Survey-based assessment of water, sanitation, and animal-associated risk factors for moderate-to-severe diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) Study: The Gambia, Mali, and Kenya, 2015-2018

David M Berendes; Kirsten Fagerli; Sunkyung Kim; Dilruba Nasrin; Helen Powell; Irene N Kasumba; Sharon M Tennant; Anna Roose; M Jahangir Hossain; Joquina Chiquita M Jones; Syed M A Zaman; Richard Omore; John B Ochieng; Jennifer R Verani; Marc-Alain Widdowson; Samba O Sow; Sanogo Doh; Ciara E Sugerman; Eric D Mintz; Karen L Kotloff

doi:10.1093/cid/ciac911

Survey-based assessment of water, sanitation, and animal-associated risk factors for moderate-to-severe diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) Study: The Gambia, Mali, and Kenya, 2015-2018

David M Berendes, Kirsten Fagerli, Sunkyung Kim, Dilruba Nasrin, Helen Powell, Irene N Kasumba, Sharon M Tennant, Anna Roose, M Jahangir Hossain, Joquina Chiquita M Jones, Syed M A Zaman, Richard Omore, John B Ochieng, Jennifer R Verani, Marc-Alain Widdowson, Samba O Sow, Sanogo Doh, Ciara E Sugerman, Eric D Mintz, Karen L Kotloff

Institute of Tropical Medicine

Research output: Contribution to journal › A1: Web of Science-article › peer-review

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Abstract

BACKGROUND: Pediatric exposures to unsafe sources of water, unsafely managed sanitation, and animals are prevalent in low- and middle-income countries. In the Vaccine Impact on Diarrhea in Africa case-control study, we examined associations between these risk factors and moderate-to-severe diarrhea (MSD) in children <5 years old in The Gambia, Kenya, and Mali.

METHODS: We enrolled children <5 years old seeking care for MSD at health centers; age-, sex-, and community-matched controls were enrolled at home. Conditional logistic regression models, adjusted for a priori confounders, were used to evaluate associations between MSD and survey-based assessments of water, sanitation, and animals living in the compound.

RESULTS: From 2015 to 2018, 4840 cases and 6213 controls were enrolled. In pan-site analyses, children with drinking water sources below "safely managed" (onsite, continuously accessible sources of good water quality) had 1.5-2.0-fold higher odds of MSD (95% confidence intervals [CIs] ranging from 1.0 to 2.5), driven by rural site results (The Gambia and Kenya). In the urban site (Mali), children whose drinking water source was less available (several hours/day vs all the time) had higher odds of MSD (matched odds ratio [mOR]: 1.4, 95% CI: 1.1, 1.7). Associations between MSD and sanitation were site-specific. Goats were associated with slightly increased odds of MSD in pan-site analyses, whereas associations with cows and fowl varied by site.

CONCLUSIONS: Poorer types and availability of drinking water sources were consistently associated with MSD, whereas the impacts of sanitation and household animals were context-specific. The association between MSD and access to safely managed drinking water sources post-rotavirus introduction calls for transformational changes in drinking water services to prevent acute child morbidity from MSD.

Original language	English
Journal	Clinical Infectious Diseases
Volume	76
Issue number	Suppl.1
Pages (from-to)	S132-S139
Number of pages	8
ISSN	1058-4838
DOIs	https://doi.org/10.1093/cid/ciac911
Publication status	Published - 2023

Keywords

Female
Animals
Cattle
Kenya/epidemiology
Sanitation/methods
Gambia/epidemiology
Mali/epidemiology
Drinking Water
Case-Control Studies
Diarrhea/epidemiology
Risk Factors

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2023cidiS132Final published version, 536 KBLicence: Other

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Berendes, D. M., Fagerli, K., Kim, S., Nasrin, D., Powell, H., Kasumba, I. N., Tennant, S. M., Roose, A., Jahangir Hossain, M., Jones, J. C. M., Zaman, S. M. A., Omore, R., Ochieng, J. B., Verani, J. R., Widdowson, M.-A., Sow, S. O., Doh, S., Sugerman, C. E., Mintz, E. D., & Kotloff, K. L. (2023). Survey-based assessment of water, sanitation, and animal-associated risk factors for moderate-to-severe diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) Study: The Gambia, Mali, and Kenya, 2015-2018. Clinical Infectious Diseases, 76(Suppl.1), S132-S139. https://doi.org/10.1093/cid/ciac911

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abstract = "BACKGROUND: Pediatric exposures to unsafe sources of water, unsafely managed sanitation, and animals are prevalent in low- and middle-income countries. In the Vaccine Impact on Diarrhea in Africa case-control study, we examined associations between these risk factors and moderate-to-severe diarrhea (MSD) in children <5 years old in The Gambia, Kenya, and Mali.METHODS: We enrolled children <5 years old seeking care for MSD at health centers; age-, sex-, and community-matched controls were enrolled at home. Conditional logistic regression models, adjusted for a priori confounders, were used to evaluate associations between MSD and survey-based assessments of water, sanitation, and animals living in the compound.RESULTS: From 2015 to 2018, 4840 cases and 6213 controls were enrolled. In pan-site analyses, children with drinking water sources below {"}safely managed{"} (onsite, continuously accessible sources of good water quality) had 1.5-2.0-fold higher odds of MSD (95% confidence intervals [CIs] ranging from 1.0 to 2.5), driven by rural site results (The Gambia and Kenya). In the urban site (Mali), children whose drinking water source was less available (several hours/day vs all the time) had higher odds of MSD (matched odds ratio [mOR]: 1.4, 95% CI: 1.1, 1.7). Associations between MSD and sanitation were site-specific. Goats were associated with slightly increased odds of MSD in pan-site analyses, whereas associations with cows and fowl varied by site.CONCLUSIONS: Poorer types and availability of drinking water sources were consistently associated with MSD, whereas the impacts of sanitation and household animals were context-specific. The association between MSD and access to safely managed drinking water sources post-rotavirus introduction calls for transformational changes in drinking water services to prevent acute child morbidity from MSD.",

keywords = "Female, Animals, Cattle, Kenya/epidemiology, Sanitation/methods, Gambia/epidemiology, Mali/epidemiology, Drinking Water, Case-Control Studies, Diarrhea/epidemiology, Risk Factors",

author = "Berendes, {David M} and Kirsten Fagerli and Sunkyung Kim and Dilruba Nasrin and Helen Powell and Kasumba, {Irene N} and Tennant, {Sharon M} and Anna Roose and {Jahangir Hossain}, M and Jones, {Joquina Chiquita M} and Zaman, {Syed M A} and Richard Omore and Ochieng, {John B} and Verani, {Jennifer R} and Marc-Alain Widdowson and Sow, {Samba O} and Sanogo Doh and Sugerman, {Ciara E} and Mintz, {Eric D} and Kotloff, {Karen L}",

note = "FTX; Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.",

year = "2023",

doi = "10.1093/cid/ciac911",

language = "English",

volume = "76",

pages = "S132--S139",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "Suppl.1",

}

Berendes, DM, Fagerli, K, Kim, S, Nasrin, D, Powell, H, Kasumba, IN, Tennant, SM, Roose, A, Jahangir Hossain, M, Jones, JCM, Zaman, SMA, Omore, R, Ochieng, JB, Verani, JR, Widdowson, M-A, Sow, SO, Doh, S, Sugerman, CE, Mintz, ED & Kotloff, KL 2023, 'Survey-based assessment of water, sanitation, and animal-associated risk factors for moderate-to-severe diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) Study: The Gambia, Mali, and Kenya, 2015-2018', Clinical Infectious Diseases, vol. 76, no. Suppl.1, pp. S132-S139. https://doi.org/10.1093/cid/ciac911

Survey-based assessment of water, sanitation, and animal-associated risk factors for moderate-to-severe diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) Study: The Gambia, Mali, and Kenya, 2015-2018. / Berendes, David M; Fagerli, Kirsten; Kim, Sunkyung et al.
In: Clinical Infectious Diseases, Vol. 76, No. Suppl.1, 2023, p. S132-S139.

Research output: Contribution to journal › A1: Web of Science-article › peer-review

TY - JOUR

T1 - Survey-based assessment of water, sanitation, and animal-associated risk factors for moderate-to-severe diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) Study: The Gambia, Mali, and Kenya, 2015-2018

AU - Berendes, David M

AU - Fagerli, Kirsten

AU - Kim, Sunkyung

AU - Nasrin, Dilruba

AU - Powell, Helen

AU - Kasumba, Irene N

AU - Tennant, Sharon M

AU - Roose, Anna

AU - Jahangir Hossain, M

AU - Jones, Joquina Chiquita M

AU - Zaman, Syed M A

AU - Omore, Richard

AU - Ochieng, John B

AU - Verani, Jennifer R

AU - Widdowson, Marc-Alain

AU - Sow, Samba O

AU - Doh, Sanogo

AU - Sugerman, Ciara E

AU - Mintz, Eric D

AU - Kotloff, Karen L

N1 - FTX; Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.

PY - 2023

Y1 - 2023

N2 - BACKGROUND: Pediatric exposures to unsafe sources of water, unsafely managed sanitation, and animals are prevalent in low- and middle-income countries. In the Vaccine Impact on Diarrhea in Africa case-control study, we examined associations between these risk factors and moderate-to-severe diarrhea (MSD) in children <5 years old in The Gambia, Kenya, and Mali.METHODS: We enrolled children <5 years old seeking care for MSD at health centers; age-, sex-, and community-matched controls were enrolled at home. Conditional logistic regression models, adjusted for a priori confounders, were used to evaluate associations between MSD and survey-based assessments of water, sanitation, and animals living in the compound.RESULTS: From 2015 to 2018, 4840 cases and 6213 controls were enrolled. In pan-site analyses, children with drinking water sources below "safely managed" (onsite, continuously accessible sources of good water quality) had 1.5-2.0-fold higher odds of MSD (95% confidence intervals [CIs] ranging from 1.0 to 2.5), driven by rural site results (The Gambia and Kenya). In the urban site (Mali), children whose drinking water source was less available (several hours/day vs all the time) had higher odds of MSD (matched odds ratio [mOR]: 1.4, 95% CI: 1.1, 1.7). Associations between MSD and sanitation were site-specific. Goats were associated with slightly increased odds of MSD in pan-site analyses, whereas associations with cows and fowl varied by site.CONCLUSIONS: Poorer types and availability of drinking water sources were consistently associated with MSD, whereas the impacts of sanitation and household animals were context-specific. The association between MSD and access to safely managed drinking water sources post-rotavirus introduction calls for transformational changes in drinking water services to prevent acute child morbidity from MSD.

AB - BACKGROUND: Pediatric exposures to unsafe sources of water, unsafely managed sanitation, and animals are prevalent in low- and middle-income countries. In the Vaccine Impact on Diarrhea in Africa case-control study, we examined associations between these risk factors and moderate-to-severe diarrhea (MSD) in children <5 years old in The Gambia, Kenya, and Mali.METHODS: We enrolled children <5 years old seeking care for MSD at health centers; age-, sex-, and community-matched controls were enrolled at home. Conditional logistic regression models, adjusted for a priori confounders, were used to evaluate associations between MSD and survey-based assessments of water, sanitation, and animals living in the compound.RESULTS: From 2015 to 2018, 4840 cases and 6213 controls were enrolled. In pan-site analyses, children with drinking water sources below "safely managed" (onsite, continuously accessible sources of good water quality) had 1.5-2.0-fold higher odds of MSD (95% confidence intervals [CIs] ranging from 1.0 to 2.5), driven by rural site results (The Gambia and Kenya). In the urban site (Mali), children whose drinking water source was less available (several hours/day vs all the time) had higher odds of MSD (matched odds ratio [mOR]: 1.4, 95% CI: 1.1, 1.7). Associations between MSD and sanitation were site-specific. Goats were associated with slightly increased odds of MSD in pan-site analyses, whereas associations with cows and fowl varied by site.CONCLUSIONS: Poorer types and availability of drinking water sources were consistently associated with MSD, whereas the impacts of sanitation and household animals were context-specific. The association between MSD and access to safely managed drinking water sources post-rotavirus introduction calls for transformational changes in drinking water services to prevent acute child morbidity from MSD.

KW - Female

KW - Animals

KW - Cattle

KW - Kenya/epidemiology

KW - Sanitation/methods

KW - Gambia/epidemiology

KW - Mali/epidemiology

KW - Drinking Water

KW - Case-Control Studies

KW - Diarrhea/epidemiology

KW - Risk Factors

U2 - 10.1093/cid/ciac911

DO - 10.1093/cid/ciac911

M3 - A1: Web of Science-article

C2 - 37074438

SN - 1058-4838

VL - 76

SP - S132-S139

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - Suppl.1

ER -