prevention surveillance reports. We developed two sets of elastic net models for five regions of the United States: 1. Using only monthly proportional hit data from the 21 disease symptoms and tick related terms, and 2. Using monthly proportional hit data from terms identified via Google correlate and the disease symptom and vector terms. Elastic net models using the full-term list were highly accurate (Root Mean Square Error: 0.74, Mean Absolute Error: 0.52, R2: 0.97) for four of the five regions of the United States and improved accuracy 1.33-fold while reducing error 0.5-fold compared to predictions from models using disease symptom and vector terms alone. Many of the terms included and found to be important for model performance were environmentally related. These models can be implemented to help local and state public health agencies accurately monitor Lyme disease burden during times of reporting lag from federal public health reporting agencies.
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Affiliation(s)
- Eric Kontowicz
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa, United States of America
| | - Grant Brown
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - James Torner
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Margaret Carrel
- Department of Geographical and Sustainability Sciences, College of Liberal Arts & Sciences, University of Iowa, Iowa City, Iowa, United States of America
| | - Kelly K. Baker
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, United States of America
| | - Christine A. Petersen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa, United States of America
- Immunology Program, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
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Tsai K, Hoffmann V, Simiyu S, Cumming O, Borsay G, Baker KK. Bacteroides Microbial Source Tracking Markers Perform Poorly in Predicting Enterobacteriaceae and Enteric Pathogen Contamination of Cow Milk Products and Milk-Containing Infant Food. Front Microbiol 2022; 12:778921. [PMID: 35058897 PMCID: PMC8764403 DOI: 10.3389/fmicb.2021.778921] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/23/2021] [Indexed: 02/03/2023] Open
Abstract
Consumption of microbiologically contaminated food is one of the leading causes of diarrheal diseases. Understanding the source of enteric pathogens in food is important to guide effective interventions. Enterobacteriaceae bacterial assays typically used to assess food safety do not shed light on the source. Source-specific Bacteroides microbial source tracking (MST) markers have been proposed as alternative indicators for water fecal contamination assessment but have not been evaluated as an alternative fecal indicator in animal-derived foods. This study tested various milk products collected from vendors in urban Kenyan communities and infant foods made with the milk (n = 394 pairs) using conventional culture methods and TaqMan qPCR for enteric pathogens and human and bovine-sourced MST markers. Detection profiles of various enteric pathogens and Bacteroides MST markers in milk products differed from that of milk-containing infant foods. MST markers were more frequently detected in infant food prepared by caregivers, indicating recent contamination events were more likely to occur during food preparation at home. However, Bacteroides MST markers had lower sensitivity in detecting enteric pathogens in food than traditional Enterobacteriaceae indicators. Bacteroides MST markers tested in this study were not associated with the detection of culturable Salmonella enterica and Shigella sonnei in milk products or milk-containing infant food. The findings show that while Bacteroides MST markers could provide valuable information about how foods become contaminated, they may not be suitable for predicting the origin of the enteric pathogen contamination sources.
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Affiliation(s)
- Kevin Tsai
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States
| | - Vivian Hoffmann
- International Food Policy Research Institute, Washington, DC, United States
| | - Sheillah Simiyu
- African Population and Health Research Center, Nairobi, Kenya
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Glorie Borsay
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States
| | - Kelly K. Baker
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States
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Osinuga A, Janssen B, Fethke NB, Story WT, Imaledo JA, Baker KK. Understanding Rural Women's Domestic Work Experiences (DWE) in Ibadan, Nigeria: Development of a Measurement Tool Using Confirmatory Factor Analysis. Int J Environ Res Public Health 2021; 18:ijerph182111043. [PMID: 34769564 PMCID: PMC8582860 DOI: 10.3390/ijerph182111043] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
Gender norms prescribe domestic labor as primarily a female's responsibility in developing countries. Many domestic tasks depend on access to water, so the physical, emotional, and time demands of domestic labor may be exacerbated for women living in water-insecure environments. We developed a set of domestic work experience (DWE) measures tailored to work in rural areas in developing countries, assessed rural Nigerian women's DWE, and examined relationships among the measures. Interviewer-administered survey data were collected between August and September from 256 women in four rural Nigerian communities. Latent factors of DWE were identified by analyzing survey items using confirmatory factor analysis. Pearson's correlation was used to examine relationships among latent factor scores, and multivariate linear regression models were used to determine if factor scores significantly differed across socio-demographic characteristics. The DWE measures consisted of latent factors of the physical domain (frequency of common domestic tasks, water sourcing and carriage, experience of water scarcity), the psychosocial domain (stress appraisal and demand-control), and the social domain (social support). Significant correlations were observed among the latent factors within and across domains. Results revealed the importance of measuring rural Nigerian women's DWE using multiple and contextual approaches rather than relying solely on one exposure measure. Multiple inter-related factors contributed to women's DWE. Water insecurity exacerbated the physical and emotional demands of domestic labor DWE varied across age categories and pregnancy status among rural Nigerian women.
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Affiliation(s)
- Abisola Osinuga
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA; (B.J.); (N.B.F.); (K.K.B.)
- Correspondence: ; Tel.: +1-3195126701
| | - Brandi Janssen
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA; (B.J.); (N.B.F.); (K.K.B.)
| | - Nathan B Fethke
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA; (B.J.); (N.B.F.); (K.K.B.)
| | - William T Story
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA;
| | - John A Imaledo
- Department of Health Promotion and Education, University of Ibadan, Ibadan 200212, Nigeria;
| | - Kelly K Baker
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA; (B.J.); (N.B.F.); (K.K.B.)
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Osinuga A, Hicks C, Ibitoye SE, Schweizer M, Fethke NB, Baker KK. A meta-analysis of the association between physical demands of domestic labor and back pain among women. BMC Womens Health 2021; 21:150. [PMID: 33849504 PMCID: PMC8045256 DOI: 10.1186/s12905-021-01294-5] [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] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/07/2021] [Indexed: 12/27/2022]
Abstract
Background Back pain (BP) is among the most common musculoskeletal problems globally and is a leading contributor to disability among adults. Millions of women especially those in low-income settings, engage in strenuous domestic activities that may increase their risk of BP. The purpose of this meta-analysis was to estimate the association between physically demanding domestic labor (PDDL) which is characterized as intensity, frequency, duration of work and biomechanical risk factors of work and BP among women. Methods Five databases were searched for records published from January 1991 to March 2020; and results from 11studies were included in the meta-analysis. A random effects model and the generic inverse-variance method was used to estimate the pooled odds ratio (OR), 95% confidence interval (CI), and the degree of heterogeneity among studies (I2). Stratified and sensitivity analyses were conducted to identify the influence of outliers and identify the sources of heterogeneity. Results Exposure to high PDDL was significantly associated with BP (OR = 1.63; 95% CI 1.30, 2.04; I2 = 70%). The odds of back pain were highest among the following groups: women performing domestic labor in non-neutral postures (OR = 2.30; 95% CI = 1.75–3.04; I2 = 0%; N = 4 studies) and among women from low- and middle-income countries (OR = 1.98; 95% CI = 1.58–2.49; I2 = 29%; N = 5 studies). We found no evidence of publication bias (Egger’s test p-value = 0.15). Conclusions PDDL may significantly increase a woman’s risk of experiencing BP, but larger prospective studies are needed to further investigate the association. Presenting data on how domestic work affects the musculoskeletal health of women will be important in designing future interventions (behavioral, infrastructural, and ergonomic) that can reduce the burdens from domestic labor. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01294-5.
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Affiliation(s)
- Abisola Osinuga
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, 52242, USA.
| | - Chelsea Hicks
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, 52242, USA
| | - Segun E Ibitoye
- Department of Health Promotion and Education, University of Ibadan, Ibadan, 200212, Nigeria
| | - Marin Schweizer
- Department of Epidemiology, University of Iowa, Iowa City, 52242, USA
| | - Nathan B Fethke
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, 52242, USA
| | - Kelly K Baker
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, 52242, USA
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11
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Mumma JAO, Cumming O, Simiyu S, Czerniewska A, Aseyo RE, Muganda DN, Davis E, Baker KK, Dreibelbis R. Infant Food Hygiene and Childcare Practices in Context: Findings from an Urban Informal Settlement in Kenya. Am J Trop Med Hyg 2020; 102:220-222. [PMID: 31746311 PMCID: PMC6947802 DOI: 10.4269/ajtmh.19-0279] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Complementary food hygiene is important to reduce infant exposures to enteric pathogens; however, interventions to improve food hygiene in low- and middle-income countries often ignore the larger context in which childcare occurs. In this study, we explore on observational and qualitative information regarding childcare in an informal community in Kenya. Our findings demonstrate that behaviors associated with food contamination, such as hand feeding and storing food for extended periods, are determined largely by the larger social and economic realities of primary caretakers. Data also show how caregiving within an informal settlement is highly dynamic and involves multiple individuals and locations throughout the day. Findings from this study will help inform the development and implementation of food hygiene interventions in informal urban communities.
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Affiliation(s)
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sheillah Simiyu
- Center of Research, Great Lakes University of Kisumu, Kisumu, Kenya
| | - Alexandra Czerniewska
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Emily Davis
- Department of International Health-Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly K Baker
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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12
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Chard AN, Levy K, Baker KK, Tsai K, Chang HH, Thongpaseuth V, Sistrunk JR, Freeman MC. Environmental and spatial determinants of enteric pathogen infection in rural Lao People's Democratic Republic: A cross-sectional study. PLoS Negl Trop Dis 2020; 14:e0008180. [PMID: 32267881 PMCID: PMC7170279 DOI: 10.1371/journal.pntd.0008180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/31/2019] [Revised: 04/20/2020] [Accepted: 02/28/2020] [Indexed: 01/10/2023] Open
Abstract
TRIAL REGISTRATION clinicaltrials.gov (NCT02342860).
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Affiliation(s)
- Anna N. Chard
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Karen Levy
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Kelly K. Baker
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Kevin Tsai
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Vonethalom Thongpaseuth
- Laboratory and Treatment Unit, Center for Malariology, Parasitology, and Entomology, Ministry of Health, Vientiane, Lao PDR
| | - Jeticia R. Sistrunk
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Matthew C. Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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13
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Bick S, Perieres L, D'Mello-Guyett L, Baker KK, Brown J, Muneme B, Nala R, Dreibelbis R, Cumming O. Risk factors for child food contamination in low-income neighbourhoods of Maputo, Mozambique: An exploratory, cross-sectional study. Matern Child Nutr 2020; 16:e12991. [PMID: 32162452 PMCID: PMC7507538 DOI: 10.1111/mcn.12991] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/27/2020] [Accepted: 02/18/2020] [Indexed: 11/26/2022]
Abstract
In low‐ and middle‐income countries, food may be a critical transmission route for pathogens causing childhood diarrhoea, but basic food hygiene is often overlooked in public health strategies. Characterising child food contamination and its risk factors could help prioritise interventions to reduce foodborne diarrhoeal disease, especially in low‐income urban areas where the diarrhoeal disease burden is often high. This cross‐sectional study comprised a caregiver questionnaire coupled with food sampling, and food preparation observations, among the study population of an ongoing sanitation trial in Maputo. The aim was to determine the prevalence of child food contamination and associated risk factors. The prevalence of Enterococcus spp., as an indicator of faecal contamination, was estimated in food samples. Risk factor analyses were performed through zero‐inflated negative binomial regression on colony counts. A modified hazard analysis and critical control point approach was used to determine critical control points (CCPs) that might effectively reduce risk. Fifty‐eight linked caregiver questionnaires and food samples were collected, and 59 food preparation observations were conducted. The prevalence of enterococci in child foods exceeding 10 colony forming units per gram was 53% (95% confidence interval [40%, 67%]). Risk factors for child food contamination were identified, including type of food, food preparation practices, and hygiene behaviours. CCPs included cooking/reheating of food and food storage and handling. This exploratory study highlights the need for more research into diarrhoeagenic pathogens and foodborne risks for children living in these challenging urban environments.
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Affiliation(s)
- Sarah Bick
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Lauren Perieres
- VITROME, Campus International IRD-UCAD de l'IRD, Dakar, Senegal
| | - Lauren D'Mello-Guyett
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Kelly K Baker
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | | | - Rassul Nala
- Ministério da Saúde, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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14
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Simiyu S, Czerniewska A, Aseyo ER, Baker KK, Cumming O, Odhiambo Mumma JA, Dreibelbis R. Designing a Food Hygiene Intervention in Low-Income, Peri-Urban Context of Kisumu, Kenya: Application of the Trials of Improved Practices Methodology. Am J Trop Med Hyg 2020; 102:1116-1123. [PMID: 32157996 PMCID: PMC7204591 DOI: 10.4269/ajtmh.19-0629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Food contamination during weaning and complementary feeding can result in high diarrheal incidence among infants. Caregiver practices are important determinants of exposure to foodborne pathogens, and can therefore play a role in reduction in infant food contamination. Through a qualitative approach, we used the Trials of Improved Practices methodology to design a food hygiene intervention in a low-income settlement of Kisumu city in Kenya. These settlements in Kisumu city host a large portion of the city’s population and are faced with a high diarrheal disease burden. Caregivers were selected if they had a child aged 6–9 months, and together, we codesigned a combination of hardware and messaging components targeting handwashing with soap, hygienic feeding, reheating, and hygienic storage of infant food. Caregivers received up to six engagement visits with the research team. The visits were aimed at improving the designed hardware and messaging components. Results showed that feeding items were easily adopted by caregivers, whereas reheating of food was less observed. Households reportedly improved their food storage and handwashing practices. As a result, the hardware components were further refined and tested among the caregivers. Messaging components spurred the aspirations that caregivers had for their children and acted as reminders of practicing good food hygiene. The outcomes of the codesign process provided valuable insights on the knowledge of caregivers, a delivery approach for implementing the intervention, and further informed a subsequent trial that adopted the designed intervention to target early childhood exposure to enteric pathogens through contaminated food.
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Affiliation(s)
- Sheillah Simiyu
- African Population and Health Research Center, Nairobi, Kenya
| | - Alexandra Czerniewska
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Kelly K Baker
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Sevilimedu V, Pressley KD, Snook KR, Hogges JV, Politis MD, Sexton JK, Duke CH, Smith BA, Swander LC, Baker KK, Gambhir M, Fung ICH. Gender-based differences in water, sanitation and hygiene-related diarrheal disease and helminthic infections: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2020; 110:637-648. [PMID: 28115686 DOI: 10.1093/trstmh/trw080] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/30/2016] [Revised: 12/14/2016] [Accepted: 12/30/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Qualitative evidence suggests that inadequate water, sanitation and hygiene (WASH) may affect diarrheal and helminthic infection in women disproportionately. We systematically searched PubMed in June 2014 (updated 2016) and the WHO website, for relevant articles. METHODS Articles dealing with the public health relevance of helminthic and diarrheal diseases, and highlighting the role of gender in WASH were included. Where possible, we carried out a meta-analysis. RESULTS In studies of individuals 5 years or older, cholera showed lower prevalence in males (OR 0.56; 95% CI 0.34-0.94), while Schistosoma mansoni (1.38; 95% CI 1.14-1.67), Schistosoma japonicum (1.52; 95% CI 1.13-2.05), hookworm (1.43; 95% CI 1.07-1.89) and all forms of infectious diarrhea (1.21; 95% CI 1.06-1.38) showed a higher prevalence in males. When studies included all participants, S. mansoni and S. japonicum showed higher prevalence with males (OR 1.40; 95% CI 1.27-1.55 and 1.84; 95% CI 1.27-2.67, respectively). Prevalence of Trichiuris and hookworm infection showed effect modification with continent. CONCLUSIONS Evidence of gender differences in infection may reflect differences in gender norms, suggesting that policy changes at the regional level may help ameliorate gender related disparities in helminthic and diarrheal disease prevalence.
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Affiliation(s)
- Varadan Sevilimedu
- Department of Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA
| | - Keisha D Pressley
- Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA
| | - Kassandra R Snook
- Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA
| | - Jamesa V Hogges
- Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA
| | - Maria D Politis
- Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA.,Department of Epidemiology, College of Public Health, University of Kentucky, KY, USA
| | - Jessica K Sexton
- Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA
| | - Carmen H Duke
- Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA
| | - Blake A Smith
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, IA, USA
| | - Lena C Swander
- Department of Epidemiology, College of Public Health, University of Iowa, IA, USA
| | - Kelly K Baker
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, IA, USA
| | - Manoj Gambhir
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Vic, Australia
| | - Isaac Chun-Hai Fung
- Department of Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, GA, USA
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16
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Mumma J, Simiyu S, Aseyo E, Anderson J, Czerniewska A, Allen E, Dreibelbis R, Baker KK, Cumming O. The Safe Start trial to assess the effect of an infant hygiene intervention on enteric infections and diarrhoea in low-income informal neighbourhoods of Kisumu, Kenya: a study protocol for a cluster randomized controlled trial. BMC Infect Dis 2019; 19:1066. [PMID: 31856747 PMCID: PMC6923833 DOI: 10.1186/s12879-019-4657-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/28/2019] [Accepted: 11/22/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Symptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infections, there have been few rigorous interventions studies to assess this, and no studies in low income urban settings where risks are plausibly very high. The aim of this study is to evaluate the impact of a novel infant food hygiene intervention on infant enteric infections and diarrhoea in peri-urban settlements of Kisumu, Kenya. METHODS This is a cluster randomized control trial with 50 clusters, representing the catchment areas of Community Health Volunteers (CHVs), randomly assigned to intervention or control, and a total of 750 infants recruited on a rolling basis at 22 weeks of age and then followed for 15 weeks. The intervention targeted four key caregiver behaviours related to food hygiene: 1) hand washing with soap before infant food preparation and feeding; 2) bringing all infant food to the boil before feeding, including when reheating or reserving; 3) storing all infant food in sealed containers; and, 4) using only specific utensils for infant feeding which are kept separate and clean. RESULTS The primary outcome of interest is the prevalence of one or more of 23 pre-specified enteric infections, determined using quantitative real-time polymerase chain reaction for enteric pathogen gene targets. In addition, infant food samples were collected at 33 weeks, and faecal indicator bacteria (Enterococcus) isolated and enumerated to assess the impact of the intervention on infant food contamination. CONCLUSION To our knowledge this is the first randomized controlled trial to assess the effect of an infant food hygiene intervention on enteric infections in a high burden, low income urban setting. Our trial responds to growing evidence that food may be a key pathway for early childhood enteric infection and disease and that basic food hygiene behaviours may be able to mitigate these risks. The Safe Start trial seeks to provide new evidence as to whether a locally appropriate infant food hygiene intervention delivered through the local health extension system can improve the health of young children. TRIAL REGISTRATION The trial was registered at clinicaltrial.gov on March 16th 2018 before enrolment of any participants (https://clinicaltrials.gov/ct2/show/NCT03468114).
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Affiliation(s)
- Jane Mumma
- Center of Research, Great Lakes University Kisumu, P.O. Box 2224-40100, Kisumu, Kenya
| | - Sheillah Simiyu
- Urbanisation and Well Being Unit, African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya
| | - Evalyne Aseyo
- Center of Research, Great Lakes University Kisumu, P.O. Box 2224-40100, Kisumu, Kenya
| | - John Anderson
- Independent Research Consultant, TX78702, Austin, USA
| | - Alexandra Czerniewska
- Disease Control Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
| | - Kelly K. Baker
- Department of Occupational and Environmental Health College of Public Health, University of Iowa, Iowa City, IA 52333 USA
| | - Oliver Cumming
- Disease Control Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK
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17
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Kinkor MA, Padhi BK, Panigrahi P, Baker KK. Frequency and determinants of health care utilization for symptomatic reproductive tract infections in rural Indian women: A cross-sectional study. PLoS One 2019; 14:e0225687. [PMID: 31805087 PMCID: PMC6894837 DOI: 10.1371/journal.pone.0225687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/05/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction The public health burden of reproductive tract infections (RTIs) among women in rural areas of low-income countries is poorly addressed because health care seeking for treatment of RTIs is inadequate. There are gaps in knowledge about whether low care seeking behavior stems from challenges in accessing health care versus women's recognition of and response to RTI-specific disease symptoms. We aim to identify determinants of care seeking behavior and analyze the difference in utilization of health care resources in response to symptoms of an RTI versus non-RTI disease symptoms in rural India. This will aid in the design of interventions that promote RTI care seeking behavior. Methods Our analysis uses data from a cross-sectional, population-based surveillance survey among rural, non-pregnant women in Odisha, India, from 2013–2014 (n = 3,600). We utilized bivariate logistic regression to determine the degree that certain determinants are associated with a woman’s likelihood to seek RTI treatment, and chi-Squared tests to assess for differences in health care resources used for non-RTI versus RTI symptoms. Results Married women were significantly more likely to seek health care for RTI symptoms (Odds Ratio (OR) = 1.9, 95% Confidence Interval (CI): 1.2–3.0) while unmarried adolescents were less likely to seek treatment (OR = 0.4, CI: 0.2–0.6). There was no association between RTI health care seeking with education level, belief about whether symptoms can be treated, or poverty. The majority (73.8%) of women who did not seek treatment for RTI symptoms reported not seeking treatment because they did not know treatment was needed. Women utilized formal health care providers at a higher rate in response to RTI symptoms than in response to their most recent symptoms of any kind (p = 0.003). Conclusions Community-based reproductive health education interventions are needed to increase health care seeking behavior for RTIs in rural Indian women. Interventions should target unmarried women and focus on both sexual health education and access to care.
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Affiliation(s)
- Mitchell A. Kinkor
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Bijaya K. Padhi
- Asian Institute of Public Health, Bhubaneswar, Odisha, India
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pinaki Panigrahi
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kelly K. Baker
- College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
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18
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Chard AN, Baker KK, Tsai K, Levy K, Sistrunk JR, Chang HH, Freeman MC. Associations between soil-transmitted helminthiasis and viral, bacterial, and protozoal enteroinfections: a cross-sectional study in rural Laos. Parasit Vectors 2019; 12:216. [PMID: 31064387 PMCID: PMC6505259 DOI: 10.1186/s13071-019-3471-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Humans are susceptible to over 1400 pathogens. Co-infection by multiple pathogens is common, and can result in a range of neutral, facilitative, or antagonistic interactions within the host. Soil-transmitted helminths (STH) are powerful immunomodulators, but evidence of the effect of STH infection on the direction and magnitude of concurrent enteric microparasite infections is mixed. Methods We collected fecal samples from 891 randomly selected children and adults in rural Laos. Samples were analyzed for 5 STH species, 6 viruses, 9 bacteria, and 5 protozoa using a quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay. We utilized logistic regression, controlling for demographics and household water, sanitation, and hygiene access, to examine the effect of STH infection on concurrent viral, bacterial, and protozoal infection. Results We found that STH infection was associated with lower odds of concurrent viral infection [odds ratio (OR): 0.48, 95% confidence interval (CI): 0.28–0.83], but higher odds of concurrent bacterial infections (OR: 1.81, 95% CI: 1.06–3.07) and concurrent protozoal infections (OR: 1.50, 95% CI: 0.95–2.37). Trends were consistent across STH species. Conclusions The impact of STH on odds of concurrent microparasite co-infection may differ by microparasite taxa, whereby STH infection was negatively associated with viral infections but positively associated with bacterial and protozoal infections. Results suggest that efforts to reduce STH through preventive chemotherapy could have a spillover effect on microparasite infections, though the extent of this impact requires additional study. The associations between STH and concurrent microparasite infection may reflect a reverse effect due to the cross-sectional study design. Additional research is needed to elucidate the exact mechanism of the immunomodulatory effects of STH on concurrent enteric microparasite infection. Electronic supplementary material The online version of this article (10.1186/s13071-019-3471-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna N Chard
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
| | - Kelly K Baker
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, 52242, USA
| | - Kevin Tsai
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, 52242, USA
| | - Karen Levy
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
| | - Jeticia R Sistrunk
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
| | - Matthew C Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA.
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19
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Tsai K, Simiyu S, Mumma J, Aseyo RE, Cumming O, Dreibelbis R, Baker KK. Enteric Pathogen Diversity in Infant Foods in Low-Income Neighborhoods of Kisumu, Kenya. Int J Environ Res Public Health 2019; 16:ijerph16030506. [PMID: 30759722 PMCID: PMC6388216 DOI: 10.3390/ijerph16030506] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 01/01/2023]
Abstract
Pediatric diarrheal disease remains the second most common cause of preventable illness and death among children under the age of five, especially in low and middle-income countries (LMICs). However, there is limited information regarding the role of food in pathogen transmission in LMICs. For this study, we examined the frequency of enteric pathogen occurrence and co-occurrence in 127 infant weaning foods in Kisumu, Kenya, using a multi-pathogen PCR diagnostic tool, and assessed household food hygiene risk factors for contamination. Bacterial, viral, and protozoan enteric pathogen DNA and RNA were detected in 62% of the infant weaning food samples collected, with 37% of foods containing more than one pathogen type. Multivariable generalized linear mixed model analysis indicated type of infant food best explained the presence and diversity of enteric pathogens in infant food, while most household food hygiene risk factors considered in this study were not significantly associated with pathogen contamination. Specifically, cow’s milk was significantly more likely to contain a pathogen (adjusted risk ratio = 14.4; 95% confidence interval (CI) 1.78–116.1) and more likely to have higher number of enteric pathogen species (adjusted risk ratio = 2.35; 95% CI 1.67–3.29) than porridge. Our study demonstrates that infants in this low-income urban setting are frequently exposed to diarrhoeagenic pathogens in food and suggests that interventions are needed to prevent foodborne transmission of pathogens to infants.
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Affiliation(s)
- Kevin Tsai
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA 52246, USA.
| | - Sheillah Simiyu
- Center of Research, Great Lakes University of Kisumu, Kisumu 40100, Kenya.
| | - Jane Mumma
- Center of Research, Great Lakes University of Kisumu, Kisumu 40100, Kenya.
| | - Rose Evalyne Aseyo
- Center of Research, Great Lakes University of Kisumu, Kisumu 40100, Kenya.
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Kelly K Baker
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA 52246, USA.
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Baker KK, Story WT, Walser-Kuntz E, Zimmerman MB. Impact of social capital, harassment of women and girls, and water and sanitation access on premature birth and low infant birth weight in India. PLoS One 2018; 13:e0205345. [PMID: 30296283 PMCID: PMC6175511 DOI: 10.1371/journal.pone.0205345] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 03/14/2018] [Accepted: 09/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, preterm birth (PTB) and low infant birth weight (LBW) are leading causes of maternal and child morbidity and mortality. Inadequate water and sanitation access (WASH) are risk factors for PTB and LBW in low-income countries. Physical stress from carrying water and psychosocial stress from addressing sanitation needs in the open may be mechanisms underlying these associations. If so, then living in a community with strong social capital should be able to buffer the adverse effects of WASH on birth outcomes. The objective of this study is to assess the relationships between WASH access and social conditions (including harassment and social capital) on PTB and LBW outcomes among Indian women, and to test whether social conditions modified the association between WASH and birth outcomes. METHODS AND FINDINGS This cohort study examined the effect of pre-birth WASH and social conditions on self-reported PTB status and LBW status for 7,926 women who gave birth between 2004/2005 and 2011/2012 Waves of the India Human Development Survey. PTB and LBW occurred in 14.9% and 15.5% of women, respectively. After adjusting for maternal biological and socioeconomic conditions, PTB was associated with sharing a building/compound latrine (Odds Ratio (OR) = 1.55; 95% Confidence Interval (CI) = 1.01, 2.38) versus private latrine access, but suggested an effect in the opposite direction for sharing a community/public latrine (OR = 0.67; CI = 0.45, 1.01). Open defecation, type of drinking water source, minutes per day spent fetching water, and one-way time to a drinking water source were not associated with PTB. LBW was associated with spending more than two hours per day fetching water compared to less than two hours (OR = 1.33; CI = 1.05, 1.70) and suggested an association with open defecation (OR = 1.22; CI = 1.00, 1.48), but was not associated with other types of sanitation, type of drinking water source, or time to a drinking water source. Harassment of women and girls in the community was associated with both PTB (OR = 1.33; CI = 1.09, 1.62) and LBW (OR = 1.26; CI = 1.03, 1.54). The data also showed a possible association of local crime with LBW (OR = 1.30; CI = 1.00, 1.68). Statistically significant (p<0.05) evidence of effect modification was only found for collective efficacy on the association between type of sanitation access and PTB. In addition, stratified analyses identified differences in effect size for walking time to the primary drinking water source and PTB by crime, sanitation access and PTB by harassment, and total hours per day fetching water and LBW by collective efficacy. Limitations of this observational study include risk of bias, inability to confirm causality, reliance on self-reported outcomes, and limited sub-group sample sizes for testing effect modification. CONCLUSIONS The relationship between adverse birth outcomes and sanitation access, domestic water fetching, crime, and gender-based harassment suggests physical and psychosocial stress are possible mechanisms by which WASH access affects PTB and LBW among Indian women. Interventions that reduce domestic responsibilities related to water and sanitation and change social norms related to gender-based harassment may reduce rates of PTB and LBW in India.
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Affiliation(s)
- Kelly K. Baker
- Department of Occupational and Environmental Health, University of Iowa College of Public Health, IA, United States of America
| | - William T. Story
- Department of Community and Behavioral Health, University of Iowa College of Public Health, IA, United States of America
| | - Evan Walser-Kuntz
- Department of Biostatistics, University of Iowa College of Public Health, IA, United States of America
| | - M. Bridget Zimmerman
- Department of Biostatistics, University of Iowa College of Public Health, IA, United States of America
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Aseyo RE, Mumma J, Scott K, Nelima D, Davis E, Baker KK, Cumming O, Dreibelbis R. Realities and experiences of community health volunteers as agents for behaviour change: evidence from an informal urban settlement in Kisumu, Kenya. Hum Resour Health 2018; 16:53. [PMID: 30286763 PMCID: PMC6172748 DOI: 10.1186/s12960-018-0318-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 08/07/2017] [Accepted: 09/19/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Community health workers play an important role in health service delivery and are increasingly involved in behaviour change interventions, including for hygiene-related behaviour change. However, their role and capacity to deliver behaviour change interventions, particularly in high-density urban settlements, remain under-researched. This study examines the behaviour change-related activities of community health volunteers (CHVs)-community health workers affiliated with the Kenyan Ministry of Health-in a peri-urban settlement in Kenya, in order to assess their capabilities, opportunities to work effectively, and sources of motivation. METHODS This mixed-methods study included a census of 16 CHVs who work in the study area. All CHVs participated in structured observations of their daily duties, structured questionnaires, in-depth interviews, and two focus group discussions. Structured data were analysed descriptively. Thematic content analysis was followed for qualitative data. Results were synthesized and interpreted using the capability, opportunity, motivation for behaviour change framework, COM-B. RESULTS In addition to their responsibilities with the Ministry of Health, CHVs partnered with a range of non-governmental organizations engaged in health and development programming, often receiving small stipends from these organizations. CHVs reported employing a limited number of behaviour change techniques when interacting with community members at the household level. Capability: While supervision and support from the MOH was robust, CHV training was inconsistent and inadequate with regard to behaviour change and CHVs often lacked material resources necessary for their work. Opportunity: CHVs spent very little time with the households in their allocated catchment area. The number of households contacted per day was insufficient to reach all assigned households within a given month as required and the brief time spent with households limited the quality of engagement. MOTIVATION Lack of compensation was noted as a demotivating factor for CHVs. This was compounded by the challenging social environment and CHVs' low motivation to encourage behaviour change in local communities. CONCLUSIONS In a complex urban environment, CHVs faced challenges that limited their capacity to be involved in behaviour change interventions. More resources, better coordination, and additional training in modern behaviour change approaches are needed to ensure their optimal performance in implementing health programmes.
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Affiliation(s)
| | - Jane Mumma
- Great Lakes University of Kisumu, P O Box 2224, Kisumu, 40100 Kenya
| | - Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 United States of America
- Bangalore, India
| | - Damaris Nelima
- Great Lakes University of Kisumu, P O Box 2224, Kisumu, 40100 Kenya
| | - Emily Davis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 United States of America
| | - Kelly K Baker
- Occupational and Environmental Health, University of Iowa College of Public Health, 145 N Riverside Dr, Iowa City, IA 52246 United States of America
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT United Kingdom
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT United Kingdom
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Baker KK, Senesac R, Sewell D, Gupta AS, Cumming O, Mumma J. Fecal Fingerprints of Enteric Pathogen Contamination in Public Environments of Kisumu, Kenya, Associated with Human Sanitation Conditions and Domestic Animals. Environ Sci Technol 2018; 52:10263-10274. [PMID: 30106283 PMCID: PMC6557411 DOI: 10.1021/acs.est.8b01528] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Young children are infected by a diverse range of enteric pathogens in high disease burden settings, suggesting pathogen contamination of the environment is equally diverse. This study aimed to characterize across- and within-neighborhood diversity in enteric pathogen contamination of public domains in urban informal settlements of Kisumu, Kenya, and to assess the relationship between pathogen detection patterns and human and domestic animal sanitation conditions. Microbial contamination of soil and surface water from 166 public sites in three Kisumu neighborhoods was measured by enterococcal assays and quantitative reverse transcription polymerase chain reaction (qRT-PCR) for 19 enteric pathogens. Regression was used to assess the association between observed sanitary indicators of contamination with enterococci and pathogen presence and concentration, and pathogen diversity. Seventeen types of pathogens were detected in Kisumu public domains. Enteric pathogens were codetected in 33% of soil and 65% of surface water samples. Greater pathogen diversity was associated with the presence of domestic animal feces but not with human open defecation, deteriorating latrines, flies, or disposal of human feces. Sanitary conditions were not associated with enterococcal bacteria, specific pathogen concentrations, or "any pathogen". Young children played at 40% of observed sites. Managing domestic animal feces may be required to reduce enteric pathogen environmental contamination in high-burden settings.
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Affiliation(s)
- Kelly K. Baker
- Department of Occupational and Environmental Health
- Corresponding Author Phone: (001) 319-384-4008;.
| | - Reid Senesac
- Department of Occupational and Environmental Health
| | | | - Ananya Sen Gupta
- Department of Electrical Engineering, University of Iowa, Iowa City, Iowa 52242, United States
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Jane Mumma
- Department of Community Nutrition, Great Lakes University of Kisumu, 40100 Kisumu, Kenya
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Berendes DM, Kirby AE, Clennon JA, Agbemabiese C, Ampofo JA, Armah GE, Baker KK, Liu P, Reese HE, Robb KA, Wellington N, Yakubu H, Moe CL. Urban sanitation coverage and environmental fecal contamination: Links between the household and public environments of Accra, Ghana. PLoS One 2018; 13:e0199304. [PMID: 29969466 PMCID: PMC6029754 DOI: 10.1371/journal.pone.0199304] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 10/08/2017] [Accepted: 06/05/2018] [Indexed: 11/18/2022] Open
Abstract
Exposure to fecal contamination in public areas, especially in dense, urban environments, may significantly contribute to enteric infection risk. This study examined associations between sanitation and fecal contamination in public environments in four low-income neighborhoods in Accra, Ghana. Soil (n = 72) and open drain (n = 90) samples were tested for E. coli, adenovirus, and norovirus. Sanitation facilities in surveyed households (n = 793) were categorized by onsite fecal sludge containment ("contained" vs. "uncontained") using previous Joint Monitoring Program infrastructure guidelines. Most sanitation facilities were shared by multiple households. Associations between spatial clustering of household sanitation coverage and fecal contamination were examined, controlling for neighborhood and population density (measured as enumeration areas in the 2010 census and spatially matched to sample locations). E. coli concentrations in drains within 50m of clusters of contained household sanitation were more than 3 log-units lower than those outside of clusters. Further, although results were not always statistically significant, E. coli concentrations in drains showed consistent trends with household sanitation coverage clusters: concentrations were lower in or near clusters of high coverage of household sanitation facilities-especially contained facilities-and vice versa. Virus detection in drains and E. coli concentrations in soil were not significantly associated with clustering of any type of household sanitation and did not exhibit consistent trends. Population density alone was not significantly associated with any of the fecal contamination outcomes by itself and was a significant, yet inconsistent, effect modifier of the association between sanitation clusters and E. coli concentrations. These findings suggest clustering of contained household sanitation, even when shared, may be associated with lower levels of fecal contamination within drains in the immediate public domain. Further research is needed to better quantify these relationships and examine impacts on health.
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Affiliation(s)
- David M. Berendes
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, United States of America
| | - Amy E. Kirby
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, United States of America
| | - Julie A. Clennon
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, United States of America
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Chantal Agbemabiese
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Joseph A. Ampofo
- Council for Scientific and Industrial Research, Water Research Institute, Accra, Ghana
| | - George E. Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Kelly K. Baker
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, United States of America
| | - Pengbo Liu
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, United States of America
| | - Heather E. Reese
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, United States of America
| | - Katharine A. Robb
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, United States of America
| | | | - Habib Yakubu
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, United States of America
| | - Christine L. Moe
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, United States of America
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24
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Just MR, Carden SW, Li S, Baker KK, Gambhir M, Fung ICH. The impact of shared sanitation facilities on diarrheal diseases with and without an environmental reservoir: a modeling study. Pathog Glob Health 2018; 112:195-202. [PMID: 29874978 DOI: 10.1080/20477724.2018.1478927] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Epidemiological studies have identified an increased risk of diarrheal diseases associated with using shared sanitation facilities. We hypothesized that this might be related to differences in transmission routes of pathogens. We proposed a mathematical model of two fictitious pathogens, one transmitted with an environmental reservoir and one without. We assumed that individuals susceptible to one pathogen are not susceptible to the other, and therefore, decoupled the two models. We initialized the model with 99% individuals being susceptible. We sampled the parameter space using Latin Hypercube Sampling. We simulated 10,000 parameter sets. We varied the effective shared sanitation coverage (the product of latrine coverage and users' compliance). Our results show that, in our hypothetical scenario, across all levels of effective coverage of shared sanitation, the median final cumulative incidence of diarrheal disease was higher than that of zero coverage. Our simulation findings suggest that increasing effective coverage of shared sanitation may have limited benefits against diarrhea-causing pathogens with an environmental reservoir and may lack benefit against diarrhea-causing pathogens without an environmental reservoir given increased human contacts if latrines are poorly maintained.
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Affiliation(s)
- Matthew R Just
- a Department of Mathematical Sciences , Georgia Southern University , Statesboro , GA , USA
| | - Stephen W Carden
- a Department of Mathematical Sciences , Georgia Southern University , Statesboro , GA , USA
| | - Sheng Li
- b CUNY School of Public Health, City University of New York , New York City , NY , USA
| | - Kelly K Baker
- c Department of Occupational and Environmental Health , College of Public Health, The University of Iowa , Iowa City , IA , USA
| | - Manoj Gambhir
- d Epidemiological Modelling Unit, Faculty of Medicine, Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Australia
| | - Isaac Chun-Hai Fung
- e Department of Epidemiology and Environmental Health Sciences , Jiann-Ping Hsu College of Public Health, Georgia Southern University , Statesboro , GA , USA
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25
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Ritter RL, Peprah D, Null C, Moe CL, Armah G, Ampofo J, Wellington N, Yakubu H, Robb K, Kirby AE, Wang Y, Roguski K, Reese H, Agbemabiese CA, Adomako LAB, Freeman MC, Baker KK. Within-Compound Versus Public Latrine Access and Child Feces Disposal Practices in Low-Income Neighborhoods of Accra, Ghana. Am J Trop Med Hyg 2018; 98:1250-1259. [PMID: 29557327 PMCID: PMC5953368 DOI: 10.4269/ajtmh.17-0654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In crowded urban settlements in low-income countries, many households rely on shared sanitation facilities. Shared facilities are not currently considered "improved sanitation" because of concerns about whether hygiene conditions sufficiently protect users from the feces of others. Prevention of fecal exposure at a latrine is only one aspect of sanitary safety. Ensuring consistent use of latrines for feces disposal, especially child feces, is required to reduce fecal contamination in households and communities. Household crowding and shared latrine access are correlated in these settings, rendering latrine use by neighbors sharing communal living areas as critically important for protecting one's own household. This study in Accra, Ghana, found that household access to a within-compound basic latrine was associated with higher latrine use by children of ages 5-12 years and for disposal of feces of children < 5 years, compared with households using public latrines. However, within-compound access was not associated with improved child feces disposal by other caregivers in the compound. Feces was rarely observed in household compounds but was observed more often in compounds with latrines versus compounds relying on public latrines. Escherichia coli and human adenovirus were detected frequently on household surfaces, but concentrations did not differ when compared by latrine access or usage practices. The differences in latrine use for households sharing within-compound versus public latrines in Accra suggest that disaggregated shared sanitation categories may be useful in monitoring global progress in sanitation coverage. However, compound access did not completely ensure that households were protected from feces and microbial contamination.
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Affiliation(s)
| | - Dorothy Peprah
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Clair Null
- Mathematica Policy Research, Washington, District of Columbia.,Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Christine L Moe
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - George Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joseph Ampofo
- Council for Scientific and Industrial Research Water Research Institute, Accra, Ghana
| | - Nii Wellington
- Training Research and Networking for Development (TREND), Accra, Ghana
| | - Habib Yakubu
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Katharine Robb
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Amy E Kirby
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Yuke Wang
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Katherine Roguski
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Heather Reese
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | | | | | - Matthew C Freeman
- Department of Environmental Health, Emory University, Atlanta, Georgia.,Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
| | - Kelly K Baker
- College of Public Health, University of Iowa, Iowa City, Iowa.,Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, Georgia
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26
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Davis E, Cumming O, Aseyo RE, Muganda DN, Baker KK, Mumma J, Dreibelbis R. Oral Contact Events and Caregiver Hand Hygiene: Implications for Fecal-Oral Exposure to Enteric Pathogens among Infants 3-9 Months Living in Informal, Peri-Urban Communities in Kisumu, Kenya. Int J Environ Res Public Health 2018; 15:ijerph15020192. [PMID: 29364184 PMCID: PMC5857049 DOI: 10.3390/ijerph15020192] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
Abstract
Childhood diarrhea is one of the leading causes of morbidity and mortality in children under five in low and middle-income countries, second only to respiratory illness. The mouthing behavior that is common in children exposes them to fecal-orally transmitted pathogens that can result in diarrhea; however, there is a need for further evidence on specific exposure routes. This study describes the frequency and diversity of two important routes of enteric pathogen exposure among infants 3-9 months of age: infant oral contact behavior and caregiver handwashing behavior. Data were collected through structured observations of 25 index infants for the oral contact data and 25 households for the caregiver handwashing data in a peri-urban setting in Kisumu (Obunga), Kenya. Breast was the most common type of oral contact event with an average of 3.00 per observation period and 0.5 events per hour. This was followed by a range of physical objects with an average of 2.49 per observation and 0.4 events per hour. The "infant's own hands" was the third most common oral contact, with an average of 2.16 events per hour, and 0.4 oral contact events per hour. Food and liquids were the 4th and 5th most common oral contact events with an average of 1.64 food contacts and 0.52 liquid oral contact events per observation period. Feeding events, including breastfeeding, were the most commonly observed key juncture-71% of total junctures observed were caregivers feeding children. This was followed by child cleaning (23%), caregiver toilet uses at (4%), and lastly food preparation at 2%. HWWS was observed only once before a feeding event (1%), twice after cleaning a child (9%), and twice after caregiver toilet use (40%). The combined implication of data from observing oral contact behavior in children and hand hygiene of caregivers suggests that caregiver hand hygiene prior to feeding events and after cleaning a child are priority interventions.
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Affiliation(s)
- Emily Davis
- Department of International Health-Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Rose Evalyne Aseyo
- Department of Community Health and Development, Great Lakes University of Kisumu, Kisumu 40100, Kenya.
| | - Damaris Nelima Muganda
- Department of Community Health and Development, Great Lakes University of Kisumu, Kisumu 40100, Kenya.
| | - Kelly K Baker
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA 52333, USA.
| | - Jane Mumma
- Nutrition Department, School of Public Health, Great Lakes University of Kisumu, Kisumu 40100, Kenya.
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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27
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Wang Y, Moe CL, Null C, Raj SJ, Baker KK, Robb KA, Yakubu H, Ampofo JA, Wellington N, Freeman MC, Armah G, Reese HE, Peprah D, Teunis PFM. Multipathway Quantitative Assessment of Exposure to Fecal Contamination for Young Children in Low-Income Urban Environments in Accra, Ghana: The SaniPath Analytical Approach. Am J Trop Med Hyg 2017; 97:1009-1019. [PMID: 29031283 PMCID: PMC5637579 DOI: 10.4269/ajtmh.16-0408] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/21/2017] [Indexed: 11/07/2022] Open
Abstract
Lack of adequate sanitation results in fecal contamination of the environment and poses a risk of disease transmission via multiple exposure pathways. To better understand how eight different sources contribute to overall exposure to fecal contamination, we quantified exposure through multiple pathways for children under 5 years old in four high-density, low-income, urban neighborhoods in Accra, Ghana. We collected more than 500 hours of structured observation of behaviors of 156 children, 800 household surveys, and 1,855 environmental samples. Data were analyzed using Bayesian models, estimating the environmental and behavioral factors associated with exposure to fecal contamination. These estimates were applied in exposure models simulating sequences of behaviors and transfers of fecal indicators. This approach allows us to identify the contribution of any sources of fecal contamination in the environment to child exposure and use dynamic fecal microbe transfer networks to track fecal indicators from the environment to oral ingestion. The contributions of different sources to exposure were categorized into four types (high/low by dose and frequency), as a basis for ranking pathways by the potential to reduce exposure. Although we observed variation in estimated exposure (108-1016 CFU/day for Escherichia coli) between different age groups and neighborhoods, the greatest contribution was consistently from food (contributing > 99.9% to total exposure). Hands played a pivotal role in fecal microbe transfer, linking environmental sources to oral ingestion. The fecal microbe transfer network constructed here provides a systematic approach to study the complex interaction between contaminated environment and human behavior on exposure to fecal contamination.
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Affiliation(s)
- Yuke Wang
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Christine L. Moe
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Clair Null
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Suraja J. Raj
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kelly K. Baker
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Katharine A. Robb
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Habib Yakubu
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Joseph A. Ampofo
- Water Research Institute (WRI), Council for Scientific and Industrial Research (CSIR), Accra, Ghana
| | - Nii Wellington
- Training Research and Networking for Development (TREND Group), Accra, Ghana
| | - Matthew C. Freeman
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - George Armah
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana - Legon, Accra, Ghana
| | - Heather E. Reese
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dorothy Peprah
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Peter F. M. Teunis
- Center of Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Centre of Zoonoses and Environmental Microbiology, Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
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28
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Specht JM, Gadi VK, Gralow JR, Korde LA, Linden HM, Salazar LG, Rodler ET, Cundy A, Buening BJ, Baker KK, Redman MW, Kurland BF, Garrison MA, Smith JC, vanHaelst C, Anderson JE. Abstract P4-22-11: Combined targeted therapies for advanced triple negative breast cancer: A phase II trial of nab-paclitaxel and bevacizumab followed by maintenance targeted therapy with bevacizumab and erlotinib. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Chemotherapy remains the mainstay of therapy for patients with metastatic triple negative breast cancer (TNBC). We hypothesized that the addition of biologic agents targeting key pathways (bevacizumab targeting angiogenesis and erlotinib directed against EGFR) may prolong progression free survival (PFS) and offer a novel treatment strategy free from chemotherapy for patients with metastatic TNBC.
Methods: Patients with TNBC receiving initial therapy for metastatic disease were eligible for this multicenter phase II trial (NCT00733408) conducted at an academic center and affiliated, community practice sites. Induction therapy included nab-paclitaxel 100 mg/m2 IV Qweek (wk) and Bevacizumab 10 mg/kg IV Q2wks x 24 weeks. Patients free of progression at 24 wks began maintenance therapy with bevacizumab 10 mg/kg IV Q2wks and erlotinib 150 mg po daily until progression with radiographic assessment every 8 wks. Primary objective was PFS with secondary objectives of response rate, overall survival (OS) and safety. All eligible patients were included in the analysis of PFS and OS. Response was evaluated among patients with measurable disease by RECIST 1.1 with central review. Patients with inadequate disease assessments were coded as non-responders. Kaplan-Meier method was used to estimate PFS and OS with patients censored at date of last tumor assessment (PFS) or date of last follow up (OS).
Results: From April 2009 – December 2015, 58 patients (median age 54, range 33-83) were enrolled; 56 (97%) had measurable disease, and all had metastatic TNBC by local assessment. 33 (57%) patients completed induction; 22 (38%) came off study during induction; 3 (5%) continue on maintenance therapy. 4 patients discontinued therapy prior to first assessment. As of June 8, 2016, 53 patients (91%) have progressed. Median follow up for surviving patients is 14.5 months (range 4.1-65.4). Median PFS is 7.7 months (95% CI 5.7, 9.5). Of 56 patients with measurable disease, 38 (66%) had partial response (PR); 10 (17%) with stable disease for clinical benefit rate (CBR) of 86%. Median OS is 18.2 months (95% CI 16.3, 24.5). Most common grade 3-4 toxicities during induction were neutropenia [17 (29%), 1 grade 4], fatigue [13 (22%), all grade 3], leukopenia [7 (12%), all grade 3], and neuropathy [7 (12%), all grade 3]. Rash was most common ≥ grade 3 toxicity during maintenance [4 (7%), grade 3]. One patient experienced clinical CHF during maintenance month 16 requiring bevacizumab discontinuation. Conclusions: Nab-paclitaxel and bevacizumab followed by maintenance targeted therapy with bevacizumab and erlotinib was well tolerated. While the observed PFS did not meet pre-specified criteria of interest, the majority of patients experienced clinical benefit (86%) with 30 (57%) receiving maintenance targeted therapy. Correlative studies are ongoing. Supported by Genentech (OSI4266s), Celegene (AX-CL-BRST-PI-003828) and Janssen.
Citation Format: Specht JM, Gadi VK, Gralow JR, Korde LA, Linden HM, Salazar LG, Rodler ET, Cundy A, Buening BJ, Baker KK, Redman MW, Kurland BF, Garrison MA, Smith JC, vanHaelst C, Anderson JE. Combined targeted therapies for advanced triple negative breast cancer: A phase II trial of nab-paclitaxel and bevacizumab followed by maintenance targeted therapy with bevacizumab and erlotinib [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-11.
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Affiliation(s)
- JM Specht
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - VK Gadi
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - JR Gralow
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - LA Korde
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - HM Linden
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - LG Salazar
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - ET Rodler
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - A Cundy
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - BJ Buening
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - KK Baker
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - MW Redman
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - BF Kurland
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - MA Garrison
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - JC Smith
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - C vanHaelst
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
| | - JE Anderson
- University of Washington, Seattle, WA; UC Davis Comprehensive Cancer Center, Sacramento, CA; Seattle Cancer Care Alliance, Seattle, WA; Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA; Biostatistics, University of Pittsburgh, Pittsburgh, PA; Confluence Health, Wenatchee, WA; SCCA EvergreenHealth, Kirkland, WA; Katmai Oncology Group, Anchorage, AK
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Baker KK, O’Reilly CE, Levine MM, Kotloff KL, Nataro JP, Ayers TL, Farag TH, Nasrin D, Blackwelder WC, Wu Y, Alonso PL, Breiman RF, Omore R, Faruque ASG, Das SK, Ahmed S, Saha D, Sow SO, Sur D, Zaidi AKM, Quadri F, Mintz ED. Sanitation and Hygiene-Specific Risk Factors for Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study, 2007-2011: Case-Control Study. PLoS Med 2016; 13:e1002010. [PMID: 27138888 PMCID: PMC4854459 DOI: 10.1371/journal.pmed.1002010] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [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: 06/30/2015] [Accepted: 03/21/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diarrheal disease is the second leading cause of disease in children less than 5 y of age. Poor water, sanitation, and hygiene conditions are the primary routes of exposure and infection. Sanitation and hygiene interventions are estimated to generate a 36% and 48% reduction in diarrheal risk in young children, respectively. Little is known about whether the number of households sharing a sanitation facility affects a child's risk of diarrhea. The objective of this study was to describe sanitation and hygiene access across the Global Enteric Multicenter Study (GEMS) sites in Africa and South Asia and to assess sanitation and hygiene exposures, including shared sanitation access, as risk factors for moderate-to-severe diarrhea (MSD) in children less than 5 y of age. METHODS/FINDINGS The GEMS matched case-control study was conducted between December 1, 2007, and March 3, 2011, at seven sites in Basse, The Gambia; Nyanza Province, Kenya; Bamako, Mali; Manhiça, Mozambique; Mirzapur, Bangladesh; Kolkata, India; and Karachi, Pakistan. Data was collected for 8,592 case children aged <5 y old experiencing MSD and for 12,390 asymptomatic age, gender, and neighborhood-matched controls. An MSD case was defined as a child with a diarrheal illness <7 d duration comprising ≥3 loose stools in 24 h and ≥1 of the following: sunken eyes, skin tenting, dysentery, intravenous (IV) rehydration, or hospitalization. Site-specific conditional logistic regression models were used to explore the association between sanitation and hygiene exposures and MSD. Most households at six sites (>93%) had access to a sanitation facility, while 70% of households in rural Kenya had access to a facility. Practicing open defecation was a risk factor for MSD in children <5 y old in Kenya. Sharing sanitation facilities with 1-2 or ≥3 other households was a statistically significant risk factor for MSD in Kenya, Mali, Mozambique, and Pakistan. Among those with a designated handwashing area near the home, soap or ash were more frequently observed at control households and were significantly protective against MSD in Mozambique and India. CONCLUSIONS This study suggests that sharing a sanitation facility with just one to two other households can increase the risk of MSD in young children, compared to using a private facility. Interventions aimed at increasing access to private household sanitation facilities may reduce the burden of MSD in children. These findings support the current World Health Organization/ United Nations Children's Emergency Fund (UNICEF) system that categorizes shared sanitation as unimproved.
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Affiliation(s)
- Kelly K. Baker
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Occupational and Environmental Health, The University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
| | - Ciara E. O’Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Myron M. Levine
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - James P. Nataro
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Tracy L. Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tamer H. Farag
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Gates Foundation, Seattle, Washington, United States of America
| | - Dilruba Nasrin
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - William C. Blackwelder
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Yukun Wu
- Center for Vaccine Development, Departments of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Emergent BioSolutions, Gaithersburg, Maryland, United States of America
| | - Pedro L. Alonso
- Centre de Recerca en Salut Internacional de Barcelona, Hospital Clinic (CRESIB), Universitat de Barcelona, Barcelona, Spain, and Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- World Health Organization, Geneva, Switzerland
| | - Robert F. Breiman
- US Centers for Disease Control and Prevention, Nairobi, Kenya
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Richard Omore
- Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC), Kisumu, Kenya
| | - Abu S. G. Faruque
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Sumon Kumar Das
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
- The University of Queensland, Brisbane, Australia
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Debasish Saha
- Medical Research Council (United Kingdom), Fajara, The Gambia
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
- India Public Health Association and PATH India Office, New Delhi, India
| | - Anita K. M. Zaidi
- Gates Foundation, Seattle, Washington, United States of America
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan; Gates Foundation, Seattle, Washington, United States of America
| | - Fahreen Quadri
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan; Gates Foundation, Seattle, Washington, United States of America
| | - Eric D. Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Gretsch SR, Ampofo JA, Baker KK, Clennon J, Null CA, Peprah D, Reese H, Robb K, Teunis P, Wellington N, Yakubu H, Moe CL. Quantification of exposure to fecal contamination in open drains in four neighborhoods in Accra, Ghana. J Water Health 2016; 14:255-266. [PMID: 27105411 DOI: 10.2166/wh.2015.138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In low-income countries, rapid urbanization adds pressure to already stressed water and sanitation systems that are critical to the health of communities. Drainage networks, designed for stormwater but commonly used for disposing of waste, are rarely covered completely, allowing residents to easily come into contact with their contents. This study used spatial mapping, documentation of physical drain characteristics, microbiological analysis of drain samples, and behavioral observation to comprehensively examine drains as a route of exposure to fecal contamination in four low-income neighborhoods in Accra, Ghana. A stochastic model of six likely exposure scenarios was constructed to estimate children's exposure to drain water. Regardless of the age of the child, any exposure scenario considered resulted in exposure to a high level of fecal contamination. Fecal contamination levels in drains were high (Escherichia coli: geometric mean (GM), 8.60 cfu log(10)/100 mL; coliphage: GM, 5.56 pfu log(10)/100 mL), and did not differ by neighborhood or physical drain characteristics, indicating that frequency of contact with drains, and not drain type or location, drives exposure risk. To mitigate health risks associated with this exposure, drains should be covered, with priority given to large concrete and small to medium dirt-lined drains that children were most commonly observed entering.
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Affiliation(s)
- Stephanie R Gretsch
- Center for Global Safe Water, Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Joseph A Ampofo
- Council for Scientific and Industrial Research, Water Research Institute, Accra, Ghana
| | - Kelly K Baker
- Center for Global Safe Water, Department of Environmental Health, Emory University, Atlanta, GA, USA; Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA
| | - Julie Clennon
- Center for Global Safe Water, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Clair A Null
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: ; Mathematica Policy Research, Princeton, NJ, USA; Radcliffe Institute for Advanced Study, Cambridge, MA, USA
| | - Dorothy Peprah
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail:
| | - Heather Reese
- Center for Global Safe Water, Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Katharine Robb
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail:
| | - Peter Teunis
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail: ; Radcliffe Institute for Advanced Study, Cambridge, MA, USA; National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Nii Wellington
- Training Research and Networking for Development (TREND Group), Accra, Ghana
| | - Habib Yakubu
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail:
| | - Christine L Moe
- Center for Global Safe Water, Hubert Department of Global Health, Emory University, 1518 Clifton Rd NE, Suite 6050, Atlanta, GA 30322, USA E-mail:
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Affiliation(s)
- Bethany A Caruso
- Center For Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Varadan Sevilimedu
- Department of Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Isaac Chun-Hai Fung
- Department of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Archana Patkar
- Water Supply and Sanitation Collaborative Council, Geneva, Switzerland
| | - Kelly K Baker
- Department of Occupational and Environmental Health, College of Public Health, The University of Iowa, Iowa City, IA, USA.
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Padhi BK, Baker KK, Dutta A, Cumming O, Freeman MC, Satpathy R, Das BS, Panigrahi P. Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study. PLoS Med 2015; 12:e1001851. [PMID: 26151447 PMCID: PMC4511257 DOI: 10.1371/journal.pmed.1001851] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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: 01/10/2015] [Accepted: 05/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs). We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India. METHODS AND FINDINGS A prospective cohort of pregnant women (n = 670) in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation). A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4%) preterm births, 95 (14.2%) births with low birth weight, 11 (1.7%) spontaneous abortions, and six (0.9%) stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72-3.71), preterm birth (OR: 2.36; 95% CI: 1.54-3.62), and low birth weight (OR: 2.00; 95% CI: 1.24-3.23) were found to be significantly associated with open defecation practices. After adjustment for potential confounders such as maternal socio-demographic and clinical factors, open defecation was still significantly associated with increased odds of APOs (AOR: 2.38; 95% CI: 1.49-3.80) and preterm birth (AOR: 2.22; 95% CI: 1.29-3.79) but not low birth weight (AOR: 1.61; 95% CI: 0.94-2.73). The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the possibility of residual confounding should not be ruled out. We did not identify specific exposure pathways that led to the outcomes. CONCLUSIONS This study provides the first evidence, to our knowledge, that poor sanitation is associated with a higher risk of APOs. Additional studies are required to elucidate the socio-behavioural and/or biological basis of this association so that appropriate targeted interventions might be designed to support improved birth outcomes in vulnerable populations. While it is intuitive to expect that caste and poverty are associated with poor sanitation practice driving APOs, and we cannot rule out additional confounders, our results demonstrate that the association of poor sanitation practices (open defecation) with these outcomes is independent of poverty. Our results support the need to assess the mechanisms, both biological and behavioural, by which limited access to improved sanitation leads to APOs.
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Affiliation(s)
| | - Kelly K. Baker
- College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | | | - Oliver Cumming
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew C. Freeman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | | | - Pinaki Panigrahi
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail:
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Das P, Baker KK, Dutta A, Swain T, Sahoo S, Das BS, Panda B, Nayak A, Bara M, Bilung B, Mishra PR, Panigrahi P, Cairncross S, Torondel B. Menstrual Hygiene Practices, WASH Access and the Risk of Urogenital Infection in Women from Odisha, India. PLoS One 2015; 10:e0130777. [PMID: 26125184 PMCID: PMC4488331 DOI: 10.1371/journal.pone.0130777] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [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: 01/15/2015] [Accepted: 05/22/2015] [Indexed: 11/24/2022] Open
Abstract
Menstrual hygiene management (MHM) practices vary worldwide and depend on the individual’s socioeconomic status, personal preferences, local traditions and beliefs, and access to water and sanitation resources. MHM practices can be particularly unhygienic and inconvenient for girls and women in poorer settings. Little is known about whether unhygienic MHM practices increase a woman’s exposure to urogenital infections, such as bacterial vaginosis (BV) and urinary tract infection (UTI). This study aimed to determine the association of MHM practices with urogenital infections, controlling for environmental drivers. A hospital-based case-control study was conducted on 486 women at Odisha, India. Cases and controls were recruited using a syndromic approach. Vaginal swabs were collected from all the participants and tested for BV status using Amsel’s criteria. Urine samples were cultured to assess UTI status. Socioeconomic status, clinical symptoms and reproductive history, and MHM and water and sanitation practices were obtained by standardised questionnaire. A total of 486 women were recruited to the study, 228 symptomatic cases and 258 asymptomatic controls. Women who used reusable absorbent pads were more likely to have symptoms of urogenital infection (AdjOR=2.3, 95%CI1.5-3.4) or to be diagnosed with at least one urogenital infection (BV or UTI) (AdjOR=2.8, 95%CI1.7-4.5), than women using disposable pads. Increased wealth and space for personal hygiene in the household were protective for BV (AdjOR=0.5, 95%CI0.3-0.9 and AdjOR=0.6, 95%CI0.3-0.9 respectively). Lower education of the participants was the only factor associated with UTI after adjusting for all the confounders (AdjOR=3.1, 95%CI1.2-7.9). Interventions that ensure women have access to private facilities with water for MHM and that educate women about safer, low-cost MHM materials could reduce urogenital disease among women. Further studies of the effects of specific practices for managing hygienically reusable pads and studies to explore other pathogenic reproductive tract infections are needed.
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Affiliation(s)
- Padma Das
- Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India
| | - Kelly K. Baker
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Ambarish Dutta
- Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India
| | - Tapoja Swain
- Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India
| | - Sunita Sahoo
- Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India
| | - Bhabani Sankar Das
- Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India
| | - Bijay Panda
- Department of Obstetrics and gynaecology, Capital Hospital, Bhubaneswar, Odisha, India
| | - Arati Nayak
- Department of Obstetrics and gynaecology, Capital Hospital, Bhubaneswar, Odisha, India
| | - Mary Bara
- Department of Obstetrics and gynaecology, Ispat General Hospital, Rourkela, Odisha, India
| | - Bibiana Bilung
- Department of Obstetrics and gynaecology, Ispat General Hospital, Rourkela, Odisha, India
| | - Pravas Ranjan Mishra
- Disease Surveillance Laboratory, Asian Institute of Public health, Bhubaneswar, Odisha, India
| | - Pinaki Panigrahi
- Departments of Epidemiology and Pediatrics, Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Sandy Cairncross
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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34
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Baker KK, Dil Farzana F, Ferdous F, Ahmed S, Kumar Das S, Faruque ASG, Nasrin D, Kotloff KL, Nataro JP, Kolappaswamy K, Levine MM. Association between moderate-to-severe diarrhea in young children in the global enteric multicenter study (GEMS) and types of handwashing materials used by caretakers in Mirzapur, Bangladesh. Am J Trop Med Hyg 2014; 91:181-189. [PMID: 24778193 PMCID: PMC4080560 DOI: 10.4269/ajtmh.13-0509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 03/24/2014] [Indexed: 11/25/2022] Open
Abstract
Handwashing practices among caretakers of case and control children < 5 years of age enrolled in the Global Enteric Multicenter Study in Mirzapur, Bangladesh were characterized and analyzed for association with moderate-to-severe diarrhea. Soap or detergent ownership was common, yet 48% of case and 47.7% of control caretakers also kept ashes for handwashing, including 36.8% of the wealthiest households. Soap, detergent, and ash were used for multiple hygiene purposes and were kept together at handwashing areas. Caretakers preferred soap for handwashing, but frequently relied on ash, or a detergent/ash mixture, as a low-cost alternative. Moderate-to-severe diarrhea was equally likely for children of caretakers who kept soap versus those who kept ash (matched OR = 0.91; 0.62-1.32). Contact with ash and water reduced concentrations of bacterial enteropathogens, without mechanical scrubbing. Thus, washing hands with ash is a prevalent behavior in Mirzapur and may help diminish transmission of diarrheal pathogens to children.
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Affiliation(s)
- Kelly K. Baker
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; University of Virginia, Pediatrics, Charlottesville, Virginia; Harlan Laboratories Inc., Indianapolis, Indiana
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Baker KK, Sow SO, Kotloff KL, Nataro JP, Farag TH, Tamboura B, Doumbia M, Sanogo D, Diarra D, O'Reilly CE, Mintz E, Panchalingam S, Wu Y, Blackwelder WC, Levine MM. Quality of piped and stored water in households with children under five years of age enrolled in the Mali site of the Global Enteric Multi-Center Study (GEMS). Am J Trop Med Hyg 2013; 89:214-222. [PMID: 23836570 PMCID: PMC3741239 DOI: 10.4269/ajtmh.12-0256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 04/14/2013] [Indexed: 01/15/2023] Open
Abstract
Water, sanitation, and hygiene information was collected during a matched case-control study of moderate and severe diarrhea (MSD) among 4,096 children < 5 years of age in Bamako, Mali. Primary use of piped water (conditional odds ratio [cOR] = 0.45; 0.34-0.62), continuous water access (cOR = 0.30; 0.20-0.43), fetching water daily (cOR = 0.77; 0.63-0.96), and breastfeeding (cOR = 0.65; 0.49-0.88) significantly reduced the likelihood of MSD. Fetching water in > 30 minutes (cOR = 2.56; 1.55-4.23) was associated with MSD. Piped tap water and courier-delivered water contained high (> 2 mg/L) concentrations of free residual chlorine and no detectable Escherichia coli. However, many households stored water overnight, resulting in inadequate free residual chlorine (< 0.2 mg/L) for preventing microbial contamination. Coliforms and E. coli were detected in 48% and 8% of stored household water samples, respectively. Although most of Bamako's population enjoys access to an improved water source, water quality is often compromised during household storage.
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Affiliation(s)
- Kelly K. Baker
- Center for Vaccine Development, Departments of Medicine and Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland; Centre pour le Développement des Vaccins du Mali (CVD-Mali), Centre National d'Appui à la Lutte Contre la Maladie (ex-Institut Marchoux), Bamako, Mali; Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Baker KK, Levine MM, Morison J, Phillips A, Barry EM. CfaE tip mutations in enterotoxigenic Escherichia coli CFA/I fimbriae define critical human intestinal binding sites. Cell Microbiol 2009; 11:742-54. [PMID: 19207729 DOI: 10.1111/j.1462-5822.2009.01287.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Enterotoxigenic Escherichia coli (ETEC) use colonization factors to attach to the human intestinal mucosa, followed by enterotoxin expression that induces net secretion and diarrhoeal illness. ETEC strain H10407 expresses CFA/I fimbriae, which are composed of multiple CfaB structural subunits and a CfaE tip subunit. Currently, the contribution of these individual fimbrial subunits in intestinal binding remains incompletely defined. To identify the role of CfaE in attachment in the native ETEC background, an R181A single-amino-acid substitution was introduced by recombination into the H10407 genome. The substitution of R181A eliminated haemagglutination and binding of intestinal mucosa biopsies in in vitro organ culture assays, without loss of CFA/I fimbriae expression. Wild-type in trans plasmid-expressed cfaE restored the binding phenotype. In contrast, in trans expression of cfaE containing amino acid 181 substitutions with similar amino acids, lysine, methionine and glutamine did not restore the binding phenotype, indicating that the loss of the binding phenotype was due to localized areas of epitope disruption. R181 appears to have an irreplaceable role in the formation of a receptor-binding feature on CFA/I fimbriae. The results specifically indicate that the CfaE tip protein is a required binding factor in CFA/I-mediated ETEC colonization, making it a potentially important vaccine antigen.
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Affiliation(s)
- K K Baker
- Center for Vaccine Development, University of Maryland-Baltimore, 685 W. Baltimore St., Baltimore, MD 21201, USA
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Abstract
This study examined the effect of aging on respiratory and laryngeal mechanisms involved in vocal loudness control. Simultaneous measures of subglottal pressure and electromyographic (EMG) activity from the thyroarytenoid (TA), lateral cricoarytenoid (LCA), and cricothyroid (CT) muscles were investigated in young and old individuals while they attempted to phonate at three loudness levels, "soft," "comfortable," and "loud." Voice sound pressure level (SPL) and fundamental frequency (F ) measures were also obtained. Across loudness conditions, subglottal pressure levels were similar for both age groups. Laryngeal EMG measures tended to be lower and more variable for old compared with young individuals. These differences were most apparent for the TA muscle. Finally, across the three loudness conditions, the old individuals generated SPLs that were lower overall than those produced by the young individuals but modulated loudness levels in a manner similar to that of the young subjects. These findings suggest that the laryngeal mechanism may be more affected than the respiratory system in these old individuals and that these changes may affect vocal loudness levels.
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Affiliation(s)
- K K Baker
- University of Colorado-Boulder, The Wilbur James Gould Voice Center, Denver 80204, USA
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Nasir GA, Baker KK. Continuous double loop closure for midline laparotomy wounds. Saudi Med J 2001; 22:351-4. [PMID: 11331495] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To determine the efficiency of continuous double loop closure of midline laparotomy wounds and how it prevents and reduces wound dehiscence. METHODS A prospective study of one hundred patients who underwent laparotomy through midline incision in Basrah General Hospital over a one year period. This study is designed to compare the difference between 2 suturing techniques for closure of midline laparotomy wounds, one is new and unpopular to use, which is the continuous double loop closure, and the other one is the continuous mass closure technique. RESULTS By comparison of the 2 techniques, we found that infection of wounds was less using the continuous double loop closure technique (12%) as compared with the control (18%). We also found that wound dehiscence is nil with the continuous double loop closure technique as compared to 8% with the control. CONCLUSION The continuous double loop closure technique is superior in closure of midline laparotomy wounds and prevention of wound dehiscence and we recommend it for closure of these wounds in high risk patients.
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Affiliation(s)
- G A Nasir
- Department of Surgery, Saddam Medical City, Baghdad, Iraq
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Sapir S, Baker KK, Larson CR, Ramig LO. Short-latency changes in voice F0 and neck surface EMG induced by mechanical perturbations of the larynx during sustained vowel phonation. J Speech Lang Hear Res 2000; 43:268-76. [PMID: 10668668 DOI: 10.1044/jslhr.4301.268] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Nineteen healthy young adult males with normal voice and speech attempted to sustain the vowel /u/ at a constant pitch (target: 180 Hz) and a constant and comfortable loudness level while receiving a sudden mechanical perturbation to the larynx (thyroid prominence) via a servo-controlled probe. The probe moved toward or away from the larynx in a ramp-and-hold fashion (3.3-mm displacement, 0.7 N force, 20-ms rise time, 250-ms duration) as the subjects attempted to maintain a constant probe-larynx pressure. Eighty stimuli were applied in each direction, one stimulus per phonation. Pairs of surface electromyography (EMG) electrodes were attached to the skin of the anterior neck over laryngeal, infralaryngeal, and supralaryngeal areas. The rectified EMG signals, the voltage analog of the voice fundamental frequency (VAF0), and the voltage analog of the probe displacement were digitized and signal-averaged relative to the onset of the stimulus. Sudden perturbation of the larynx induced an instantaneous decrease or increase in VAF0, depending on the direction of the probe's movement, and a short-latency increase in the EMG (30-35 ms) and VAF0 (55-65 ms). We argue that the instantaneous VAF0 change was related to a mechanical effect, and the short-latency VAF0 and EMG changes to reflexogenic effects-the latter most likely associated with both intrinsic and extrinsic laryngeal sensorimotor mechanisms. Further physiological studies are needed to elucidate the sources of the VAF0 and EMG responses. Once elucidated, the present method may provide a powerful noninvasive tool for studying laryngeal neurophysiology. The theoretical and clinical implications of the present findings are addressed.
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Affiliation(s)
- S Sapir
- The Wilbur James Gould Voice Research Center, The Denver Center for the Performing Arts, CO 80204, USA.
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Abstract
OBJECTIVE To compare electromyographic (EMG) amplitudes of the thyroarytenoid (TA) muscle in young and older individuals and individuals with idiopathic PD (IPD) under conditions of known vocal loudness (sound pressure level). BACKGROUND Voice disorders frequently accompany aging and IPD, but it is unclear how laryngeal muscle physiology is affected by these processes and how changes in laryngeal muscle activity result in characteristic changes of the voice. METHODS Absolute and relative (to maximum) EMG amplitudes of the TA muscle were compared during speech and nonspeech tasks. Corresponding sound pressure level (SPL) measures were obtained for the speech tasks. RESULTS Absolute TA amplitudes were consistently the highest in the young individuals, lowest in the individuals with IPD, and intermediate in the older individuals. Relative TA amplitudes were generally the highest for the young individuals, lowest for the older individuals, and intermediate for the individuals with IPD. SPL findings showed the older individuals and individuals with IPD produced most of the speech tasks with comparable SPLs, and these levels were consistently lower than those of the young individuals. CONCLUSIONS Reduced levels of TA muscle activity may contribute to the characteristic hypophonic voice disorders that frequently accompany IPD and aging.
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Affiliation(s)
- K K Baker
- Denver Center for the Performing Arts, Wilbur J. Gould Voice Research Center, CO 80204, USA
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Baker KK, Ramig LO, Johnson AB, Freed CR. Preliminary voice and speech analysis following fetal dopamine transplants in 5 individuals with Parkinson disease. J Speech Lang Hear Res 1997; 40:615-626. [PMID: 9210118 DOI: 10.1044/jslhr.4003.615] [Citation(s) in RCA: 28] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A surgical procedure involving transplantation of fetal dopamine cells into the striatum of persons with advanced Parkinson disease (PD) has recently been performed in an attempt to alleviate Parkinsonian and drug-dose related symptoms (e.g., the "on-off" phenomena). Improvements in limb motor and neurological function, as well as less severe and shorter on-off episodes have been reported following fetal cell transplant (FCT) surgery. Acoustic, electroglottographic, and perceptual measures were analyzed pre- and post-surgery to determine if phonotory and articulatory function were affected by this relatively new form of treatment. In addition, speech and motor exam measures were compared to determine if similar directional changes across motor systems were apparent. Findings suggest that FCT surgery did not systematically influence voice and speech production. Also, it appears that FCT surgery may differentially affect phonatory, articulatory, and limb motor systems. Findings are discussed relative to these differential effects.
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Affiliation(s)
- K K Baker
- Wilbur James Gould Voice Research Center, Denver Center for the Performing Arts, CO, USA.
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Zaim M, Baker KK, Newson HD. Natural infection of the tree hole breeding mosquito Aedes triseriatus (Diptera: Culicidae) with the fungus Funicularius triseriatus. J Invertebr Pathol 1979; 34:199-202. [PMID: 575384 DOI: 10.1016/0022-2011(79)90102-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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