Effect of Water, Sanitation, Handwashing, and Nutrition Interventions on Enteropathogens in Children 14 Months Old: A Cluster-Randomized Controlled Trial in Rural Bangladesh

Jessica A. Grembi, Audrie Lin, Md Abdul Karim, Md Ohedul Islam, Rana Miah, Benjamin F. Arnold, Elizabeth T. Rogawski McQuade, Shahjahan Ali, Md Ziaur Rahman, Zahir Hussain, Abul K. Shoab, Syeda L. Famida, Md Saheen Hossen, Palash Mutsuddi, Mahbubur Rahman, Leanne Unicomb, Rashidul Haque, Mami Taniuchi, Jie Liu, James A. Platts-MillsSusan P. Holmes, Christine P. Stewart, Jade Benjamin-Chung, John M. Colford, Eric R. Houpt, Stephen P. Luby

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12 Scopus citations


Background. We evaluated the impact of low-cost water, sanitation, and handwashing (WSH) and child nutrition interventions on enteropathogen carriage in the WASH Benefits cluster-randomized controlled trial in rural Bangladesh. Methods. We analyzed 1411 routine fecal samples from children 14 ± 2 months old in the WSH (n = 369), nutrition counseling plus lipid-based nutrient supplement (n = 353), nutrition plus WSH (n = 360), and control (n = 329) arms for 34 enteropathogens using quantitative polymerase chain reaction. Outcomes included the number of co-occurring pathogens; cumulative quantity of 4 stunting-associated pathogens; and prevalence and quantity of individual pathogens. Masked analysis was by intention-to-treat. Results. Three hundred twenty-six (99.1%) control children had 1 or more enteropathogens detected (mean, 3.8 ± 1.8). Children receiving WSH interventions had lower prevalence and quantity of individual viruses than controls (prevalence difference for norovirus: –11% [95% confidence interval {CI}, –5% to –17%]; sapovirus: –9% [95% CI, –3% to –15%]; and adenovirus 40/41: –9% [95% CI, –2% to –15%]). There was no difference in bacteria, parasites, or cumulative quantity of stunting-associated pathogens between controls and any intervention arm. Conclusions. WSH interventions were associated with fewer enteric viruses in children aged 14 months. Different strategies are needed to reduce enteric bacteria and parasites at this critical young age.

Original languageEnglish (US)
Pages (from-to)434-447
Number of pages14
JournalJournal of Infectious Diseases
Issue number3
StatePublished - Feb 1 2023

All Science Journal Classification (ASJC) codes

  • General Medicine

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