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
Year: 2016
Type: article
Study design: Observational Study
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.
Source: PLoS Medicine
Authors: Kelly K. Baker, Ciara E. O’Reilly, Myron M. Levine, Karen L. Kotloff, James P. Nataro, Tracy L. Ayers, Tamer H. Farag, Dilruba Nasrin, William C. Blackwelder, Yukun Wu, Pedro L. Alonso, Robert F. Breiman, Richard Omore, Abu S. G. Faruque, Sumon Kumar Das, Shahnawaz Ahmed, Debasish Saha, Samba O. Sow, Dipika Sur, Anita K. M. Zaidi, Fahreen Quadri, Eric D. Mintz
Institutions: University of Iowa, University of Maryland, Baltimore, Centers for Disease Control and Prevention, University of Virginia, Gates Foundation, Emergent BioSolutions (United States), World Health Organization, Manhiça Health Research Centre, Universitat de Barcelona, Emory University, Centers for Disease Control and Prevention, Emory Global Health Institute, Kenya Medical Research Institute, International Centre for Diarrhoeal Disease Research, The University of Queensland, Medical Research Council, Centre Pour le Développement des Vaccins-Mali, Program for Appropriate Technology in Health, National Institute of Cholera and Enteric Diseases, Aga Khan University
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $6,460
OpenAlex ID: W2345868033