Abstract
.Poor nutrition and hand hygiene are risk factors for acute respiratory infections (ARIs). Safe drinking water and sanitation can reduce exposure to pathogens and encourage healthy immune responses, reducing the risk of ARIs. Within a trial assessing impacts of water, sanitation, and handwashing (WASH), and nutritional interventions, we evaluated effects on ARIs. The WASH Benefits cluster-randomized trial enrolled pregnant women from Kenyan villages and evaluated health outcomes in children born to enrolled mothers 1 and 2 years after intervention delivery. Geographically adjacent clusters were block-randomized into a passive control (no promotional visits), a double-sized active control (monthly visits to measure mid–upper arm circumference), and six intervention groups: chlorinated drinking water (W), improved sanitation (S), handwashing with soap (H), combined WSH, improved nutrition (N) through counseling and lipid-based nutrient supplementation (LNS), and combined WSHN. The main outcome was the prevalence of ARI symptoms (cough, panting, wheezing, or difficulty breathing) in children younger than 3 years. Masking participants was not possible. Analyses were intention-to-treat. Between November 2012 and May 2014, 702 clusters were enrolled, including 6,960 (year 1) and 7,088 (year 2) children with ARI data. The cluster-level intra-cluster correlation coefficient for ARIs was 0.026 across both years. Water, sanitation, and handwashing interventions with behavior change messaging did not reduce ARIs. Nutrition counseling and LNS modestly reduced ARI symptoms compared with controls in year 1 [prevalence ratio (PR): 0.87, 95% confidence interval (CI): 0.77–0.99], but no effect in the combined WSHN group weakens this finding.
Highlights
Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality in children younger than 5 years.[1]
Nutrition counseling and lipidbased nutrient supplementation (LNS) modestly reduced acute respiratory infections (ARIs) symptoms compared with controls in year 1 [prevalence ratio (PR): 0.87, 95% confidence interval (CI): 0.77–0.99], but no effect in the combined WSHN group weakens this finding
A recent systematic review and meta-analysis of observational studies found that severe malnutrition and inadequate breastfeeding practices were associated with increased odds of acute lower respiratory illness mortality.[6]
Summary
Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality in children younger than 5 years.[1]. Exclusive breastfeeding from 0 to 6 months provides infants with essential nutrients and antibodies, promoting healthy immune system development.[8]. A recent systematic review and meta-analysis of observational studies found that severe malnutrition and inadequate breastfeeding practices were associated with increased odds of acute lower respiratory illness mortality.[6]. A 2013 systematic review and meta-analysis reported that breastfeeding, defined heterogeneously across studies, reduced the incidence or prevalence of lower respiratory infections by 32% (95% CI: 23–40%) in children younger than 2 years.[9]. A recent Cochrane review identified three studies examining the impacts of lipid-based nutrient supplementation (LNS) on respiratory illnesses, none of which demonstrated differences between intervention and control groups.[10]. A clusterrandomized effectiveness trial found that LNS might reduce ARIs among infants in Bangladesh but yielded inconsistent results.[11]
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