Leveraging water, sanitation and hygiene for nutrition in low‐ and middle‐income countries: A conceptual framework

Zavala, Eleonor; King, Shannon; Sawadogo‐Lewis, Talata; Roberton, Timothy

doi:10.1111/mcn.13202

Cited by 12 publications

(9 citation statements)

References 56 publications

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Section: Discussionmentioning

confidence: 99%

“…28 It is also important to recognize that participation in WASH programs has gained popularity over the past decade as numerous research studies have been published that support the protective effects of triple-duty programs to improve diet and nutritional status in marginal communities. [29][30][31][32][33] Since 2011, security and agricultural production have been met with several challenges that have resulted in poor food production, distribution, and a sustained prevalence of internally displaced persons as well as differential administration of domestic or international nutrition aid or programs. 34 Each challenge in and of itself has contributed to crises in a few states, but most especially in Eastern Equatoria, Upper Nile, Unity, and Jonglei.…”

Section: Discussionmentioning

confidence: 99%

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Childhood Stunting and Wasting Following Independence in South Sudan

Hoffman

Kassim²,

Ndiaye³

et al. 2022

Food Nutr Bull

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Background: South Sudan has experienced ongoing civil and environmental problems since gaining independence in 2011 that may influence childhood nutritional status. Objective: To estimate the prevalence of undernutrition among children in South Sudan in 2018 and 2019 compared to the prevalence in 2010. Methods: Data on height and weight were collected using a 2-stage stratified sample framework in which households were randomly selected at the county level and nutritional status was calculated for all children under 5 years of age to determine height-for-age, weight-for-height, and weight-for-age Z-scores (HAZ, WHZ, and WAZ) and the prevalence of stunting, wasting, and underweight. Linear and logistic regression analyses were used to determine factors associated with nutritional status and the odds ratio for nutritional outcomes. Results: In 2010, the mean HAZ, WHZ, and WAZ was −0.78, −0.82, and −1.15, respectively, and the prevalence of stunting, wasting, and underweight was 30%, 23%, and 32%, respectively. In 2018 and 2019, the mean HAZ, WHZ, and WAZ was −0.50, −0.70, −0.77 and −0.53, −0.77, −0.76, respectively. The prevalence of stunting, wasting, and underweight in 2018 and 2019 was 17%, 14%, 15% and 16%, 16%, 17%, respectively. Age was negatively associated with all nutritional indices and girls had higher HAZ, WHZ, and WAZ and a lower mid upper arm circumference ( P < .01) compared to boys. The risk of poor nutritional outcomes was associated with vaccine status and varied by state of residence. Conclusions: Following independence in 2010, the prevalence of undernutrition in South Sudan decreased, but the risk for undernutrition varied by state and efforts to address food security and health need to ensure equitable access for all children in South Sudan.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Childhood Stunting and Wasting Following Independence in South Sudan

Hoffman

Kassim²,

Ndiaye³

et al. 2022

Food Nutr Bull

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“…One explanation for this is the comparatively higher fitness cost of VISA and VRSA lineages [ 463 , 468 ]. The global distribution of VRSA and VISA in agriculture is unknown, but presumably highest in developing nations due to their high quantity of antimicrobial consumption, high prevalence of intensive farming and lower levels of hygiene, antimicrobial stewardship and surveillance [ 279 , 280 , 281 , 282 , 283 , 284 , 285 , 289 , 398 , 476 , 477 ].…”

Section: Vancomycinmentioning

confidence: 99%

Vancomycin Resistance in Enterococcus and Staphylococcus aureus

Walker

Oliveira

2022

Microorganisms

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Enterococcus faecalis, Enterococcus faecium and Staphylococcus aureus are both common commensals and major opportunistic human pathogens. In recent decades, these bacteria have acquired broad resistance to several major classes of antibiotics, including commonly employed glycopeptides. Exemplified by resistance to vancomycin, glycopeptide resistance is mediated through intrinsic gene mutations, and/or transferrable van resistance gene cassette-carrying mobile genetic elements. Here, this review will discuss the epidemiology of vancomycin-resistant Enterococcus and S. aureus in healthcare, community, and agricultural settings, explore vancomycin resistance in the context of van and non-van mediated resistance development and provide insights into alternative therapeutic approaches aimed at treating drug-resistant Enterococcus and S. aureus infections.

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“…WASH improvements have been responsible for major public health gains by greatly reducing diarrheal disease burden caused by a variety of enteropathogens. Reducing the diarrheal burden can also result in improved nutrition and reduced stunting of child growth [1]. Transmission of the enteropathogens responsible for diarrheal disease can occur through multiple, interconnected pathways by which a susceptible person may come in contact with pathogens shed (in feces) by an infected individual.…”

Section: Introductionmentioning

confidence: 99%

Leveraging infectious disease models to interpret randomized controlled trials: controlling enteric pathogen transmission through water, sanitation, and hygiene interventions

Brouwer

Eisenberg

Bakker

et al. 2022

Preprint

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Randomized controlled trials (RCTs), which evaluate hypotheses in specific contexts, are often considered the gold standard of evidence for infectious disease interventions, but their results cannot immediately generalize to other contexts. Mechanistic models are one approach to generalizing findings between contexts, but infectious disease transmission models are not immediately suited for analyzing RCTs, since they often rely on time-series surveillance data that is rarely collected by RCTs. We developed a modeling framework to explain the main outcome of an infectious disease RCT—relative risk—and applied it to a water, sanitation, and hygiene (WASH) RCT. This model can generalize the RCT results to other contexts and conditions. We developed this compartmental modeling framework to account for key WASH RCT factors: i) transmission across multiple environmental pathways, ii) multiple interventions applied individually and in combination, iii) adherence to interventions or preexisting conditions, and iv) the impact of individuals not enrolled in the study. We employed a hybrid sampling-importance resampling and estimation framework to obtain posterior estimates of mechanistic parameters and their uncertainties and illustrated our model using WASH Benefits Bangladesh RCT data (n=17,187). Our model reproduced reported diarrheal prevalence in this RCT. The baseline estimate of the basic reproduction number ℛ0 for the control arm (1.15, 95% CI: 1.09, 1.27) corresponded to an endemic prevalence of 13% (95% CI: 9–21%) in the absence of intervention or preexisting WASH conditions. No single pathway was likely able to sustain transmission: pathway-specific ℛ0s for water, fomites, and all other pathways were 0.49 (95% CI: 0.07, 0.99), 0.26 (95% CI: 0.04, 0.57), and 0.40 (95% CI: 0.02, 0.88), respectively. An infectious disease modeling approach to evaluating RCTs can complement RCT analysis by providing a rigorous framework for generating data-driven hypotheses that explain trial findings, particularly unexpected null results, opening up existing data to deeper epidemiological understanding.Author summaryA randomized controlled trial (RCT) testing an intervention to reduce infectious disease transmission can provide high-quality scientific evidence about the impact of that intervention in a specific context, but the results are often difficult to generalize to other policy-relevant contexts and conditions. Infectious disease transmission models can be used to explore what might happen to disease dynamics under different conditions, but the standard use of these models is to fit to longitudinal, surveillance data, which is rarely collected by RCTs. We developed a framework to fit an infectious disease model to steady-state diarrheal prevalence data in water, sanitation, and hygiene RCTs, explicitly accounting for completeness, coverage, and compliance. Although this framework is developed with water, sanitation, and hygiene interventions for enteropathogens in mind, it could be extended to other disease contexts. By leveraging existing large-scale RCT data sets, it will be possible to better understand the underlying disease epidemiology and investigate the likely outcomes of policy-relevant scenarios. Ultimately, this work can be incorporated into decision making for public health policy and programs.

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Leveraging water, sanitation and hygiene for nutrition in low‐ and middle‐income countries: A conceptual framework

Cited by 12 publications

References 56 publications

Childhood Stunting and Wasting Following Independence in South Sudan

Childhood Stunting and Wasting Following Independence in South Sudan

Vancomycin Resistance in Enterococcus and Staphylococcus aureus

Leveraging infectious disease models to interpret randomized controlled trials: controlling enteric pathogen transmission through water, sanitation, and hygiene interventions

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