Bacterial Contamination on Household Toys and Association with Water, Sanitation and Hygiene Conditions in Honduras

Stauber, Christine E.; Walters, Adam; Aceituno, Anna; Sobsey, Mark D.

doi:10.3390/ijerph10041586

Cited by 18 publications

(18 citation statements)

References 19 publications

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“…This finding affirms the current strategy of the WHO and UNICEF to promote POU water treatment and safe storage, even though this will not increase the number of households with access to improved water supplies and therefore will not contribute towards achieving current international water targets (WHO 2011). The effectiveness of POU interventions in settings without improved sanitation contradicts earlier findings that interventions to improve water quality are effective only where sanitation has already been addressed (Esrey 1986; VanDerslice 1995), or that environmental interventions to prevent diarrhoea are effective only by employing an integrated approach (Eisenberg 2007). …”

Section: Discussionmentioning

confidence: 63%

Interventions to improve water quality for preventing diarrhoea

Clasen

Alexander

Sinclair

et al. 2015

Cochrane Database of Systematic Reviews

247

159

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BackgroundDiarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces.In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home.ObjectivesTo assess the effectiveness of interventions to improve water quality for preventing diarrhoea.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014.Selection criteriaRandomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults.Data collection and analysisTwo review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach.Main resultsForty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with unimproved water sources (30 studies) and unimproved or unclear sanitation (34 studies). The primary outcome in most studies was self-reported diarrhoea, which is at high risk of bias due to the lack of blinding in over 80% of the included studies.Source-based water quality improvementsThere is currently insufficient evidence to know if source-based improvements such as protected wells, communal tap stands, or chlorination/filtration of community sources consistently reduce diarrhoea (one cluster-RCT, five CBA studies, very low quality evidence). We found no studies evaluating reliable piped-in water supplies delivered to households.Point-of-use water quality interventionsOn average, distributing water disinfection products for use at the household level may reduce diarrhoea by around one quarter (Home chlorination products: RR 0.77, 95% CI 0.65 to 0.91; 14 trials, 30,746 participants, low quality evidence; flocculation and disinfection sachets: RR 0.69, 95% CI 0.58 to 0.82, four trials, 11,788 participants, moderate quality evidence). However, there was substantial h...

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Section: Discussionmentioning

confidence: 63%

Interventions to improve water quality for preventing diarrhoea

Clasen

Alexander

Sinclair

et al. 2015

Cochrane Database of Systematic Reviews

247

159

View full text Add to dashboard Cite

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“…In LMICs, there is extensive evidence of fecal contamination (namely E. coli, and thermotolerant coliform) on fomites, including dishes in Peru, dish cloths in South Africa, children's toys in Bangladesh, Honduras, and rural India, and throughout households in Cambodia and Tanzania. 92,[123][124][125][126][127][128][129] In studies of E. coli, contamination levels range dramatically, between 1 and 100 CFU/100 cm 2 , and occasionally exceeding 1000 CFU/100 cm 2especially on wet surfaces. 92,127 This level of contamination corresponds to 10 À3 to 10 À5 g feces and occasionally more than 10 À2 g feces.…”

Section: Perspectivementioning

confidence: 99%

Environmental transmission of diarrheal pathogens in low and middle income countries

Julian

2016

Environ. Sci.: Processes Impacts

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Every year, more than half a million children die due to diarrheal diseases. Recent studies have identified the most important etiologies of diarrheal disease are enterotoxigenic and enteropathogenic E. coli, Shigella spp., rotavirus, norovirus and Cryptosporidium spp. These etiologies are unsurprisingly characterized by a combination of high shedding, high infectivity, and transmissibility through multiple environmental reservoirs. The relative importance of the transmission routes is likely site-specific. So the impact of interventions, which typically target only one or two environmental reservoirs, is likely also site-specific. The factors influencing the transmission routes most important for diarrheal disease are complex, including - at a minimum - etiology of endemic disease; and water, sanitation, and hygiene infrastructure and practices. The site-specific nature - and complexity of transmission - helps explain the observed variation in impacts of water, sanitation, and hygiene interventions. It may also render efforts to estimate or quantify global means for interventions' impacts irrelevant. The theme of this Perspective is that greater reductions in diarrheal disease transmission in LMICs can be achieved by designing interventions to interrupt the most important environmental transmission pathways. Intervention choice should be informed by site-specific conditions, most notably: diarrheal etiology and existing water, sanitation, and hygiene infrastructure and practices. The theme is discussed through the lens of the characteristics of the most important diarrheal diseases (shedding, infectivity, growth, and persistence) and the general characteristics of environmental reservoirs (exposure pathways and fecal contamination). The discussion highlights when interventions - and combinations of interventions - will be most effective at reducing diarrheal disease burden.

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“…The specificity of ␤-glucuronidase-based assays for the detection of E. coli for fecal samples has been demonstrated previously (11). As a result, ␤-glucuronidase-based assays are used for detection of E. coli in diverse environmental matrices despite limited data on the assay specificity (12,13).…”

mentioning

confidence: 99%

Genotypic and Phenotypic Characterization of Escherichia coli Isolates from Feces, Hands, and Soils in Rural Bangladesh via the Colilert Quanti-Tray System

Julian

Islam

Pickering

et al. 2015

Appl Environ Microbiol

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The increased awareness of the role of environmental matrices in enteric disease transmission has resulted in the need for rapid, field-based methods for fecal indicator bacteria and pathogen detection. Evidence of the specificity of β-glucuronidase-based assays for detection of Escherichia coli from environmental matrices relevant to enteric pathogen transmission in developing countries, such as hands, soils, and surfaces, is limited. In this study, we quantify the false-positive rate of a β-glucuronidase-based E. coli detection assay (Colilert) for two environmental reservoirs in Bangladeshi households (hands and soils) and three fecal composite sources (cattle, chicken, and humans). We investigate whether or not the isolation source of E. coli influences phenotypic and genotypic characteristics. Phenotypic characteristics include results of biochemical assays provided by the API-20E test; genotypic characteristics include the Clermont phylogroup and the presence of enteric and/or environmental indicator genes sfmH, rfaI, and fucK. Our findings demonstrate no statistically significant difference in the false-positive rate of Colilert for environmental compared to enteric samples. E. coli isolates from all source types are genetically diverse, representing six of the seven phylogroups, and there is no difference in relative frequency of phylogroups between enteric and environmental samples. We conclude that Colilert, and likely other β-glucuronidase-based assays, is appropriate for detection of E. coli on hands and in soils with low false-positive rates. Furthermore, E. coli isolated from hands and soils in Bangladeshi households are diverse and indistinguishable from cattle, chicken, and human fecal isolates, using traditional biochemical assays and phylogrouping.

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Bacterial Contamination on Household Toys and Association with Water, Sanitation and Hygiene Conditions in Honduras

Cited by 18 publications

References 19 publications

Interventions to improve water quality for preventing diarrhoea

Interventions to improve water quality for preventing diarrhoea

Environmental transmission of diarrheal pathogens in low and middle income countries

Genotypic and Phenotypic Characterization of Escherichia coli Isolates from Feces, Hands, and Soils in Rural Bangladesh via the Colilert Quanti-Tray System

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