Grembi Jessica A, Lin Audrie, Karim Md Abdul, Islam Md Ohedul, Miah Rana, Arnold Benjamin F, McQuade Elizabeth T Rogawski, Ali Shahjahan, Rahman Md Ziaur, Hussain Zahir, Shoab Abul K, Famida Syeda L, Hossen Md Saheen, Mutsuddi Palash, Rahman Mahbubur, Unicomb Leanne, Haque Rashidul, Taniuchi Mami, Liu Jie, Platts-Mills James A, Holmes Susan P, Stewart Christine P, Benjamin-Chung Jade, Colford John M, Houpt Eric R, Luby Stephen P
Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States of America.
Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, United States of America.
J Infect Dis. 2020 Aug 29;227(3):434-47. doi: 10.1093/infdis/jiaa549.
We evaluated the impact of low-cost water, sanitation, handwashing (WSH) and child nutrition interventions on enteropathogen carriage in the WASH Benefits cluster-randomized controlled trial in rural Bangladesh.
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 PCR. Outcomes included the number of co-occurring pathogens; cumulative quantity of four stunting-associated pathogens; and prevalence and quantity of individual pathogens. Masked analysis was by intention-to-treat.
326 (99.1%) control children had one 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.
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.
在孟加拉国农村地区开展的“水、卫生设施、洗手与健康益处”整群随机对照试验中，我们评估了低成本的水、卫生设施、洗手（WSH）及儿童营养干预措施对肠道病原体携带情况的影响。
我们对来自14±2月龄儿童的1411份常规粪便样本进行了分析，这些儿童分别来自水、卫生设施与洗手组（n = 369）、营养咨询加脂质营养补充剂组（n = 353）、营养加WSH组（n = 360）以及对照组（n = 329），使用定量PCR检测34种肠道病原体。结果包括同时出现的病原体数量；四种与发育迟缓相关病原体的累积量；以及单个病原体的患病率和数量。采用意向性分析进行盲法分析。
326名（99.1%）对照儿童检测出一种或多种肠道病原体（平均3.8±1.8种）。接受WSH干预的儿童感染单个病毒的患病率和数量低于对照组（诺如病毒的患病率差异：-11% [95%置信区间[CI]，-5至-17%]；札幌病毒：-9% [95%CI，-3至-15%]；腺病毒40/41：-9% [95%CI，-2至-15%]）。对照组与任何干预组在细菌、寄生虫或与发育迟缓相关病原体的累积量方面均无差异。
WSH干预措施与14月龄儿童肠道病毒感染减少有关。在这个关键的幼年时期，需要采取不同策略来减少肠道细菌和寄生虫感染。
