Household Settings Research Articles

Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Acquisition Is Associated With Individual Exposure but Not Community-Level Transmission.

BackgroundTransmission rates after exposure to a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–positive individual within households and healthcare settings varies significantly between studies. Variability in the extent of exposure and community SARS-CoV-2 incidence may contribute to differences in observed rates.MethodsWe examined risk factors for SARS-CoV-2 infection in a randomized controlled trial of hydroxychloroquine as postexposure prophylaxis. Study procedures included standardized questionnaires at enrollment and daily self-collection of midturbinate swabs for SARS-CoV-2 polymerase chain reaction testing. County-level incidence was modeled using federally sourced data. Relative risks and 95% confidence intervals were calculated using modified Poisson regression.ResultsEighty-six of 567 (15.2%) household/social contacts and 12 of 122 (9.8%) healthcare worker contacts acquired SARS-CoV-2 infection. Exposure to 2 suspected index cases (vs 1) significantly increased risk for both household/social contacts (relative risk [RR], 1.86) and healthcare workers (RR, 8.18). Increased contact time also increased risk for healthcare workers (3–12 hours: RR, 7.82, >12 hours: RR, 11.81, vs ≤2 hours), but not for household/social contacts. County incidence did not impact risk.ConclusionsIn our study, increased exposure to SARS-CoV-2 within household or healthcare settings led to higher risk of infection, but elevated community incidence did not. This reinforces the importance of interventions to decrease transmission in close contact settings.

Medical Oxygen: A Lifesaving Drug During the COVID-19 Pandemic-Source and Distribution.

Oxygen is an essential lifesaving medicine used for several indications at all levels of health care. The COVID-19 pandemic and its recent second wave have resulted in a surge in demand for necessary resources, including trained staff, hospital beds, and medical supplies like oxygen. Limited availability of these resources resulted in added risk of adverse outcomes. Also, the widespread unregulated use of oxygen by the general public in household settings poses safety concerns. This review focuses on sources of medical oxygen like cryogenic oxygen plants, pressure swing adsorption, oxygen concentrators, and oxygen cylinders. Their specifications, storage, distribution within healthcare settings, regulation, and safety concerns have been considered. Resources needed for calculating oxygen demand, surge planning, identifying the suitable source, and distribution systems for different settings have been detailed. This review aims to help the hospital administrators, biomedical engineers, and clinicians plan and rationalize oxygen usage in low- and middle-income countries during the COVID-19 pandemic.

Antimicrobial Resistance Following Prolonged Use of Hand Hygiene Products: A Systematic Review.

Background: This systematic review aimed to establish whether antimicrobial resistance (AMR) occurs following prolonged use of antimicrobial hand hygiene (HH) products, and, if so, in what magnitude. Methods: Key bibliographic databases were searched to locate items on HH use and AMR development from database inception to December 2020. Records were screened and full texts of all potentially eligible articles were retrieved and checked for inclusion. The following data from the included studies were abstracted: type of HH product used, including the name of antimicrobial agent, study setting, country, study year, duration of use and development of AMR including the organisms involved. Quality assessment was done using the Newcastle-Ottawa Scale (NOS). Results: Of 339 full-text articles assessed for eligibility, only four heterogeneous United States (US) studies conducted in the period between 1986 and 2015 were found eligible, and included. One hospital-based study showed evidence of AMR following long term use of HH products, two studies conducted in household settings showed no evidence of AMR, and another experimental study showed partial evidence of AMR. The overall certainty of the evidence was moderate. Conclusion: Prolonged use of HH products may cause AMR in health care settings, but perhaps not in other settings.

The effect of hand hygiene frequency on reducing acute respiratory infections in the community: a meta-analysis.

Hand hygiene is a simple, low-cost intervention that may lead to substantial population-level effects in suppressing acute respiratory infection epidemics. However, quantification of the efficacy of hand hygiene on respiratory infection in the community is lacking. We searched PubMed for randomised controlled trials on the effect of hand hygiene for reducing acute respiratory infections in the community published before 11 March 2021. We performed a meta-regression analysis using a Bayesian mixed-effects model. A total of 105 publications were identified, out of which six studies reported hand hygiene frequencies. Four studies were performed in household settings and two were in schools. The average number of handwashing events per day ranged from one to eight in the control arms, and four to 17 in the intervention arms. We estimated that a single hand hygiene event is associated with a 3% (80% credible interval (-1% to 7%)) decrease in the daily probability of an acute respiratory infection. Three of these six studies were potentially at high risk of bias because the primary outcome depended on self-reporting of upper respiratory tract symptoms. Well-designed trials with an emphasis on monitoring hand hygiene adherence are needed to confirm these findings.

A Review on the Design of Chimney for Air Cooled Condenser

Wind coils were used in the US electricity company in the early 1970s, however the amount of facilities has skyrocketed within last 10-15 years, due mainly to an increasing emphasis on green security. In addition, as the consumption of water grows in both household and commercial settings, more people are interested in using wind condensers. The Passively Cooled Compressor and its Contest is the topic of this article. This monthly bases the components of a wind capacitor.

Transmission of SARS-CoV-2 by children and young people in households and schools: A meta-analysis of population-based and contact-tracing studies

BackgroundThe role of children and young people (CYP) in transmission of SARS-CoV-2 in household and educational settings remains unclear. We undertook a systematic review and meta-analysis of contact-tracing and population-based studies at low risk of bias.MethodsWe searched 4 electronic databases on 28 July 2021 for contact-tracing studies and population-based studies informative about transmission of SARS-CoV-2 from 0 to 19 year olds in household or educational settings. We excluded studies at high risk of bias, including from under-ascertainment of asymptomatic infections. We undertook multilevel random effects meta-analyses of secondary attack rates (SAR: contact-tracing studies) and school infection prevalence, and used meta-regression to examine the impact of community SARS-CoV-2 incidence on school infection prevalence.Findings4529 abstracts were reviewed, resulting in 37 included studies (16 contact-tracing; 19 population studies; 2 mixed studies). The pooled relative transmissibility of CYP compared with adults was 0.92 (0.68, 1.26) in adjusted household studies. The pooled SAR from CYP was lower (p = 0.002) in school studies 0.7% (0.2, 2.7) than household studies (7.6% (3.6, 15.9) . There was no difference in SAR from CYP to child or adult contacts. School population studies showed some evidence of clustering in classes within schools. School infection prevalence was associated with contemporary community 14-day incidence (OR 1.003 (1.001, 1.004), p<0.001).InterpretationWe found no difference in transmission of SARS-CoV-2 from CYP compared with adults within household settings. SAR were markedly lower in school compared with household settings, suggesting that household transmission is more important than school transmission in this pandemic. School infection prevalence was associated with community infection incidence, supporting hypotheses that school infections broadly reflect community infections. These findings are important for guiding policy decisions on shielding, vaccination school and operations during the pandemic.

Costs of hand hygiene for all in household settings: estimating the price tag for the 46 least developed countries

IntroductionDomestic hand hygiene could prevent over 500 000 attributable deaths per year, but 6 in 10 people in least developed countries (LDCs) do not have a handwashing facility (HWF) with...

Distinct influenza surveillance networks and their agreement in recording regional influenza circulation: Experience from Southeast Michigan.

IntroductionIn Southeast Michigan, active surveillance studies monitor influenza activity in hospitals, ambulatory clinics, and community households. Across five respiratory seasons, we assessed the contribution of data from each of the three networks towards improving our overall understanding of regional influenza circulation.MethodsAll three networks used case definitions for acute respiratory illness (ARI) and molecularly tested for influenza from research‐collected respiratory specimens. Age‐ and network‐stratified epidemic curves were created for influenza A and B. We compared stratified epidemic curves visually and by centering at seasonal midpoints.ResultsAcross all seasons (from 2014/2015 through 2018/2019), epidemic curves from each of the three networks were comparable in terms of both timing and magnitude. Small discrepancies in epidemics recorded by each network support previous conclusions about broader characteristics of particular influenza seasons.ConclusionInfluenza surveillance systems based in hospital, ambulatory clinic, and community household settings appear to provide largely similar information regarding regional epidemic activity. Together, multiple levels of influenza surveillance provide a detailed view of regional influenza epidemics, but a single surveillance system—regardless of population subgroup monitored—appears to be sufficient in providing vital information regarding community influenza epidemics.

Exploring Potentials and Constraints of H2O2 Water Disinfection for Household Settings

Exploring Potentials and Constraints of H2O2 Water Disinfection for Household Settings

Characterization of Unlinked Cases of COVID-19 and Implications for Contact Tracing Measures: Retrospective Analysis of Surveillance Data.

BackgroundContact tracing and intensive testing programs are essential for controlling the spread of COVID-19. However, conventional contact tracing is resource intensive and may not result in the tracing of all cases due to recall bias and cases not knowing the identity of some close contacts. Few studies have reported the epidemiological features of cases not identified by contact tracing (“unlinked cases”) or described their potential roles in seeding community outbreaks.ObjectiveFor this study, we characterized the role of unlinked cases in the epidemic by comparing their epidemiological profile with the linked cases; we also estimated their transmission potential across different settings.MethodsWe obtained rapid surveillance data from the government, which contained the line listing of COVID-19 confirmed cases during the first three waves in Hong Kong. We compared the demographics, history of chronic illnesses, epidemiological characteristics, clinical characteristics, and outcomes of linked and unlinked cases. Transmission potentials in different settings were assessed by fitting a negative binomial distribution to the observed offspring distribution.ResultsTime interval from illness onset to hospital admission was longer among unlinked cases than linked cases (median 5.00 days versus 3.78 days; P<.001), with a higher proportion of cases whose condition was critical or serious (13.0% versus 8.2%; P<.001). The proportion of unlinked cases was associated with an increase in the weekly number of local cases (P=.049). Cluster transmissions from the unlinked cases were most frequently identified in household settings, followed by eateries and workplaces, with the estimated probability of cluster transmissions being around 0.4 for households and 0.1-0.3 for the latter two settings.ConclusionsThe unlinked cases were positively associated with time to hospital admission, severity of infection, and epidemic size—implying a need to design and implement digital tracing methods to complement current conventional testing and tracing. To minimize the risk of cluster transmissions from unlinked cases, digital tracing approaches should be effectively applied in high-risk socioeconomic settings, and risk assessments should be conducted to review and adjust the policies.

P155 ASSOCIATION OF PRIOR COVID-19 INFECTION AND SYSTEMIC SIDE EFFECTS AFTER COVID-19 VACCINATION IN HEALTHCARE POPULATION

There is limited information on risk factors associated with COVID-19 vaccination systemic side effects (SSE). Our study assesses if prior history of COVID-19 infection or close exposure is associated with SSE after COVID-19 vaccination. A survey was emailed to study participants using institutional listservs. Questions included demographics, COVID-19 infection history, any known COVID-19 exposure in household or healthcare settings, side effects experienced after both doses of the COVID-19 vaccines, onset and duration of side effects, and reporting of adverse effects. 538 participants completed the survey. Of those, 520 (97%) participants received the Pfizer vaccine. 49 (9%) reported prior COVID-19 infection. 222 (41%) reported exposure to COVID-19 in household settings and/or healthcare settings. SSE after the first dose of the COVID-19 vaccine were seen in 43% (21/49) of participants with prior COVID-19 infection history vs 25% (121/487) of participants without history of COVID-19 infection (p-value < 0.05). There was no significant difference in SSE after the second dose of the vaccine between groups. There was no significant difference in SSE between participants reporting COVID-19 exposure vs no exposure. Of the secondary outcomes, age and workplace were not significantly associated with increased SSE. Females reported more systemic symptoms after the 2nd dose compared to males (p<0.05). Immediate type reactions were very rare (<1%) and precluded data analysis because of their scarcity in our study population. Prior history of COVID-19 infection was associated with SSE after the 1st dose of the COVID-19 vaccine.

Determinants of Persistent Organic Pollutants (POPs) Levels in Human Specimens: A Review

Introduction: Numerous studies have been conducted regarding persistent organic pollutants (POPs) concentrations in human biological matrices such as blood, breast milk, urine, and hair that cause adverse health effects such as breast cancer, cardiovascular diseases, and type 2 diabetes. This study aimed to determine the POPs presence in human specimens in household settings. Discussion: A total of 28 articles were included in this study with the criteria published in 2016- 2021, original research articles, free full text available, and studied at least one of the confounding variables of POPs levels in human specimens. The narrative method was selected to synthesize this study. Grouping articles with similar results was carried out to respond to research questions. This study discovered that age, dietary habits, BMI, sex, race/ethnicity, smoking status, physical activities, residency, household dust, and industry emissions were associated with POPs levels in human specimens. Conclusion: This study concluded that each determinant could not affect the POPs levels in the human specimens on its own since those determinants are influenced by each other. Future research using systematic literature review and meta-analysis is therefore strongly advised.

Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study

SummaryBackgroundThe SARS-CoV-2 delta (B.1.617.2) variant is highly transmissible and spreading globally, including in populations with high vaccination rates. We aimed to investigate transmission and viral load kinetics in vaccinated and unvaccinated individuals with mild delta variant infection in the community.MethodsBetween Sept 13, 2020, and Sept 15, 2021, 602 community contacts (identified via the UK contract-tracing system) of 471 UK COVID-19 index cases were recruited to the Assessment of Transmission and Contagiousness of COVID-19 in Contacts cohort study and contributed 8145 upper respiratory tract samples from daily sampling for up to 20 days. Household and non-household exposed contacts aged 5 years or older were eligible for recruitment if they could provide informed consent and agree to self-swabbing of the upper respiratory tract. We analysed transmission risk by vaccination status for 231 contacts exposed to 162 epidemiologically linked delta variant-infected index cases. We compared viral load trajectories from fully vaccinated individuals with delta infection (n=29) with unvaccinated individuals with delta (n=16), alpha (B.1.1.7; n=39), and pre-alpha (n=49) infections. Primary outcomes for the epidemiological analysis were to assess the secondary attack rate (SAR) in household contacts stratified by contact vaccination status and the index cases’ vaccination status. Primary outcomes for the viral load kinetics analysis were to detect differences in the peak viral load, viral growth rate, and viral decline rate between participants according to SARS-CoV-2 variant and vaccination status.FindingsThe SAR in household contacts exposed to the delta variant was 25% (95% CI 18–33) for fully vaccinated individuals compared with 38% (24–53) in unvaccinated individuals. The median time between second vaccine dose and study recruitment in fully vaccinated contacts was longer for infected individuals (median 101 days [IQR 74–120]) than for uninfected individuals (64 days [32–97], p=0·001). SAR among household contacts exposed to fully vaccinated index cases was similar to household contacts exposed to unvaccinated index cases (25% [95% CI 15–35] for vaccinated vs 23% [15–31] for unvaccinated). 12 (39%) of 31 infections in fully vaccinated household contacts arose from fully vaccinated epidemiologically linked index cases, further confirmed by genomic and virological analysis in three index case–contact pairs. Although peak viral load did not differ by vaccination status or variant type, it increased modestly with age (difference of 0·39 [95% credible interval –0·03 to 0·79] in peak log10 viral load per mL between those aged 10 years and 50 years). Fully vaccinated individuals with delta variant infection had a faster (posterior probability >0·84) mean rate of viral load decline (0·95 log10 copies per mL per day) than did unvaccinated individuals with pre-alpha (0·69), alpha (0·82), or delta (0·79) variant infections. Within individuals, faster viral load growth was correlated with higher peak viral load (correlation 0·42 [95% credible interval 0·13 to 0·65]) and slower decline (–0·44 [–0·67 to –0·18]).InterpretationVaccination reduces the risk of delta variant infection and accelerates viral clearance. Nonetheless, fully vaccinated individuals with breakthrough infections have peak viral load similar to unvaccinated cases and can efficiently transmit infection in household settings, including to fully vaccinated contacts. Host–virus interactions early in infection may shape the entire viral trajectory.FundingNational Institute for Health Research.

Visualising household air pollution: Colorimetric sensor arrays for monitoring volatile organic compounds indoors.

Indoor air quality monitoring as it relates to the domestic setting is an integral part of human exposure monitoring and health risk assessment. Hence there is a great need for easy to use, fast and economical indoor air quality sensors to monitor the volatile organic compound composition of the air which is known to be significantly perturbed by the various source emissions from activities in the home. To meet this need, paper-based colorimetric sensor arrays were deployed as volatile organic compound detectors in a field study aiming to understand which activities elicit responses from these sensor arrays in household settings. The sensor array itself is composed of pH indicators and aniline dyes that enable molecular recognition of carboxylic acids, amines and carbonyl-containing compounds. The sensor arrays were initially deployed in different rooms in a single household having different occupant activity types and levels. Sensor responses were shown to differ for different room settings on the basis of occupancy levels and the nature of the room emission sources. Sensor responses relating to specific activities such as cooking, cleaning, office work, etc were noted in the temporal response. Subsequently, the colorimetric sensor arrays were deployed in a broader study across 9 different households and, using multivariate analysis, the sensor responses were shown to correlate strongly with household occupant activity and year of house build. Overall, this study demonstrates the significant potential for this type of simple approach to indoor air pollution monitoring in residential environments.

Description of a Human-Centered Design Approach to Develop Novel Virtual Reality Applications to Improve Functional Outcomes Following Brain Injury

<h3>Research Objectives</h3> Brain injury continues to be a leading cause of serious long-term disability. The objective of this project is to develop and implement innovative assessment and intervention strategies, via robotics and virtual reality systems, to improve balance and walking capabilities for persons with neurologic conditions. <h3>Design</h3> A Human-centered design (HCD) framework is being used to guide the development process and to ensure its end products are usable and useful. HCD develops solutions by involving the stakeholder perspective in all steps of the problem solving process - which includes brainstorming, conceptualizing, developing, and implementing the solution. <h3>Setting</h3> Remote collaboration between a Neuro-recovery Center and an independent virtual reality (VR) and robotics laboratory (Immersive Experience Laboratories LLC (IXL)). <h3>Participants</h3> Physical Therapists, Occupational Therapists, persons with traumatic brain injury, and VR application hardware and software developers. <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Description of the development process of a clinician-designed virtual reality (VR) application for deployment with individuals recovering from brain injury; time to initial uptake of technology; patient and clinician preferences; and clinical outcome scores. <h3>Results</h3> Focus group meetings with clinicians have revealed needs that have strong potential to be effectively addressed by immersive and interactive virtual-reality (VR) interventions, including Identification of Hazards, Care of Others, Garage Time, and Guided Walking. Development of functional platforms for immersive VR training and asset development of indoor household settings is principally complete. Development of treadmill-integrated gait-management platform is principally complete. We currently continue iterative development of content with biweekly feedback from subject-matter-expert clinicians. <h3>Conclusions</h3> The HCD framework could be readily adaptable to other rehabilitation centers interested in developing and implementing these kinds of technologies for the patients they serve. <h3>Author(s) Disclosures</h3> No conflicts of interest

The properties of hot household hygroscopic materials and their potential use for non-medical facemask decontamination.

The widespread use of facemasks throughout the population is recommended by the WHO to reduce transmission of the SARS-CoV-2 virus. As some regions of the world are facing mask shortages, reuse may be necessary. However, used masks are considered as a potential hazard that may spread and transmit disease if they are not decontaminated correctly and systematically before reuse. As a result, the inappropriate decontamination practices that are commonly witnessed in the general public are challenging management of the epidemic at a large scale. To achieve public acceptance and implementation, decontamination procedures need to be low-cost and simple. We propose the use of hot hygroscopic materials to decontaminate non-medical facemasks in household settings. We report on the inactivation of a viral load on a facial mask exposed to hot hygroscopic materials for 15 minutes. As opposed to recent academic studies whereby decontamination is achieved by maintaining heat and humidity above a given value, a more flexible procedure is proposed here using a slow decaying pattern, which is both effective and easier to implement, suggesting straightforward public deployment and hence reliable implementation by the population.

Acrylamide Exposure from Common Culinary Preparations in Spain, in Household, Catering and Industrial Settings.

In 2019, the European Commission recommended monitoring the presence of acrylamide in certain foods not included in Regulation 2158/2017, to consider other sources of exposure to the contaminant. In the present study, eleven groups of processed foods commonly consumed in Spain were classified, according to their food matrix, into potato-based food, cereal-based food and food based on cereal mixed with meat, fish or vegetables. Samples were collected from three different settings: household, catering services and industrial origin, to evaluate the influence of the food preparation site on acrylamide formation. The highest concentrations of acrylamide were observed in chips (French fries), especially those prepared at home. Although at lower levels, all the other foods also contained significant concentrations of acrylamide, confirming the need to control its content in foods not included in the EU regulation. Industrially processed foods made a lower contribution to acrylamide exposure, probably due to the more stringent controls exercised on culinary processes in this context. The higher levels recorded for households and catering services highlight the need for greater awareness of culinary processes and for measures to be adopted in these settings to limit the formation of acrylamide in food preparation.

Common plants used in the treatment of typhoid fever, their active components and toxicity related issues: A review

Plants and their extracts are a primary source of health care in most communities. The usage of plants in the treatment of diseases has been observed in ancient times and still applicable in the present. Plants extracts are used due to their easy availability and affordability. Some of these extracts are being sold locally in markets while others manufactured and used in household settings. Most often, the producers of these extracts do not show proof of safety and efficacy before marketing these products. Consequently, the negative effects and the downside following the consumption of these products remain unknown. Moreover, the plant extracts are not regulated for purity and potency. Impurities present and the potency of the plant products might also contribute significantly to adverse effects following consumption. Typhoid fever has been one of the disease in which most developing countries especially in Africa, resort to the usage of traditional methods involving plant extracts in its treatment. Various research carried out have documented the anti-typhoid activity of these extracts on the basis of zone of inhibition against the pathogen. There is however scarcity of information on the bioactive components possessed by these plants. This paper reviews the common plants used in the treatment of typhoid fever, active components and risk following their indiscriminate usage. The review is composed by literature search on herbal plants for typhoid fever obtained from PubMed and Google Scholar. Knowledge of these active components will help effectively standardize the safe dose needed in the disease treatment

Epidemiology of Foodborne Disease Outbreaks Caused by Nontyphoidal Salmonella in Zhejiang Province, China, 2010-2019.

Nontyphoidal Salmonella infection is a common cause of bacterial foodborne illness in Zhejiang Province, China. This study aimed to summarize the epidemiological and etiological characteristics of the outbreak of nontyphoidal Salmonella infection in Zhejiang Province. Data collected over a 10-year period (2010-2019) from the China National Foodborne Diseases Surveillance Network (NFDSN) were analyzed. A total of 78 outbreaks due to nontyphoidal Salmonella, causing 1450 illnesses and 353 hospitalizations with no deaths, were reported. The outbreak rate from May to October was about four times as high as that in other months. In addition, 33.3% (25/78) outbreaks occurred in household settings, and 41.8% (606/1450) cases were exposed at bakery product-processing factories (or shops). Moreover, food vehicles were identified in 75.6% (59/78) of Salmonella outbreaks. Of these, 30.5% (35/59) were caused by cooked meat products, followed by cold-processed cakes and sandwiches usually containing meat and/or eggs (28.81%, 17/59). Salmonella Enteritidis (56.9%, 33/78) and Salmonella Typhimurium (17.2%, 10/78) were the dominant strains. Outbreaks were most frequently attributed to cross-contamination (88.1%) and improper storage temperature (61.0%). Outbreaks caused by Salmonella are important targets for public health intervention efforts, and improving the safety and quality of cooked meat products, cold-processed cakes, and sandwiches should be a priority.

Attributes of drinking water, sanitation, and hygiene associated with microbiological water quality of stored drinking water in rural schools in Mozambique and Uganda.

Contaminated drinking water causes morbidity and mortality worldwide, especially in low- and middle-income countries. Drinking water quality has been studied extensively in household settings, but little research is available on drinking water quality in schools. School settings are of particular importance, because children are more susceptible than adults to a variety of diseases from contaminated drinking water. Many school water, sanitation and hygiene (WaSH) interventions have been studied for their efficacy to reduce diarrheal disease incidence, but few have evaluated drinking water quality, which reflects an important exposure pathway between WaSH services and health outcomes. Using school surveys developed from internationally established WaSH indicators and field microbiological water quality tests, we studied 374 rural schools in Mozambique and Uganda to understand the association between specific WaSH services and drinking water microbiological contamination, specifically testing most probable number (MPN) of Escherichia coli, an indicator of fecal contamination, per 100mL. In Mozambique and Uganda, 71% and 83% respectively of rural schools had low risk drinking water quality (<1 E. coli/100mL); thirteen percent and seven percent had very high-risk water quality (≥100 E. coli/100mL). When accounting for all WaSH services studied, schools that used an improved-type water source had 0.22 times less E. coli in stored drinking water in Mozambique (95% CI: 0.07, 0.65) and 0.12 times less E. coli in Uganda (95% CI: 0.02, 0.80). In Mozambique, use of a water source within 30minutes for travel and collection and the presence of water and soap/ash for handwashing were also significantly associated with less E. coli in drinking water. The findings of this study provide public health practitioners with implementable WaSH services to improve school drinking water quality, which has implications for the health, learning environment, and cognitive development of school children in rural Mozambique and Uganda.