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Cited by 103Child Nutrition and Water AccessViral gastroenteritis research and epidemiologyParasitic Infections and Diagnostics

Impact of Water Quality, Sanitation, Handwashing, and Nutritional Interventions on Enteric Infections in Rural Zimbabwe: The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial

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Rogawski McQuade, Elizabeth T, Platts-Mills, James A, Gratz, Jean, Zhang, Jixian, Moulton, Lawrence H, Mutasa, Kuda, Majo, Florence D, Tavengwa, Naume +5 more·2020·The Journal of Infectious Diseases
DOI 10.1093/infdis/jiz179PMC PMC7325799
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Abstract

Background: We assessed the impact of water, sanitation, and hygiene (WASH) and infant and young child feeding (IYCF) interventions on enteric infections in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Methods: We tested stool samples collected at 1, 3, 6, and 12 months of age and during diarrhea using quantitative molecular diagnostics for 29 pathogens. We estimated the effects of the WASH, IYCF, and combined WASH + IYCF interventions on individual enteropathogen prevalence and quantity, total numbers of pathogens detected, and incidence of pathogen-attributable diarrhea. Results: WASH interventions decreased the number of parasites detected (difference in number compared to non-WASH arms, –0.07 [95% confidence interval, –.14 to –.02]), but had no statistically significant effects on bacteria, viruses, or the prevalence and quantity of individual enteropathogens after accounting for multiple comparisons. IYCF interventions had no significant effects on individual or total enteropathogens. Neither intervention had significant effects on pathogen-attributable diarrhea. Conclusions: The WASH interventions implemented in SHINE (improved pit latrine, hand-washing stations, liquid soap, point-of-use water chlorination, and clean play space) did not prevent enteric infections. Transformative WASH interventions are needed that are more efficacious in interrupting fecal–oral microbial transmission in children living in highly contaminated environments.

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  • Evidence on the impact of improving household safe drinking water sources and/or treatment and storage, access to basic latrines and handwashing with soap on overall enteric pathogen detection and diarrhoea in children under 2 years of age is mixed, with some rigorously controlled and well-powered trials of interventions reporting little impact, even with high levels of behavioural compliance.

    “Evidence on impact of improving household safe drinking water sources and/or treatment and storage, access to basic latrines and handwashing with soap on overall enteric pathogen detection and diarrhoea in children under 2 years of age is mixed, with some rigorously controlled and well-powered trials of interventions reporting little impact, even with high levels of behavioural compliance.1 6 7”

    From Environmental and behavioural exposure pathways associated with diarrhoea and enteric pathogen detection in 5-month-old, periurban Kenyan infants: a cross-sectional study (2022) · cites this paper as [1]

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Authors
Rogawski McQuade, E. T., Platts-Mills, J. A., Gratz, J., Zhang, J., Moulton, L. H., Mutasa, K., Majo, F. D., Tavengwa, N., Ntozini, R., Prendergast, A. J., Humphrey, J. H., Liu, J., & Houpt, E. R.
Affiliations
  • Department of Public Health Sciences, University of Virginia, Charlottesville
  • University of Virginia (US)
  • Johns Hopkins University (US)
  • Zvitambo Institute for Maternal and Child Health Research (ZW)
  • Queen Mary University of London (GB)
ORCID
Venue
The Journal of Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2019-04-20
Volume
221
Issue
8
Pages
1379-1386
ISSN
  • 0022-1899 (ISSN-L)
  • 1537-6613
DOI
10.1093/infdis/jiz179
PMC
PMC7325799
OpenAlex
W2935825922
Cited by
103
References
4
Citations by year
2026: 9 · 2025: 17 · 2024: 12 · 2023: 14 · 2022: 13 · 2021: 19 · 2020: 14 · 2019: 5
FWCI
9.70
Type
journal article
Language
en
Open access
Licence
Locations
  • The Journal of Infectious Diseases (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
  • Greater South Information System
Funders
  • Bill and Melinda Gates Foundation (OPP1021542, OPP1143707)
  • UK Department for International Development (093768/Z/10/Z, 108065/Z/15/Z, 201293/Z/16/Z)
  • Swiss Agency for Development and Cooperation
  • National Institutes of Health (K01AI130326, 01HD060338-06)
  • European Union
  • Wellcome Trust
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
  • Life Sciences › Immunology and Microbiology › Parasitology › Parasitic Infections and Diagnostics
Keywords
water, sanitation and hygiene, infant and young child feeding, gastrointestinal infections, enteric pathogens, diarrhea, hand washing, pit latrines, fecal-oral transmission, rural Zimbabwe, SHINE trial
MeSH terms
Diarrhea, Female, Hand Disinfection, Humans, Hygiene, Infant, Infant, Newborn, Infections, Male, Nutritional Status, Rural Population, Sanitation, Water, Zimbabwe, Gastrointestinal Tract, Water Quality

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