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
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 youn...
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| Veröffentlicht in: | PLoS medicine 2016-05, Vol.13 (5), p.e1002010 |
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| creator | Baker, Kelly K O'Reilly, Ciara E Levine, Myron M Kotloff, Karen L Nataro, James P Ayers, Tracy L Farag, Tamer H Nasrin, Dilruba Blackwelder, William C Wu, Yukun Alonso, Pedro L Breiman, Robert F Omore, Richard Faruque, Abu S G Das, Sumon Kumar Ahmed, Shahnawaz Saha, Debasish Sow, Samba O Sur, Dipika Zaidi, Anita K M Quadri, Fahreen Mintz, Eric D |
| description | 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.
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 |
| doi_str_mv | 10.1371/journal.pmed.1002010 |
| format | Article |
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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.
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.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1002010</identifier><identifier>PMID: 27138888</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Africa - epidemiology ; Asia - epidemiology ; Biology and Life Sciences ; Case-Control Studies ; Child, Preschool ; Children ; Diarrea ; Diarrhea ; Diarrhea - epidemiology ; Diarrhea - etiology ; Earth Sciences ; Ecology and Environmental Sciences ; Female ; Health aspects ; Health risk assessment ; Higiene ; Households ; Humans ; Hygiene ; Infant ; Infant, Newborn ; Infants ; Male ; Medicine and Health Sciences ; People and Places ; Risk Factors ; Sanitation - statistics & numerical data ; Studies</subject><ispartof>PLoS medicine, 2016-05, Vol.13 (5), p.e1002010</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Baker KK, O'Reilly CE, Levine MM, Kotloff KL, Nataro JP, Ayers TL, et al. (2016) 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 13(5): e1002010. doi:10.1371/journal.pmed.1002010</rights><rights>cc0 (c) Baker et al., 2016 info:eu-repo/semantics/openAccess <a href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</a></rights><rights>2016 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Baker KK, O'Reilly CE, Levine MM, Kotloff KL, Nataro JP, Ayers TL, et al. (2016) 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. 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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.
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.
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.</description><subject>Africa - epidemiology</subject><subject>Asia - epidemiology</subject><subject>Biology and Life Sciences</subject><subject>Case-Control Studies</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Diarrea</subject><subject>Diarrhea</subject><subject>Diarrhea - epidemiology</subject><subject>Diarrhea - etiology</subject><subject>Earth Sciences</subject><subject>Ecology and Environmental Sciences</subject><subject>Female</subject><subject>Health aspects</subject><subject>Health risk assessment</subject><subject>Higiene</subject><subject>Households</subject><subject>Humans</subject><subject>Hygiene</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infants</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>People 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Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baker, Kelly K</au><au>O'Reilly, Ciara E</au><au>Levine, Myron M</au><au>Kotloff, Karen L</au><au>Nataro, James P</au><au>Ayers, Tracy L</au><au>Farag, Tamer H</au><au>Nasrin, Dilruba</au><au>Blackwelder, William C</au><au>Wu, Yukun</au><au>Alonso, Pedro L</au><au>Breiman, Robert F</au><au>Omore, Richard</au><au>Faruque, Abu S G</au><au>Das, Sumon Kumar</au><au>Ahmed, Shahnawaz</au><au>Saha, Debasish</au><au>Sow, Samba O</au><au>Sur, Dipika</au><au>Zaidi, Anita K M</au><au>Quadri, Fahreen</au><au>Mintz, Eric D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2016-05-03</date><risdate>2016</risdate><volume>13</volume><issue>5</issue><spage>e1002010</spage><pages>e1002010-</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>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.
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.
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>27138888</pmid><doi>10.1371/journal.pmed.1002010</doi><tpages>19</tpages><orcidid>https://orcid.org/0000-0002-3774-2628</orcidid><orcidid>https://orcid.org/0000-0003-4140-3263</orcidid><orcidid>https://orcid.org/0000-0003-4159-0097</orcidid><orcidid>https://orcid.org/0000-0001-8174-9643</orcidid><orcidid>https://orcid.org/0000-0002-2747-5685</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2016-05, Vol.13 (5), p.e1002010 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_1797497765 |
| source | MEDLINE; Public Library of Science; Recercat; PubMed Central; Directory of Open Access Journals; EZB Electronic Journals Library |
| subjects | Africa - epidemiology Asia - epidemiology Biology and Life Sciences Case-Control Studies Child, Preschool Children Diarrea Diarrhea Diarrhea - epidemiology Diarrhea - etiology Earth Sciences Ecology and Environmental Sciences Female Health aspects Health risk assessment Higiene Households Humans Hygiene Infant Infant, Newborn Infants Male Medicine and Health Sciences People and Places Risk Factors Sanitation - statistics & numerical data Studies |
| title | 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 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T16%3A02%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Sanitation%20and%20Hygiene-Specific%20Risk%20Factors%20for%20Moderate-to-Severe%20Diarrhea%20in%20Young%20Children%20in%20the%20Global%20Enteric%20Multicenter%20Study,%202007-2011:%20Case-Control%20Study&rft.jtitle=PLoS%20medicine&rft.au=Baker,%20Kelly%20K&rft.date=2016-05-03&rft.volume=13&rft.issue=5&rft.spage=e1002010&rft.pages=e1002010-&rft.issn=1549-1676&rft.eissn=1549-1676&rft_id=info:doi/10.1371/journal.pmed.1002010&rft_dat=%3Cgale_plos_%3EA479531536%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1797497765&rft_id=info:pmid/27138888&rft_galeid=A479531536&rft_doaj_id=oai_doaj_org_article_e0dafca353de4aa48430e6adc774d0ad&rfr_iscdi=true |