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PLoS Negl Trop Dis. 2018 Apr 16;12(4):e0006418. doi: 10.1371/journal.pntd.0006418. eCollection 2018 Apr.

The impact of school water, sanitation, and hygiene improvements on infectious disease using serum antibody detection.

Author information

1
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
2
Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
3
Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
4
Malaria Research and Training Center, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
5
Division of Parasitic Diseases and Malaria, Centers for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

Abstract

BACKGROUND:

Evidence from recent studies assessing the impact of school water, sanitation and hygiene (WASH) interventions on child health has been mixed. Self-reports of disease are subject to bias, and few WASH impact evaluations employ objective health measures to assess reductions in disease and exposure to pathogens. We utilized antibody responses from dried blood spots (DBS) to measure the impact of a school WASH intervention on infectious disease among pupils in Mali.

METHODOLOGY/PRINCIPAL FINDINGS:

We randomly selected 21 beneficiary primary schools and their 21 matched comparison schools participating in a matched-control trial of a comprehensive school-based WASH intervention in Mali. DBS were collected from 20 randomly selected pupils in each school (n = 807). We analyzed eluted IgG from the DBS using a Luminex multiplex bead assay to 28 antigens from 17 different pathogens. Factor analysis identified three distinct latent variables representing vector-transmitted disease (driven primarily by dengue), food/water-transmitted enteric disease (driven primarily by Escherichia coli and Vibrio cholerae), and person-to-person transmitted enteric disease (driven primarily by norovirus). Data were analyzed using a linear latent variable model. Antibody evidence of food/water-transmitted enteric disease (change in latent variable mean (β) = -0.24; 95% CI: -0.53, -0.13) and person-to-person transmitted enteric disease (β = -0.17; 95% CI: -0.42, -0.04) was lower among pupils attending beneficiary schools. There was no difference in antibody evidence of vector-transmitted disease (β = 0.11; 95% CI: -0.05, 0.33).

CONCLUSIONS/SIGNIFICANCE:

Evidence of enteric disease was lower among pupils attending schools benefitting from school WASH improvements than students attending comparison schools. These findings support results from the parent study, which also found reduced incidence of self-reported diarrhea among pupils of beneficiary schools. DBS collection was feasible in this resource-poor field setting and provided objective evidence of disease at a low cost per antigen analyzed, making it an effective measurement tool for the WASH field.

TRIAL REGISTRATION:

The trial was registered at ClinicalTrials.gov (NCT01787058).

PMID:
29659574
PMCID:
PMC5919668
DOI:
10.1371/journal.pntd.0006418
[Indexed for MEDLINE]
Free PMC Article

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