Impact of an Urban Sanitation Intervention on Enteric Pathogen Detection in Soils

Environmental fecal contamination is common in many low-income cities, contributing to a high burden of enteric infections and associated negative sequelae. To evaluate the impact of a shared onsite sanitation intervention in Maputo, Mozambique on enteric pathogens in the domestic environment, we collected 179 soil samples at shared latrine entrances from intervention (n= 49) and control (n= 51) compounds during baseline (pre-intervention) and after 24 months (post-intervention) as part of the Maputo Sanitation Trial. We tested soils for the presence of nucleic acids associated with 20 enteric pathogens using a multiplex reverse transcription qPCR platform. We detected at least one pathogen-associated target in 91% (163/179) of soils and a median of 3 (IQR=1.5, 5) pathogens. Using a difference-in-difference analysis and adjusting for compound population, visibly wet soil, sun exposure, wealth, temperature, animal presence, and visible feces, we estimate the intervention reduced the probability of ≥1 pathogen detected by 15% (adjusted prevalence ratio, aPR=0.85; 95% CI: 0.70, 1.0) and the total number of pathogens detected by 35% (aPR =0.65; 0.44, 0.95) in soil 24 months following the intervention. These results suggest that the intervention reduced the presence of some fecal contamination in the domestic environment, but pathogen detection remained prevalent 24-months following the introduction of new latrines.

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Associations between enteric pathogen carriage and height-for-age, weight-for-age and weight-for-height in children under 5 years old in urban Dhaka, Bangladesh

Epidemiology and Infection ◽

10.1017/s0950268820000369 ◽

2020 ◽

Vol 148 ◽

Author(s):

David Berendes ◽

Drew Capone ◽

Jackie Knee ◽

David Holcomb ◽

Sonia Sultana ◽

...

Keyword(s):

Low Income ◽

Pathogen Detection ◽

Controlled Trial ◽

Prevalence Ratio ◽

Enteric Pathogen ◽

Enteric Pathogens ◽

Related Factors ◽

Environmental Interventions ◽

Height For Age ◽

Weight For Age

Abstract Nutritional factors and infectious agents may contribute to paediatric growth deficits in low- and middle-income countries; however, the contribution of enteric pathogens is only beginning to be understood. We analysed the stool from children <5 years old from an open cohort, cluster-randomised controlled trial of a point-of-collection water chlorinator in urban Bangladesh. We compared the presence/absence of 15 enteric pathogens detected via multiplex, molecular methods in the stool with concurrent Z-scores/Z-score cut-offs (−2 standard deviations (s.d.)) for height-for-age (HAZ/stunting), weight-for-age (WAZ/underweight) and weight-for-height (WHZ/wasting), adjusted for sociodemographic and trial-related factors, and measured caregiver-reported diarrhoea. Enteric pathogen prevalence in the stool was high (88% had ≥1 enteric pathogen, most commonly Giardia spp. (40%), Salmonella enterica (33%), enterotoxigenic E. coli (28%) and Shigella spp. (27%)) while reported 7-day diarrhoea prevalence was 6%, suggesting high subclinical infection rates. Many children were stunted (26%) or underweight (24%). Adjusted models suggested Giardia spp. detection was associated with lower HAZ (−0.22 s.d., 95% CI −0.44 to 0.00; prevalence ratio for stunting: 1.39, 95% CI 0.94–2.06) and potentially lower WAZ. No pathogens were associated with reported diarrhoea in adjusted models. Giardia spp. carriage may be associated with growth faltering, but not diarrhoea, in this and similar low-income settings. Stool-based enteric pathogen detection provides a direct indication of previous exposure that may be useful as a broader endpoint of trials of environmental interventions.

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Somewhere to go: Assessing the impact of public restroom interventions on reports of open defecation in San Francisco, California from 2014 to 2020

10.21203/rs.3.rs-936620/v1 ◽

2021 ◽

Author(s):

Heather Kathleen Amato ◽

Douglas Martin ◽

Christopher Michael Hoover ◽

Jay Paul Graham

Keyword(s):

Public Health ◽

San Francisco ◽

Fecal Contamination ◽

The United States ◽

Public Health Issue ◽

Intervention Period ◽

Interrupted Time Series Analysis ◽

Post Intervention ◽

Open Defecation ◽

The Impact

Abstract Background Open defecation due to a lack of access to sanitation facilities remains a public health issue in the United States. People experiencing homelessness face barriers to accessing sanitation facilities, and are often forced to practice open defecation on streets and sidewalks. Exposed feces may contain harmful pathogens posing a significant threat to public health, especially among unhoused persons living near open defecation sites. The City of San Francisco’s Department of Public Works implemented the Pit Stop Program to provide the unhoused and the general public with improved access to sanitation with the goal of reducing fecal contamination on streets and sidewalks. The objective of this study was to assess the impact of these public restroom interventions on reports of exposed feces in San Francisco, California. Methods We evaluated the impact of various public restroom interventions implemented from January 1, 2014 to January 1, 2020 on reports of exposed feces, captured through a 311 municipal service. Publicly available 311 reports of exposed feces were spatially and temporally matched to 31 Pit Stop restroom interventions in ten San Francisco neighborhoods. We conducted an interrupted time-series analysis to compare pre- versus post-intervention rates of feces reports near the restrooms. Results Feces reports declined by 12.47 reports per week after the installation of 13 Pit Stop restrooms (p-value = 0.0002). The rate of reports per week declined from the six-month pre-intervention period to the post-intervention period (slope change=-0.024 [95% CI=-0.033, -0.014]). Reports also declined after new restroom installations in the Mission and Golden Gate Park, and after the provision of attendants in the Mission, Castro/Upper Market, and Financial District/South Beach. Conclusions Increased access to public toilets and the addition of restroom attendants reduced fecal contamination in San Francisco, especially in neighborhoods with people experiencing homelessness. Programs that improve access to public restrooms should be evaluated at the neighborhood level in order to tailor sanitation interventions to neighborhood-specific needs.

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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 Infectious Diseases ◽

10.1186/s12879-019-4657-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Jane Mumma ◽

Sheillah Simiyu ◽

Evalyne Aseyo ◽

John Anderson ◽

Alexandra Czerniewska ◽

...

Keyword(s):

Low Income ◽

Controlled Trial ◽

Infant Food ◽

Food Hygiene ◽

Randomized Controlled ◽

Hygiene Intervention ◽

Enteric Infections ◽

Cluster Randomized ◽

Start Trial ◽

The Impact

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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The impact of a multi-component physical activity programme in low-income elementary schools

Health Education Journal ◽

10.1177/0017896917700681 ◽

2017 ◽

Vol 76 (5) ◽

pp. 517-530 ◽

Cited By ~ 14

Author(s):

William V Massey ◽

Megan B Stellino ◽

Megan Holliday ◽

Travis Godbersen ◽

Rachel Rodia ◽

...

Keyword(s):

Physical Activity ◽

Elementary Schools ◽

Low Income ◽

Training Programme ◽

Fifth Grade ◽

Positive Interactions ◽

Post Intervention ◽

Beneficial Effects ◽

Fifth Grade Students ◽

The Impact

Objective: To identify the effects of a structured and multifaceted physical activity and recess intervention on student and adult behaviour in school. Design: Mixed-methods and community-based participatory approach. Setting: Large, urban, low-income school district in the USA. Methods: Data were collected at three time points over a 1-year period. Sources included recess observations at four elementary schools, in-class behavioural observations of fifth-grade students ( n = 21) and focus groups with fourth- and fifth-grade students ( n = 75). Results: Results suggested an increased amount of positive interactions between adults and students and a decreased amount of conflict in the playground post intervention. Results also suggested that a peer-leadership training programme had beneficial effects on students’ classroom behaviour. Conclusion: Results from this study provide evidence that school recess can be used to teach social–emotional competencies that can impact student behaviour during recess and in the classroom.

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Effects of an urban sanitation intervention on childhood enteric infection and diarrhoea in Mozambique

10.1101/2020.08.20.20178608 ◽

2020 ◽

Author(s):

Jackie Knee ◽

Trent Sumner ◽

Zaida Adriano ◽

Claire Anderson ◽

Farran Bush ◽

...

Keyword(s):

Low Income ◽

Urban Areas ◽

Critical Infrastructure ◽

Controlled Trial ◽

Prevalence Ratio ◽

Low Income Countries ◽

Enteric Infection ◽

Urban Sanitation ◽

Protozoan Infection ◽

The Impact

Background. Onsite sanitation serves more than 740 million people in urban areas, primarily in low-income countries. Although this critical infrastructure may play an important role in controlling enteric infections in high-burden settings, its health impacts have never been evaluated in a controlled trial. Methods. We conducted a controlled before and after trial to evaluate the impact an onsite urban sanitation intervention on the prevalence of bacterial and protozoan infection (primary outcome), soil transmitted helminth (STH) re-infection, and seven-day period prevalence of diarrhoea among children living in informal neighborhoods of Maputo, Mozambique. A non-governmental organization replaced existing shared latrines in poor condition with engineered pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1-48 months at baseline and measured outcomes before the intervention and at 12 and 24 months following intervention. We measured outcomes concurrently among children served by the sanitation improvements and those in a comparable control arm served by existing poor sanitation. The trial was registered at ClinicalTrials.gov, number NCT02362932. Findings. At baseline, we enrolled 454 children from 208 intervention clusters and 533 children from 287 control clusters. We enrolled or re-visited 462 intervention and 477 control children 12 months 60 after intervention and 502 intervention and 499 control children 24 months after intervention. Despite nearly exclusive use of the intervention, we found no evidence that engineered onsite sanitation affected the overall prevalence of any measured bacterial or protozoan infection (12-month adjusted prevalence ratio 1.05, 95% CI [0.95-1.16]; 24-month adjusted prevalence ratio 0.99, 95% CI [0.91-1.09]), any STH re-infection (1.11 [0.89-1.38]; 0.95 [0.77-1.17]), or diarrhoea (1.69 [0.89-3.21]; 0.84 [0.47-1.51]) after 12 or 24 months of exposure. Among children born into study sites after the intervention and measured at the 24-month visit, we observed a reduced prevalence of any STH re-infection of 49% (adjusted prevalence ratio 0.51 [95% confidence interval 0.27 - 0.95]), Trichuris of 76% (0.24 [0.10 - 0.60]), and Shigella infection by 51% (0.49 [0.28-0.85]) relative to the same age group at baseline. Interpretation. The intervention did not reduce the overall prevalence of enteric infection and diarrhoea among all enrolled children but may have substantially reduced the prevalence of STHs and Shigella among children born into clusters with sanitary improvements.

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Smoking Urges During Treatment and Long-Term Cessation among Low-Income African Americans

Ethnicity & Disease ◽

10.18865/ed.27.4.395 ◽

2017 ◽

Vol 27 (4) ◽

pp. 395 ◽

Cited By ~ 1

Author(s):

Monica Webb Hooper ◽

Noella A. Dietz ◽

Joseph C. Wilson

Keyword(s):

African Americans ◽

Low Income ◽

Group Intervention ◽

Smoking Status ◽

Nicotine Patch ◽

Post Intervention ◽

Patch Use ◽

Status Assessment ◽

The Impact

Objective: The urge to smoke is a predictor of smoking relapse. Little research has focused on the impact of acute urges during treatment among African Americans. This study examined the relationship between smoking urges and long-term abstinence among treatment seekers. Design: Longitudinal prospective investigation. Urges to smoke were assessed at the initial (session 1) and final (session 8) sessions among adult smokers (N=308) enrolled in a 4-week group intervention trial. Nicotine patch use was assessed over 30 days. Main Outcome Measures: Biochemically verified 7-day point prevalence abstinence (7-day ppa) was assessed immediately postintervention, and at 3-, 6-, and 12-month follow-ups. Hierarchical logistic regressions tested associations between session 1 and session 8 urges and 7-day ppa at each smoking status assessment. Results: There was a significant overall decrease in smoking urges (M=29, SD=15 at session 1; M=17, SD=11 at session 8). After controlling for covariates, urges to smoke at session 1 were unrelated to 7-day ppa at any of the assessment points. However, session 8 urges were inversely associated with 7-day ppa post-intervention (AOR=.94, CI:.92-.97), at 3-months (AOR=.93, CI: .89-.97), 6-months (AOR=.93, CI: .90-.97), and 12-months (AOR=.96, CI: .96-.99). Nicotine patch use was positively associated with 7-day ppa at each assessment. Conclusions: The most robust predictors of abstinence through 12-months postintervention were decreased urges over the 4-week, 8-session group intervention and the frequency of nicotine patch use. Interventions aimed at addressing the needs of African American smokers should address urges and encourage nicotine replacement adherence to increase abstinence rates.Ethn Dis. 2017;27(4):395-402; doi:10.18865/ ed.27.4.395.

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Can Digital Technologies Play a Role in Improving Children’s Learning Outcomes in India?

Journal of Development Policy and Practice ◽

10.1177/2455133317736234 ◽

2017 ◽

Vol 3 (1) ◽

pp. 55-86

Author(s):

Sashwati Banerjee ◽

Sujoy Chakravarty ◽

Ira Joshi ◽

Siddharth Pillai

Keyword(s):

Learning Outcomes ◽

Low Income ◽

Community Intervention ◽

Educational Interventions ◽

Third Graders ◽

School Intervention ◽

New Delhi ◽

Post Intervention ◽

Government Schools ◽

The Impact

In this study, we explore the effects of an educational intervention in the form of digital games targeted towards improving the learning outcomes in mathematics and Hindi language among first, second and third graders in four government schools in southern New Delhi. In addition to administering these games in the classroom, we randomly recruited 40 households from a low-income community, where children play the games as an extra-curricular activity. We measure the improvement in aptitude in math and Hindi pre- and post-intervention, using various demographic controls and find that the community intervention had some impact in boosting aptitude. In contrast, the school intervention did not show the desired results though it did register some improvement in children’s knowledge. Using qualitative observation coupled with the quantitative assessment of impact, we attempt to deconstruct the various infrastructural challenges and sampling issues posed in our school intervention, and identify key features that need to be adhered to for future researchers who may want to assess the impact of educational interventions on young children from underprivileged backgrounds in India.

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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

10.21203/rs.2.14053/v2 ◽

2019 ◽

Author(s):

Jane Awiti Odhiambo Mumma ◽

Sheillah Simiyu ◽

Evalyne Aseyo ◽

John Anderson ◽

Alexandra Czerniewska ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Low Income ◽

Controlled Trial ◽

Infant Food ◽

Food Hygiene ◽

Randomized Controlled ◽

Hygiene Intervention ◽

Enteric Infections ◽

Cluster Randomized ◽

The Impact

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, especially in low-income urban settings. 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 targets 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; 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 trial seeks to provide new evidence as to whether a locally appropriate infant food hygiene intervention delivered through the extension system can improve the health of young children.

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Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000210 ◽

2014 ◽

Vol 84 (5-6) ◽

pp. 244-251 ◽

Cited By ~ 2

Author(s):

Robert J. Karp ◽

Gary Wong ◽

Marguerite Orsi

Keyword(s):

Low Income ◽

Energy Content ◽

Food Selection ◽

The United States ◽

United States Department ◽

Micronutrient Deficiencies ◽

Caloric Density ◽

Low Income Families ◽

The Cost ◽

The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

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