This intervention significantly reduced symptomatic Vibrio cholerae infection.

Background Culturing is generally considered to be the gold standard for detecting Vibrio cholerae in stool, though it is not always feasible in resource-limited settings. The Crystal VC dipstick test allows for rapid stool testing for the diagnosis of cholera in the field. However, previous studies have found low specificities (49%–79%) associated with direct testing of stool for cholera using this kit when compared to culturing. Methods In the present study conducted in Dhaka, Bangladesh in 2013, we compare direct testing using the Crystal VC dipstick test and testing after enrichment for 6-hours in Alkaline Peptone Water (APW) to bacterial culture as the gold standard. Samples positive by dipstick but negative by culture were also tested using PCR. Results Stool was collected from 125 patients. The overall specificities of the direct testing and testing after 6-hour enrichment in APW compared to bacterial culture were 91.8% and 98.4% (p=0.125) respectively, and the sensitivities were 65.6% and 75.0% (p=0.07), respectively. Conclusion The increase in the sensitivity of the Crystal VC kit with the use of the 6 hour enrichment step in APW compared to direct testing was marginally significant. The Crystal VC dipstick was found to have a much higher specificity than previously reported (91–98%). Therefore this method provides a promising screening tool for cholera outbreak surveillance in resource limited settings where elimination of false positive results is critical.

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Abstract. Diarrhea is the second leading cause of death in children under 5 years of age globally. The time patients and caregivers spend at a health facility for severe diarrhea presents the opportunity to deliver water, sanitation, and hygiene (WASH) interventions. We recently developed Cholera-Hospital-Based Intervention for 7 days (CHoBI7), a 1-week hospital-based handwashing with soap and water treatment intervention, for household members of cholera patients. To investigate if this intervention could lead to sustained WASH practices, we conducted a follow-up evaluation of 196 intervention household members and 205 control household members enrolled in a randomized controlled trial of the CHoBI7 intervention 6 to 12 months post-intervention. Compared with the control arm, the intervention arm had four times higher odds of household members' handwashing with soap at a key time during 5-hour structured observation (odds ratio [OR]: 4.71, 95% confidence interval [CI]: 2.61, 8.49) (18% versus 50%) and a 41% reduction in households in the World Health Organization very high-risk category for stored drinking water (OR: 0.38, 95% CI: 0.15, 0.96) (58% versus 34%) 6 to 12 months post-intervention. Furthemore, 71% of observed handwashing with soap events in the intervention arm involved the preparation and use of soapy water, which was promoted during the intervention, compared to 9% of control households. These findings demonstrate that the hospital-based CHoBI7 intervention can lead to significant increases in handwashing with soap practices and improved stored drinking water quality 6 to 12 months post-intervention.

BackgroundThe gut of human harbors diverse commensal microbiota performing an array of beneficial role for the hosts. In the present study, the major commensal gut bacteria isolated by culturing methods from 15 children of moderate income families, aged between 10 and 24 months, were studied for their response to different antibiotics, and the molecular basis of drug resistance.ResultsOf 122 bacterial colonies primarily selected from Luria–Bertani agar, bacterial genera confirmed by analytical profile index (API) 20E® system included Escherichia as the predominant (52%) organism, followed by Enterobacter (16%), Pseudomonas (12%), Klebsiella (6%), Pantoea (6%), Vibrio (3%), and Citrobacter (3%); while Aeromonas and Raoultella were identified as the infrequently occurring genera. An estimated 11 and 22% of the E. coli isolates carried virulence marker genes stx-2 and eae, respectively. Antimicrobial susceptibility assay revealed 78% of the gut bacteria to be multidrug resistant (MDR) with highest resistance to erythromycin (96%), followed by ampicillin (63%), tetracycline (59%), azithromycin (53%), sulfamethoxazole-trimethoprim (43%), cefixime (39%), and ceftriaxone (33%). PCR assay results revealed 56% of the gut bacteria to possess gene cassette Class 1 integron; while 8, 17.5 and 6% of the strains carried tetracycline resistance-related genes tetA, tetB, and tetD, respectively. The macrolide (erythromycin and azithromycin) resistance marker genes mphA, ereB, and ermB were found in 28, 3 and 5% of bacterial isolates, respectively; while 26, 12, 17, 32, 7, 4 and 3% of the MDR bacterial isolates carried the extended spectrum β-lactamase (ESBL)-related genes e.g., bla TEM, bla SHV, bla CMY-9, bla CTX-M1, bla CTX-M2, bla CMY-2 and bla OXA respectively. Majority of the MDR gut bacteria harbored large plasmids [e.g., 140 MDa (43%), 105 MDa (30%), 90 MDa (14%)] carrying invasion and related antibiotic resistance marker genes.ConclusionsOur results suggest gut of young Bangladeshi children to be an important reservoir for multi-drug resistant pathogenic bacteria carrying ESBL related genes.

Background The Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) mobile health (mHealth) program was a cluster-randomized controlled trial of diarrhea patient households conducted in Dhaka, Bangladesh. Methods Patients were block-randomized to three arms: standard recommendation on oral rehydration solution use; health facility delivery of CHoBI7 plus mHealth (no home visits); and health facility delivery of CHoBI7 plus two home visits and mHealth. The primary outcome was reported diarrhea in the past two weeks collected monthly for 12 months. The secondary outcomes were stunting, underweight, and wasting at a 12 month follow-up. Analysis was intention-to-treat. The trial is registered at ClinicalTrials.gov (NCT04008134). Results Between December 4, 2016 and April 26, 2018, 2626 participants in 769 households were randomly allocated to three arms: 849 participants to standard message, 886 to mHealth with no home visits, and 891 to mHealth with two home visits. Children under five years had significantly lower 12-month diarrhea prevalence in both the mHealth with two home visits arm (Prevalence Ratio(PR): 0.73 (95% Confidence Interval(CI): 0.61, 0.87)) and the mHealth with no home visits arm (PR: 0.82 (95% CI: 0.69, 0.97)). Children under 2 years were significantly less likely to be stunted in both the mHealth with two home visits arm (33% vs. 45%, Odds Ratio(OR): 0.55, 95% CI: 0.31, 0.97) and the mHealth with no home visits arm (32% vs. 45%, OR: 0.54, 95% CI: 0.31, 0.96) compared to children in the standard message arm. Conclusion The CHoBI7 mHealth program lowered pediatric diarrhea and stunting among diarrhea patient households.

Household contacts of cholera patients are at a 100 times higher risk of a infection than the general population. To examine risk factors for infections and investigate intervention strategies among this population, we followed household contacts of cholera patients for the 1-week high-risk period after the index patient obtained care. This study was nested within a randomized controlled trial of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7), a handwashing with soap and water treatment intervention in Dhaka, Bangladesh. Rectal swab results were available from 320 household contacts of cholera patients at five time points over a 1-week period. Fecal and water samples were analyzed for by bacterial culture. All analyses were stratified by study arm. Within the intervention arm, stored household drinking water with a median free chlorine concentration below 0.5 mg/L was associated with a three times higher odds of a cholera infection (odds ratio [OR]: 3.0; 95% confidence interval [CI]: 1.32, 6.63). In the control arm, having in stored water was associated with a significantly higher odds of a symptomatic cholera infection (OR: 8.66; 95% CI: 2.11, 35.48). No association was found between observed handwashing with soap at food and stool-related events and infections. Stored household drinking water with detectable and chlorine concentrations below the World Health Organization guideline were found to be important risk factors for cholera infection among household contacts of cholera patients. These findings emphasize the need for water treatment interventions targeting this high risk population.