Reactivity in Rapidly Collected Hygiene and Toilet Spot Check Measurements: A Cautionary Note for Longitudinal Studies

Arnold, Benjamin F.; Khush, Ranjiv; Padmavathi, R; Rajkumar, Paramasivan; Natesan, Durairaj; Ramaprabha, P; Balakrishnan, Kalpana; Colford, John M.

doi:10.4269/ajtmh.14-0306

Cited by 27 publications

(20 citation statements)

References 8 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, geophagy may not be the only vector linking animal exposure to health outcomes. For example, a recent microbiological study of 24 rural villages conducted in Odisha, India, found that animal fecal matter was present in 83% of public water sources 39. Finally, although the Alive and Thrive surveys are advantageous in allowing us to control for a range of socioeconomic and hygiene factors that one would expect to be associated with both the presence of animal feces and nutrition outcomes (Table 3), it is still possible that our results are biased by unobserved confounding factors.…”

Section: Discussionmentioning

confidence: 99%

Is Exposure to Animal Feces Harmful to Child Nutrition and Health Outcomes? A Multicountry Observational Analysis

Headey

Nguyen

Kim

et al. 2017

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

It has recently been hypothesized that exposure to livestock constitutes a significant risk factor for diarrhea and environmental enteric disorder in young children, which may significantly contribute to undernutrition. To date, though, very little research has documented the extent of exposure to animal feces and whether this exposure is associated with child anthropometry in large samples and diverse settings. This study investigates these issues using data from the Alive and Thrive study conducted in rural areas of Ethiopia, Bangladesh, and Vietnam. These surveys used spot-checks to collect data on proxies of hygiene behaviors such as the cleanliness of mothers, young children, and the homestead environment, including the presence of animal feces. Animal feces were visible in 38–42% of household compounds across the three countries and were positively associated with household livestock ownership and negatively associated with maternal and child cleanliness. One-sided tests from multivariate least squares models for children 6–24 months of age indicate that the presence of animal feces is significantly and negatively associated with child height-for-age z scores in Ethiopia (β = −0.22), Bangladesh (β = −0.13), and in a pooled sample (β = −0.11), but not in Vietnam. There is also suggestive evidence that animal feces may be positively associated with diarrhea symptoms in Bangladesh. The results in this article, therefore, contribute to a growing body of evidence suggesting that animal ownership may pose a significant risk to child nutrition and health outcomes in developing countries.

show abstract

Section: Discussionmentioning

confidence: 99%

Is Exposure to Animal Feces Harmful to Child Nutrition and Health Outcomes? A Multicountry Observational Analysis

Headey

Nguyen

Kim

et al. 2017

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

show abstract

“…compared with control groups, 34 but three observations fail to support this hypothesis: reductions in diarrhoea were consistent with objectively measured reductions in Giardia spp infections; 35 reduc tions in diarrhoea occurred only during the seasonal monsoons, the periods of presumed highest transmission (ie, biological plausibility); 9 and interventions did not reduce reported bruising or abrasions (included in the morbidity history as negative control outcomes), a finding that suggests that courtesy bias in child illness symptoms was unlikely to explain the effects. We reviewed the evidence to date for the effect on diarrhoea of interventions promoting point-of-use water treatment and handwashing in low-income and middleincome countries.…”

Section: Table: Effect Of Intervention On Diarrhoea For Randomised Comentioning

confidence: 99%

The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhoea

Pickering

Null

Winch

et al. 2019

The Lancet Global Health

274

259

View full text Add to dashboard Cite

Child stunting is a global problem and is only modestly responsive to dietary interventions. Numerous observational studies have shown that water quality, sanitation, and handwashing (WASH) in a household are strongly associated with linear growth of children living in the same household. We have completed three randomised efficacy trials testing improved household-level WASH with and without improved infant and young child feeding (IYCF) on stunting and diarrhoea in Bangladesh, Kenya, and Zimbabwe. In all trials, improved IYCF had a statistically significant benefit, but WASH had no effect on linear growth. In observational analyses of data from the control groups of the three trials, baseline sanitation was a strong risk factor for stunting in the study populations, suggesting this frequently reported association might be confounded by unmeasured factors of household wellbeing. WASH interventions reduced diarrhoea in Bangladesh, but not in Kenya or Zimbabwe. Intervention promoters visited participants six times per month in Bangladesh compared with monthly in Kenya and Zimbabwe; a review of the literature shows that virtually all published studies that have reported an effect on diarrhoea through home-based water treatment and handwashing promotion achieved high adherence by visiting participants at daily to fortnightly intervals. Despite achieving substantial behavioural change and significant reduction in infection prevalence for some enteric pathogens, detection of enteropathogens among children in the WASH groups of the trials was typically at ten times higher prevalence compared with high-income countries. Considering these results, we recommend that future research in the WASH sector focus on developing and evaluating interventions that are radically more effective in reducing faecal contamination in the domestic environment than the interventions implemented in these trials.

show abstract

“…Spot-checks and latrine use indicators provide only an indication of household use, not individual use 10,11,15,16. Some evidence suggests that repeated spot-checks have potential to cause reactivity in longitudinal studies 17. Sensor-monitored use based on passive latrine use monitors (PLUMs) or similar devices are useful in assessing the reliability of other methods 14.…”

Section: Introductionmentioning

confidence: 99%

Assessing Latrine Use in Rural India: A Cross-Sectional Study Comparing Reported Use and Passive Latrine Use Monitors

Sinha

Nagel

Thomas

et al. 2016

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Although large-scale programs, like India's Total Sanitation Campaign (TSC), have improved latrine coverage in rural settings, evidence suggests that actual use is suboptimal. However, the reliability of methods to assess latrine use is uncertain. We assessed the reliability of reported use, the standard method, by comparing survey-based responses against passive latrine use monitors (PLUMs) through a cross-sectional study among 292 households in 25 villages in rural Odisha, India, which recently received individual household latrines under the TSC. PLUMs were installed for 2 weeks and householders responded to surveys about their latrine use behavior. Reported use was compared with PLUM results using Bland–Altman (BA) plots and concordance statistics. Reported use was higher than corresponding PLUM-recorded events across the range of comparisons. The mean reported “usual” daily events per household (7.09, 95% confidence interval [CI] = 6.51, 7.68) was nearly twice that of the PLUM-recorded daily average (3.62, 95% CI = 3.29, 3.94). There was poor agreement between “usual” daily latrine use and the average daily PLUM-recorded events (ρc = 0.331, 95% CI = 0.242, 0.427). Moderate agreement (ρc = 0.598, 95% CI = 0.497, 0.683) was obtained when comparing daily reported use during the previous 48 hours with the average daily PLUM count. Reported latrine use, though already suggesting suboptimal adoption, likely exaggerates the actual level of uptake of latrines constructed under the program. Where reliance on self-reports is used, survey questions should focus on the 48 hours prior to the date of the survey rather than asking about “usual” latrine use behavior.

show abstract

Reactivity in Rapidly Collected Hygiene and Toilet Spot Check Measurements: A Cautionary Note for Longitudinal Studies

Cited by 27 publications

References 8 publications

Is Exposure to Animal Feces Harmful to Child Nutrition and Health Outcomes? A Multicountry Observational Analysis

Is Exposure to Animal Feces Harmful to Child Nutrition and Health Outcomes? A Multicountry Observational Analysis

The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhoea

Assessing Latrine Use in Rural India: A Cross-Sectional Study Comparing Reported Use and Passive Latrine Use Monitors

Contact Info

Product

Resources

About