Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Mar 28;221(8):1379-1386.
doi: 10.1093/infdis/jiz179.

Impact of Water Quality, Sanitation, Handwashing, and Nutritional Interventions on Enteric Infections in Rural Zimbabwe: The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial

Elizabeth T Rogawski McQuade  1   2 , James A Platts-Mills  2 , Jean Gratz  2 , Jixian Zhang  2 , Lawrence H Moulton  3   4 , Kuda Mutasa  3 , Florence D Majo  3 , Naume Tavengwa  3 , Robert Ntozini  3 , Andrew J Prendergast  3   5 , Jean H Humphrey  3   4 , Jie Liu  2 , Eric R Houpt  2
Affiliations
Randomized Controlled Trial

Impact of Water Quality, Sanitation, Handwashing, and Nutritional Interventions on Enteric Infections in Rural Zimbabwe: The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial

Elizabeth T Rogawski McQuade et al. J Infect Dis. .

Abstract

Background: We assessed the impact of water, sanitation, and hygiene (WASH) and infant and young child feeding (IYCF) interventions on enteric infections in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe.

Methods: We tested stool samples collected at 1, 3, 6, and 12 months of age and during diarrhea using quantitative molecular diagnostics for 29 pathogens. We estimated the effects of the WASH, IYCF, and combined WASH + IYCF interventions on individual enteropathogen prevalence and quantity, total numbers of pathogens detected, and incidence of pathogen-attributable diarrhea.

Results: WASH interventions decreased the number of parasites detected (difference in number compared to non-WASH arms, -0.07 [95% confidence interval, -.14 to -.02]), but had no statistically significant effects on bacteria, viruses, or the prevalence and quantity of individual enteropathogens after accounting for multiple comparisons. IYCF interventions had no significant effects on individual or total enteropathogens. Neither intervention had significant effects on pathogen-attributable diarrhea.

Conclusions: The WASH interventions implemented in SHINE (improved pit latrine, hand-washing stations, liquid soap, point-of-use water chlorination, and clean play space) did not prevent enteric infections. Transformative WASH interventions are needed that are more efficacious in interrupting fecal-oral microbial transmission in children living in highly contaminated environments.

Keywords: enteric infections; environmental enteric dysfunction; hygiene; sanitation; stunting.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Enteropathogen prevalence in stool samples collected from 996 children in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. High prevalence of rotavirus at 1 and 3 months of age may be due to shedding of rotavirus vaccine. Abbreviations: aEPEC, atypical enteropathogenic Escherichia coli; EAEC, enteroaggregative Escherichia coli; ETEC, enterotoxigenic Escherichia coli; STEC, Shiga toxin–producing Escherichia coli; tEPEC, typical enteropathogenic Escherichia coli.
See this image and copyright information in PMC

Comment in

References

    1. Black RE, Brown KH, Becker S. Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh. Pediatrics 1984; 73:799–805. - PubMed
    1. Garzón M, Pereira-da-Silva L, Seixas J, Papoila AL, Alves M. Subclinical enteric parasitic infections and growth faltering in infants in São Tomé, Africa: a birth cohort study. Int J Environ Res Public Health 2018; 15. - PMC - PubMed
    1. Steiner KL, Ahmed S, Gilchrist CA, et al. . Species of cryptosporidia causing subclinical infection associated with growth faltering in rural and urban Bangladesh: a birth cohort study. Clin Infect Dis 2018; 67:1347–55. - PMC - PubMed
    1. George CM, Burrowes V, Perin J, et al. . Enteric infections in young children are associated with environmental enteropathy and impaired growth. Trop Med Int Health 2018; 23:26–33. - PubMed
    1. Rogawski ET, Liu J, Platts-Mills JA, et al. . Use of quantitative molecular diagnostic methods to investigate the effect of enteropathogen infections on linear growth in children in low-resource settings: longitudinal analysis of results from the MAL-ED cohort study. Lancet Glob Health 2018; 6:e1319–28. - PMC - PubMed

Publication types