A Randomized Controlled Trial to Measure Spillover Effects of a Combined Water, Sanitation, and Handwashing Intervention in Rural Bangladesh.

Benjamin-Chung, J; Amin, N; Ercumen, A; Arnold, BF; Hubbard, AE; Unicomb, L; Rahman, M; Luby, SP; Colford, JM

A Randomized Controlled Trial to Measure Spillover Effects of a Combined Water, Sanitation, and Handwashing Intervention in Rural Bangladesh.

Benjamin-Chung, J Amin, N Ercumen, A Arnold, BF Hubbard, AE Unicomb, L Rahman, M Luby, SP Colford, JM

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Publisher:: OXFORD UNIV PRESS INC
Publication Type:: Journal Article
Citation:: Am J Epidemiol, 2018, 187, (8), pp. 1733-1744
Issue Date:: 2018-08-01

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Field	Value	Language
dc.contributor.author	Benjamin-Chung, J
dc.contributor.author	Amin, N
dc.contributor.author	Ercumen, A
dc.contributor.author	Arnold, BF
dc.contributor.author	Hubbard, AE
dc.contributor.author	Unicomb, L
dc.contributor.author	Rahman, M
dc.contributor.author	Luby, SP
dc.contributor.author	Colford, JM
dc.date.accessioned	2022-03-14T07:03:18Z
dc.date.available	2018-02-27
dc.date.available	2022-03-14T07:03:18Z
dc.date.issued	2018-08-01
dc.identifier.citation	Am J Epidemiol, 2018, 187, (8), pp. 1733-1744
dc.identifier.issn	0002-9262
dc.identifier.issn	1476-6256
dc.identifier.uri	http://hdl.handle.net/10453/155218
dc.description.abstract	Water, sanitation, and handwashing interventions may confer spillover effects on intervention recipients' neighbors by interrupting pathogen transmission. We measured geographically local spillovers in the Water Quality, Sanitation, and Handwashing (WASH) Benefits Study, a cluster-randomized trial in rural Bangladesh, by comparing outcomes among neighbors of intervention versus those of control participants. Geographically defined clusters were randomly allocated to a compound-level intervention (i.e., chlorinated drinking water, upgraded sanitation, and handwashing promotion) or control arm. From January 2015 to August 2015, in 180 clusters, we enrolled 1,799 neighboring children who were age matched to trial participants who would have been eligible for the study had they been conceived slightly earlier or later. After 28 months of intervention, we quantified fecal indicator bacteria in toy rinse and drinking water samples and measured soil-transmitted helminth infections and caregiver-reported diarrhea and respiratory illness. Neighbors' characteristics were balanced across arms. Detectable Escherichia coli prevalence in tubewell samples was lower for intervention participants' neighbors than control participants' (prevalence ratio = 0.83; 95% confidence interval: 0.73, 0.95). Fecal indicator bacteria prevalence did not differ between arms for other environmental samples. Prevalence was similar in neighbors of intervention participants versus those of control participants for soil-transmitted helminth infection, diarrhea, and respiratory illness. A compound-level water, sanitation, and handwashing intervention reduced neighbors' tubewell water contamination but did not affect neighboring children's health.
dc.format	Print
dc.language	eng
dc.publisher	OXFORD UNIV PRESS INC
dc.relation.ispartof	Am J Epidemiol
dc.relation.isbasedon	10.1093/aje/kwy046
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	01 Mathematical Sciences, 11 Medical and Health Sciences
dc.subject.classification	Epidemiology
dc.subject.mesh	Bangladesh
dc.subject.mesh	Cluster Analysis
dc.subject.mesh	Communicable Disease Control
dc.subject.mesh	Diarrhea
dc.subject.mesh	Female
dc.subject.mesh	Hand Disinfection
dc.subject.mesh	Helminthiasis
dc.subject.mesh	Humans
dc.subject.mesh	Infant
dc.subject.mesh	Male
dc.subject.mesh	Respiratory Tract Diseases
dc.subject.mesh	Rural Population
dc.subject.mesh	Sanitation
dc.subject.mesh	Water Quality
dc.subject.mesh	Humans
dc.subject.mesh	Helminthiasis
dc.subject.mesh	Respiratory Tract Diseases
dc.subject.mesh	Diarrhea
dc.subject.mesh	Cluster Analysis
dc.subject.mesh	Sanitation
dc.subject.mesh	Communicable Disease Control
dc.subject.mesh	Infant
dc.subject.mesh	Rural Population
dc.subject.mesh	Bangladesh
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Water Quality
dc.subject.mesh	Hand Disinfection
dc.title	A Randomized Controlled Trial to Measure Spillover Effects of a Combined Water, Sanitation, and Handwashing Intervention in Rural Bangladesh.
dc.type	Journal Article
utslib.citation.volume	187
utslib.location.activity	United States
utslib.for	01 Mathematical Sciences
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/DVC (Research)
pubs.organisational-group	/University of Technology Sydney/DVC (Research)/Institute For Sustainable Futures
utslib.copyright.status	open_access	*
dc.date.updated	2022-03-14T07:03:15Z
pubs.issue	8
pubs.publication-status	Published
pubs.volume	187
utslib.citation.issue	8

Abstract:

Water, sanitation, and handwashing interventions may confer spillover effects on intervention recipients' neighbors by interrupting pathogen transmission. We measured geographically local spillovers in the Water Quality, Sanitation, and Handwashing (WASH) Benefits Study, a cluster-randomized trial in rural Bangladesh, by comparing outcomes among neighbors of intervention versus those of control participants. Geographically defined clusters were randomly allocated to a compound-level intervention (i.e., chlorinated drinking water, upgraded sanitation, and handwashing promotion) or control arm. From January 2015 to August 2015, in 180 clusters, we enrolled 1,799 neighboring children who were age matched to trial participants who would have been eligible for the study had they been conceived slightly earlier or later. After 28 months of intervention, we quantified fecal indicator bacteria in toy rinse and drinking water samples and measured soil-transmitted helminth infections and caregiver-reported diarrhea and respiratory illness. Neighbors' characteristics were balanced across arms. Detectable Escherichia coli prevalence in tubewell samples was lower for intervention participants' neighbors than control participants' (prevalence ratio = 0.83; 95% confidence interval: 0.73, 0.95). Fecal indicator bacteria prevalence did not differ between arms for other environmental samples. Prevalence was similar in neighbors of intervention participants versus those of control participants for soil-transmitted helminth infection, diarrhea, and respiratory illness. A compound-level water, sanitation, and handwashing intervention reduced neighbors' tubewell water contamination but did not affect neighboring children's health.

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http://hdl.handle.net/10453/155218