Research updates from the SHARE project

Below are links to 2017 and 2018 articles from the SHARE project

Oral Contact Events and Caregiver Hand Hygiene: Implications for Fecal-Oral Exposure to Enteric Pathogens among Infants 3–9 Months Living in Informal, Peri-Urban Communities in Kisumu, Kenya – Childhood diarrhea is one of the leading causes of morbidity and mortality in children under five in low and middle-income countries, second only to respiratory illness. The mouthing behavior that is common in children exposes them to fecal-orally transmitted pathogens that can result in diarrhea; however, there is a need for further evidence on specific exposure routes. This study describes the frequency and diversity of two important routes of enteric pathogen exposure among infants 3–9 months of age: infant oral contact behavior and caregiver handwashing behavior. The combined implication of data from observing oral contact behavior in children and hand hygiene of caregivers suggests that caregiver hand hygiene prior to feeding events and after cleaning a child are priority interventions.

From menarche to menopause: A population-based assessment of water, sanitation, and hygiene risk factors for reproductive tract infection symptoms over life stages in rural girls and women in India – Women face greater challenges than men in accessing WASH resources to address their daily needs, and may respond to these challenges by adopting unsafe practices that increase the risk of reproductive tract infections (RTIs). WASH practices may change as women transition through socially-defined life stage experiences, like marriage and pregnancy. Thus, the relationship between WASH practices and RTIs might vary across female reproductive life stages. This cross-sectional study conducted by Baker et al. assessed the relationship between WASH exposures and self-reported RTI symptoms in 3,952 girls and women from two rural districts in India, and tested whether social exposures represented by reproductive life stage was an effect modifier of associations.

Estimating the Health Risk Associated with the Use of Ecological Sanitation Toilets in Malawi – Main exposure pathways were through poor storage of sludge, contamination of foods during drying, walking barefoot on the ground contaminated with sludge, pit emptying without protection, and application of sludge in the fields. Estimated annual risk for Ascaris lumbricoides, Taenia, and hookworms was approximately over 5.6 × 10−1 for both Fossa Alternas (FAs) and Urine Diverting Dry Toilet (UDDTs). Risk from E. coli and Salmonella was 8.9 × 10−2 and above. The risks were higher than WHO acceptable risk for use of faecal sludge in crops of 10−4 infections per year. Promoters and users of EcoSan latrines need to consider advocating for strict guidelines to reduce the risk.

Role, ownership and presence of domestic animals in peri-urban households of Kisumu, Kenya – The research demonstrates the high prevalence of animal ownership in a low-income and high-density peri-urban neighbourhood of Kisumu, which may facilitate zoonotic disease transmission. Further research should assess if and to what extent animal ownership in such communities is associated with disease risk.

High prevalence of ESBL-Producing E. coli in private and shared latrines in an informal urban settlement in Dar es Salaam, Tanzania – Almost a quarter of private and shared latrines in an informal urban settlement in Tanzania are contaminated with ESBL-producing microorganisms, suggesting a high prevalence of human ESBL faecal carriage in the community. Shared latrines may serve as a reservoir for transmission in urban community settings in Tanzania.

Contributing to the debate on categorising shared sanitation facilities as ‘unimproved’: An account based on field researchers’ observations and householders’ opinions in three regions, Tanzania – Having an ‘improved’ latrine remains important as JMP recommends, but based on our study findings, we argue that possessing a non-shared latrine neither guarantees safety to its users nor its categorisation as ‘improved’. Instead, the state of the latrine, the construction technology used and the behaviours of the users may be more important.

Immunogenicity of rotavirus vaccine (RotarixTM) in infants with environmental enteric dysfunction – Deployment of rotavirus vaccines has contributed to significant declines in diarrheal morbidity and mortality globally. Unfortunately, vaccine performance in low-middle income countries (LMICs) is generally lower than in developed countries. The cause for this has been associated with several host and maternal factors including poor WASH status, which are predominant in LMICs. More recently, environmental enteric dysfunction (EED) has specifically been hypothesized to contribute to poor vaccine uptake and response. The aim of this study was to examine the association between serological biomarkers of EED and seroconversion to rotavirus vaccine in Zambian infants.

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