Journal article
Environmental and spatial determinants of enteric pathogen infection in rural Lao People's Democratic Republic: A cross-sectional study
PLoS neglected tropical diseases, Vol.14(4), pp.e0008180-e0008180
04/2020
DOI: 10.1371/journal.pntd.0008180
PMCID: PMC7170279
PMID: 32267881
Abstract
Though the health risks associated with poor access to water, sanitation, and hygiene (WASH) are well established, recent large-scale WASH trials have found limited impact on enteric disease. The aims of this study were to: 1. estimate the prevalence of enteropathogens among children <5, school-aged children, and adults; 2. model associations between WASH transmission pathways and enteropathogen infections; and 3. quantify clustering of enteropathogen infections at the household- and village-level. We conducted a cross-sectional survey in 50 villages in Saravane Province, Lao People’s Democratic Republic. From 297 households, we collected 891 fecal samples from one child <5, one school-aged child, and one adult living in the same household, and collected survey and observational data on household demographics, WASH access, and animal ownership. Fecal samples were analyzed for 25 enteropathogens using a qRT-PCR assay. We observed near universal infection with at least one enteropathogen (98.3%). Few household or village-level WASH covariates were statistically associated with enteropathogen infection. Concordant household infection was higher than expected under the independence assumption for 14 of the 21 pathogens for which we had sufficient data, indicating strong household correlation for many infections. Median odds ratios (MORs), a measure of cluster-level (e.g. village and household) influence on an individual’s odds of infection, were elevated at the village level, particularly for viruses (MOR: 3.89; 95% confidence interval [CI]: 2.64, 6.69), protozoa (MOR: 2.07; 95% CI: 1.59, 3.10), and soil-transmitted helminths (MOR: 2.46; 95% CI: 1.89, 3.56), indicating strong village-level differences in individuals' odds of enteric infections. WASH access, as hypothesized, is associated with fewer enteroinfections, but WASH access as currently defined does not reveal a measurably protective association with infection for many etiologies. Household- and community-level factors beyond WASH access, such as intra-household pathogen transmission, exposure to animal feces, and contextual factors in the public domain may be important risk factors for enteric infections.
clinicaltrials.gov (NCT02342860).
Details
- Title: Subtitle
- Environmental and spatial determinants of enteric pathogen infection in rural Lao People's Democratic Republic: A cross-sectional study
- Creators
- Anna N Chard - Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of AmericaKaren Levy - Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of AmericaKelly K Baker - Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States of AmericaKevin Tsai - Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States of AmericaHoward H Chang - Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of AmericaVonethalom Thongpaseuth - Laboratory and Treatment Unit, Center for Malariology, Parasitology, and Entomology, Ministry of Health, Vientiane, Lao PDRJeticia R Sistrunk - Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of AmericaMatthew C Freeman - Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Resource Type
- Journal article
- Publication Details
- PLoS neglected tropical diseases, Vol.14(4), pp.e0008180-e0008180
- DOI
- 10.1371/journal.pntd.0008180
- PMID
- 32267881
- PMCID
- PMC7170279
- NLM abbreviation
- PLoS Negl Trop Dis
- ISSN
- 1935-2735
- eISSN
- 1935-2735
- Publisher
- United States
- Grant note
- DOI: 10.13039/100004331, name: Johnson and Johnson
- Language
- English
- Date published
- 04/2020
- Academic Unit
- Occupational and Environmental Health; Epidemiology
- Record Identifier
- 9984066115402771
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