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- ItemSpatiotemporal variation in risk of Shigella infection in childhood: a global risk mapping and prediction model using individual participant data(Oxford : Elsevier, 2023) Badr, Hamada S.; Colston, Josh M.; Nguyen, Nhat-Lan H.; Chen, Yen Ting; Burnett, Eleanor; Ali, Syed Asad; Rayamajhi, Ajit; Satter, Syed M.; Van Trang, Nguyen; Eibach, Daniel; Krumkamp, Ralf; May, Jürgen; Adegnika, Ayola Akim; Manouana, Gédéon Prince; Kremsner, Peter Gottfried; Chilengi, Roma; Hatyoka, Luiza; Debes, Amanda K.; Ateudjieu, Jerome; Faruque, Abu S. G.; Hossain, M. Jahangir; Kanungo, Suman; Kotloff, Karen L; Mandomando, Inácio; Nisar, M. Imran; Omore, Richard; Sow, Samba O.; Zaidi, Anita K. M.; Lambrecht, Nathalie; Adu, Bright; Page, Nicola; Platts-Mills, James A.; Mavacala Freitas, Cesar; Pelkonen, Tuula; Ashorn, Per; Maleta, Kenneth; Ahmed, Tahmeed; Bessong, Pascal; Bhutta, Zulfiqar A.; Mason, Carl; Mduma, Estomih; Olortegui, Maribel P.; Peñataro Yori, Pablo; Lima, Aldo A. M.; Kang, Gagandeep; Humphrey, Jean; Ntozini, Robert; Prendergast, Andrew J.; Okada, Kazuhisa; Wongboot, Warawan; Langeland, Nina; Moyo, Sabrina J.; Gaensbauer, James; Melgar, Mario; Freeman, Matthew; Chard, Anna N.; Thongpaseuth, Vonethalom; Houpt, Eric; Zaitchik, Benjamin F.; Kosek, Margaret N.BACKGROUND: Diarrhoeal disease is a leading cause of childhood illness and death globally, and Shigella is a major aetiological contributor for which a vaccine might soon be available. The primary objective of this study was to model the spatiotemporal variation in paediatric Shigella infection and map its predicted prevalence across low-income and middle-income countries (LMICs). METHODS: Individual participant data for Shigella positivity in stool samples were sourced from multiple LMIC-based studies of children aged 59 months or younger. Covariates included household-level and participant-level factors ascertained by study investigators and environmental and hydrometeorological variables extracted from various data products at georeferenced child locations. Multivariate models were fitted and prevalence predictions obtained by syndrome and age stratum. FINDINGS: 20 studies from 23 countries (including locations in Central America and South America, sub-Saharan Africa, and south and southeast Asia) contributed 66 563 sample results. Age, symptom status, and study design contributed most to model performance followed by temperature, wind speed, relative humidity, and soil moisture. Probability of Shigella infection exceeded 20% when both precipitation and soil moisture were above average and had a 43% peak in uncomplicated diarrhoea cases at 33°C temperatures, above which it decreased. Compared with unimproved sanitation, improved sanitation decreased the odds of Shigella infection by 19% (odds ratio [OR]=0·81 [95% CI 0·76-0·86]) and open defecation decreased them by 18% (OR=0·82 [0·76-0·88]). INTERPRETATION: The distribution of Shigella is more sensitive to climatological factors, such as temperature, than previously recognised. Conditions in much of sub-Saharan Africa are particularly propitious for Shigella transmission, although hotspots also occur in South America and Central America, the Ganges-Brahmaputra Delta, and the island of New Guinea. These findings can inform prioritisation of populations for future vaccine trials and campaigns. FUNDING: NASA, National Institutes of Health-The National Institute of Allergy and Infectious Diseases, and Bill & Melinda Gates Foundation.
- ItemKey Food Hygiene Behaviors to Reduce Microbial Contamination of Complementary Foods in Rural Bangladesh(Northbrook, Ill. : American Soc. of Tropical Medicine and Hygiene, 2022) Müller-Hauser, Anna A.; Sobhan, Shafinaz; Huda, Tarique Md. Nurul; Waid, Jillian L.; Wendt, Amanda S.; Islam, Mohammad Aminul; Rahman, Mahbubur; Gabrysch, SabineMicrobial contamination of complementary foods puts young children at risk of developing intestinal infections and could be reduced by improved handwashing and food hygiene practices. We aimed to identify which promoted food hygiene practices are associated with reduced complementary food contamination in a rural population in Bangladesh. We collected cross-sectional data on reported and observed maternal food hygiene behaviors and measured Escherichia coli counts as an indicator of microbial contamination in complementary food samples from 342 children of women enrolled in the Food and Agricultural Approaches to Reducing Malnutrition trial in Sylhet, Bangladesh. We used multivariable logistic regression to examine associations of food hygiene behaviors with food contamination. Approximately 46%of complementary food samples had detectable levels of Escherichia coli. Handwashing with soap at critical times and fresh preparation of food before feeding were strongly associated with reduced odds of food sample contamination (odds ratio [OR]: 0.8, 95% confidence interval [CI]: 0.6-0.9 and OR: 0.3, 95% CI: 0.1-0.7, respectively); in contrast, there was no or only weak evidence that reheating of stored food, safe food storage, and cleanliness of feeding utensils reduced contamination. Reduction in food contamination could be more than halved only when several food hygiene behaviors were practiced in combination. In conclusion, single food hygiene practices showed limited potential and a combined practice of multiple food hygiene behaviors may be needed to achieve a substantial reduction of complementary food contamination.