학술논문
Survey-Based Assessment of Water, Sanitation, and Animal-Associated Risk Factors for Moderate-to-Severe Diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) Study: The Gambia, Mali, and Kenya, 2015-2018.
Document Type
Academic Journal
Author
Berendes DM; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.; Fagerli K; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.; Kim S; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.; Nasrin D; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Powell H; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Kasumba IN; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Tennant SM; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Roose A; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Jahangir Hossain M; Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia.; Jones JCM; Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia.; Zaman SMA; Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia.; Omore R; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.; Ochieng JB; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.; Verani JR; Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya.; Widdowson MA; Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya.; Sow SO; Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.; Doh S; Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali.; Sugerman CE; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.; Mintz ED; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.; Kotloff KL; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Source
Publisher: Oxford University Press Country of Publication: United States NLM ID: 9203213 Publication Model: Print Cited Medium: Internet ISSN: 1537-6591 (Electronic) Linking ISSN: 10584838 NLM ISO Abbreviation: Clin Infect Dis Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Pediatric exposures to unsafe sources of water, unsafely managed sanitation, and animals are prevalent in low- and middle-income countries. In the Vaccine Impact on Diarrhea in Africa case-control study, we examined associations between these risk factors and moderate-to-severe diarrhea (MSD) in children <5 years old in The Gambia, Kenya, and Mali.
Methods: We enrolled children <5 years old seeking care for MSD at health centers; age-, sex-, and community-matched controls were enrolled at home. Conditional logistic regression models, adjusted for a priori confounders, were used to evaluate associations between MSD and survey-based assessments of water, sanitation, and animals living in the compound.
Results: From 2015 to 2018, 4840 cases and 6213 controls were enrolled. In pan-site analyses, children with drinking water sources below "safely managed" (onsite, continuously accessible sources of good water quality) had 1.5-2.0-fold higher odds of MSD (95% confidence intervals [CIs] ranging from 1.0 to 2.5), driven by rural site results (The Gambia and Kenya). In the urban site (Mali), children whose drinking water source was less available (several hours/day vs all the time) had higher odds of MSD (matched odds ratio [mOR]: 1.4, 95% CI: 1.1, 1.7). Associations between MSD and sanitation were site-specific. Goats were associated with slightly increased odds of MSD in pan-site analyses, whereas associations with cows and fowl varied by site.
Conclusions: Poorer types and availability of drinking water sources were consistently associated with MSD, whereas the impacts of sanitation and household animals were context-specific. The association between MSD and access to safely managed drinking water sources post-rotavirus introduction calls for transformational changes in drinking water services to prevent acute child morbidity from MSD.
Competing Interests: Potential conflicts of interest. H. P., R, O., S. O. S., and M. J. H. report receiving grant funding for their institution from the Bill and Melinda Gates Foundation. K. L. K. reports consultation fees and travel support from PATH and the University of Washington related to diarrheal diseases and grant support to her institution from the National Institutes of Health, Institut Pasteur, and the Bill & Melinda Gates Foundation. M. A. W. reports receiving salary pay from the Centers for Disease Control and Prevention and the Institute for Tropical Medicine. S. M. T. reports receiving grant funding for their institution from the Bill and Melinda Gates Foundation, National Institutes of Health, Wellcome Trust, Affinivax, Lumen Biosciences, PATH, and the Medical Research Council. They report receiving royalty payments related to intellectual property for the development of salmonella vaccines and klebsiella/Pseudomonas vaccines and consulting fees and travel support from the University of Washington, in addition to multiple planned, issued and pending patents. They hold an unpaid position on multiple committees with the American Society of Tropical Medicine and Hygiene. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
(Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.)
Methods: We enrolled children <5 years old seeking care for MSD at health centers; age-, sex-, and community-matched controls were enrolled at home. Conditional logistic regression models, adjusted for a priori confounders, were used to evaluate associations between MSD and survey-based assessments of water, sanitation, and animals living in the compound.
Results: From 2015 to 2018, 4840 cases and 6213 controls were enrolled. In pan-site analyses, children with drinking water sources below "safely managed" (onsite, continuously accessible sources of good water quality) had 1.5-2.0-fold higher odds of MSD (95% confidence intervals [CIs] ranging from 1.0 to 2.5), driven by rural site results (The Gambia and Kenya). In the urban site (Mali), children whose drinking water source was less available (several hours/day vs all the time) had higher odds of MSD (matched odds ratio [mOR]: 1.4, 95% CI: 1.1, 1.7). Associations between MSD and sanitation were site-specific. Goats were associated with slightly increased odds of MSD in pan-site analyses, whereas associations with cows and fowl varied by site.
Conclusions: Poorer types and availability of drinking water sources were consistently associated with MSD, whereas the impacts of sanitation and household animals were context-specific. The association between MSD and access to safely managed drinking water sources post-rotavirus introduction calls for transformational changes in drinking water services to prevent acute child morbidity from MSD.
Competing Interests: Potential conflicts of interest. H. P., R, O., S. O. S., and M. J. H. report receiving grant funding for their institution from the Bill and Melinda Gates Foundation. K. L. K. reports consultation fees and travel support from PATH and the University of Washington related to diarrheal diseases and grant support to her institution from the National Institutes of Health, Institut Pasteur, and the Bill & Melinda Gates Foundation. M. A. W. reports receiving salary pay from the Centers for Disease Control and Prevention and the Institute for Tropical Medicine. S. M. T. reports receiving grant funding for their institution from the Bill and Melinda Gates Foundation, National Institutes of Health, Wellcome Trust, Affinivax, Lumen Biosciences, PATH, and the Medical Research Council. They report receiving royalty payments related to intellectual property for the development of salmonella vaccines and klebsiella/Pseudomonas vaccines and consulting fees and travel support from the University of Washington, in addition to multiple planned, issued and pending patents. They hold an unpaid position on multiple committees with the American Society of Tropical Medicine and Hygiene. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
(Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.)