Abstract
ObjectiveThis study examined associations between household sanitation and enteric infection – including diarrhoeal‐specific outcomes – in children 0–2 years of age in a low‐income, dense urban neighbourhood.MethodsAs part of the MAL‐ED study, 230 children in a low‐income, urban, Indian neighbourhood provided stool specimens at 14–17 scheduled time points and during diarrhoeal episodes in the first 2 years of life that were analysed for bacterial, parasitic (protozoa and helminths) and viral pathogens. From interviews with caregivers in 100 households, the relationship between the presence (and discharge) of household sanitation facilities and any, pathogen‐specific, and diarrhoea‐specific enteric infection was tested through mixed‐effects Poisson regression models.ResultsFew study households (33%) reported having toilets, most of which (82%) discharged into open drains. Controlling for season and household socio‐economic status, the presence of a household toilet was associated with lower risks of enteric infection (RR: 0.91, 95% CI: 0.79–1.06), bacterial infection (RR: 0.87, 95% CI: 0.75–1.02) and protozoal infection (RR: 0.64, 95% CI: 0.39–1.04), although not statistically significant, but had no association with diarrhoea (RR: 1.00, 95% CI: 0.68–1.45) or viral infections (RR: 1.12, 95% CI: 0.79–1.60). Models also suggested that the relationship between household toilets discharging to drains and enteric infection risk may vary by season.ConclusionsThe presence of a household toilet was associated with lower risk of bacterial and protozoal enteric infections, but not diarrhoea or viral infections, suggesting the health effects of sanitation may be more accurately estimated using outcome measures that account for aetiologic agents.
Highlights
Despite an estimated 1.7 billion cases of diarrhoea annually, most of which are in children, the impact of enteric infections worldwide is underestimated due to high, undetected rates of asymptomatic infection [1,2,3]
These infections are thought to be driven by poor water, sanitation and hygiene (WASH), few studies have evaluated the impact of WASH on combined symptomatic and asymptomatic infections [5]
The goal of this study was to evaluate the associations between household sanitation and paediatric enteric infections and diarrhoea in a low-income, urban setting, focusing on associations with specific groups of aetiologic agents and diarrhoeal episodes
Summary
Despite an estimated 1.7 billion cases of diarrhoea annually, most of which are in children, the impact of enteric infections worldwide is underestimated due to high, undetected rates of asymptomatic infection [1,2,3]. Even in the absence of diarrhoea, these infections are detrimental to child health, growth and cognition [4]. These infections are thought to be driven by poor water, sanitation and hygiene (WASH), few studies have evaluated the impact of WASH on combined symptomatic and asymptomatic infections [5]. While the WASH – and especially sanitation – research field has recently focused on rural settings in the context of the Millennium Development Goals, there is a need to understand the complex association between sanitation and health in urban areas, which are rapidly growing and already include over half of the world’s population [16,17,18]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
