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Dr. Md Mahbubur Rahman is a Project Coordinator and leading Environmental Interventions Unit, Infectious Diseases Division at icddr, b. Interested areas: environmental health including WASH, Heavy metals, Planetary Health, and Antimicrobial Resistance. He completed MBBS from Rajshahi Medical College, Bangladesh, Masters of population Sciences from Dhaka University, Bangladesh, and Masters of Public Health from an affiliated institution of University of Newcastle. He has several publications in peer reviewed journals. He is member of American Society of Tropical Medicine and Hygiene, Planetary Health Alliance, Bangladesh Medical association, Public Health Association of Bangladesh, One Health Initiative, Environmental Health and Interventions Working Group.
Community Health Workers (CHWs) can effectively implement maternal and child health interventions, but there is paucity of evidence on how to integrate child stimulation into these interventions, and their delivery at scale. In rural Bangladesh, CHWs implemented an intervention integrating psychosocial stimulation, nutrition, maternal mental health, water, sanitation, hygiene (WASH) and lead exposure prevention. In each of 16 intervention villages, one CHW worked with 20 households. CHWs bi-weekly held group meetings or alternated group meetings and home visits with pregnant women and lactating mothers. We assessed the intervention through five focus groups, four interviews and one group discussion with CHWs and their supervisors to explore success factors of implementation. CHWs’ training, one-on-one supervision and introduction by staff to their own community, and adoption of tablet computers as job aids, enabled successful session delivery to convey behavioral recommendations. CHWs reported difficulties delivering session due to the complexity of behavioral recommendations and struggled with age-specific intervention material. Young children’s attendance in group sessions generated distractions that undermined content delivery. We identified ways to minimize the difficulties to strengthen intervention-delivery during implementation, and scale-up. Iterative revisions of similarly integrated interventions based on qualitative evaluation findings could be delivered feasibly by CHWs and allow for implementation at scale.
Tania Jahir; Peter Winch; Elli Leontsini; Sharon Hwang; Farzana Yeasmin; Khobair Hossain; Jyoti Das; Ruhul Amin; Tarique Nurul Huda; Jesmin Sultana; Rizwana Khan; Fahmida Akter; Akm Shoab; Rezaul Hasan; Helen Pitchik; Fahmida Tofail; Lia Fernald; Stephen Luby; Mahbubur Rahman. Success Factors for Community Health Workers in Implementing an Integrated Group-Based Child Development Intervention in Rural Bangladesh. International Journal of Environmental Research and Public Health 2021, 18, 7891 .
AMA StyleTania Jahir, Peter Winch, Elli Leontsini, Sharon Hwang, Farzana Yeasmin, Khobair Hossain, Jyoti Das, Ruhul Amin, Tarique Nurul Huda, Jesmin Sultana, Rizwana Khan, Fahmida Akter, Akm Shoab, Rezaul Hasan, Helen Pitchik, Fahmida Tofail, Lia Fernald, Stephen Luby, Mahbubur Rahman. Success Factors for Community Health Workers in Implementing an Integrated Group-Based Child Development Intervention in Rural Bangladesh. International Journal of Environmental Research and Public Health. 2021; 18 (15):7891.
Chicago/Turabian StyleTania Jahir; Peter Winch; Elli Leontsini; Sharon Hwang; Farzana Yeasmin; Khobair Hossain; Jyoti Das; Ruhul Amin; Tarique Nurul Huda; Jesmin Sultana; Rizwana Khan; Fahmida Akter; Akm Shoab; Rezaul Hasan; Helen Pitchik; Fahmida Tofail; Lia Fernald; Stephen Luby; Mahbubur Rahman. 2021. "Success Factors for Community Health Workers in Implementing an Integrated Group-Based Child Development Intervention in Rural Bangladesh." International Journal of Environmental Research and Public Health 18, no. 15: 7891.
We evaluated the relationship between estimated 24-hour urinary sodium excretion from the Kawasaki, Tanaka, and INTERSALT (International Study of Sodium, Potassium, and Blood Pressure) formulas and blood pressure (BP). We pooled 10 034 person-visit data from 3 cohort studies in Bangladesh that had measured 24-hour urine sodium (m-24hUNa), potassium, creatinine excretion, and BP. We used m-24hUNa, potassium, and creatinine where necessary, rather than spot urine values in the formulas. Bland-Altman plots were used to determine the bias associated with formula-estimated sodium relative to m-24hUNa. We compared the sodium excretion and BP relationships from m-24hUNa versus formula-estimated sodium excretions, using restricted cubic spline plots for adjusted multilevel linear models. All formulas overestimated 24-hour sodium at lower levels but underestimated 24-hour sodium at higher levels. There was a linear relationship between m-24hUNa excretion and systolic BP, while estimated sodium excretion from all 3 formulas had a J-shaped relationship with systolic BP. The relationships between urine sodium excretion and diastolic BP were more complex but were also altered by using formulas. All formulas had associations with BP when a sex-specific constant sodium concentration was inserted in place of measured sodium. Since we used the m-24hUNa, potassium, and creatinine concentrations in formulas, the J-shaped relationships are due to intrinsic problems in the formulas, not due to spot urine sampling. Formula-estimated 24-hour urine sodium excretion should not be used to examine the relationship between sodium excretion and BP since they alter the real associations.
Abu Mohd Naser; Feng J. He; Mahbubur Rahman; Norm R.C. Campbell. Spot Urine Formulas to Estimate 24-Hour Urinary Sodium Excretion Alter the Dietary Sodium and Blood Pressure Relationship. Hypertension 2021, 77, 2127 -2137.
AMA StyleAbu Mohd Naser, Feng J. He, Mahbubur Rahman, Norm R.C. Campbell. Spot Urine Formulas to Estimate 24-Hour Urinary Sodium Excretion Alter the Dietary Sodium and Blood Pressure Relationship. Hypertension. 2021; 77 (6):2127-2137.
Chicago/Turabian StyleAbu Mohd Naser; Feng J. He; Mahbubur Rahman; Norm R.C. Campbell. 2021. "Spot Urine Formulas to Estimate 24-Hour Urinary Sodium Excretion Alter the Dietary Sodium and Blood Pressure Relationship." Hypertension 77, no. 6: 2127-2137.
Lead exposure is harmful at any time in life, but pre-natal and early childhood exposures are particularly detrimental to cognitive development. In Bangladesh, multiple household-level lead exposures pose risks, including turmeric adulterated with lead chromate and food storage in lead-soldered cans. We developed and evaluated an intervention to reduce lead exposure among children and their caregivers in rural Bangladesh. We conducted formative research to inform theory-based behavioral recommendations. Lead exposure was one of several topics covered in the multi-component intervention focused on early child development. Community health workers (CHWs) delivered the lead component of the intervention during group sessions with pregnant women and mother-child dyads (<15 months old) in a cluster-randomized trial. We administered household surveys at baseline (control n = 301; intervention n = 320) and 9 months later at endline (control n = 279; intervention n = 239) and calculated adjusted risk and mean differences for primary outcomes. We conducted two qualitative assessments, one after 3 months and a second after 9 months, to examine the feasibility and benefits of the intervention. At endline, the prevalence of lead awareness was 52 percentage points higher in the intervention arm compared to the control (adjusted risk difference: 0.52 [95% CI 0.46 to 0.61]). Safe turmeric consumption and food storage practices were more common in the intervention versus control arm at endline, with adjusted risk differences of 0.22 [0.10 to 0.32] and 0.13 [0.00 to 0.19], respectively. Semi-structured interviews conducted with a subset of participants after the intervention revealed that the perceived benefit of reducing lead exposure was high because of the long-term negative impacts that lead can have on child cognitive development. The study demonstrates that a group-based CHW-led intervention can effectively raise awareness about and motivate lead exposure prevention behaviors in rural Bangladesh. Future efforts should combine similar awareness-raising efforts with longer-term regulatory and structural changes to systematically and sustainably reduce lead exposure.
Tania Jahir; Helen O. Pitchik; Mahbubur Rahman; Jesmin Sultana; A.K.M. Shoab; Tarique Md Nurul Huda; Kendra A. Byrd; Saiful Islam; Farzana Yeasmin; Musa Baker; Dalia Yeasmin; Syeda Nurunnahar; Stephen P. Luby; Peter J. Winch; Jenna E. Forsyth. Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh. Environmental Research 2021, 199, 111292 .
AMA StyleTania Jahir, Helen O. Pitchik, Mahbubur Rahman, Jesmin Sultana, A.K.M. Shoab, Tarique Md Nurul Huda, Kendra A. Byrd, Saiful Islam, Farzana Yeasmin, Musa Baker, Dalia Yeasmin, Syeda Nurunnahar, Stephen P. Luby, Peter J. Winch, Jenna E. Forsyth. Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh. Environmental Research. 2021; 199 ():111292.
Chicago/Turabian StyleTania Jahir; Helen O. Pitchik; Mahbubur Rahman; Jesmin Sultana; A.K.M. Shoab; Tarique Md Nurul Huda; Kendra A. Byrd; Saiful Islam; Farzana Yeasmin; Musa Baker; Dalia Yeasmin; Syeda Nurunnahar; Stephen P. Luby; Peter J. Winch; Jenna E. Forsyth. 2021. "Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh." Environmental Research 199, no. : 111292.
The episodic outbreak of COVID-19 due to SARS-CoV-2 is severely affecting the economy, and the global count of infected patients is increasing. The actual number of patients had been underestimated due to limited facilities for testing as well as asymptomatic nature of the expression of COVID-19 on individual basis. Tragically, for emerging economies with high population density, the situation has been more complex due to insufficient testing facilities for diagnosis of the disease. However, the recent reports about persistent shedding of viral RNA of SARS-CoV-2 in the human feces have created a possibility to track the prevalence and trends of the disease in communities, known as wastewater-based epidemiology (WBE). In this article, we highlight the current limitations and future prospects for WBE to manage pandemics.
Prosun Bhattacharya; Manish Kumar; Tahmidul Islam; Rehnuma Haque; Sudip Chakraborty; Arslan Ahmad; Nabeel Khan Niazi; Zeynep Cetecioglu; David Nilsson; Julian Ijumulana; Tom van der Voorn; Jakariya; Maqsud Hossain; Firoz Ahmed; Mahbubur Rahman; Nargis Akter; Dara Johnston; Kazi Matin Ahmed. Prevalence of SARS-CoV-2 in Communities Through Wastewater Surveillance—a Potential Approach for Estimation of Disease Burden. Current Pollution Reports 2021, 7, 160 -166.
AMA StyleProsun Bhattacharya, Manish Kumar, Tahmidul Islam, Rehnuma Haque, Sudip Chakraborty, Arslan Ahmad, Nabeel Khan Niazi, Zeynep Cetecioglu, David Nilsson, Julian Ijumulana, Tom van der Voorn, Jakariya, Maqsud Hossain, Firoz Ahmed, Mahbubur Rahman, Nargis Akter, Dara Johnston, Kazi Matin Ahmed. Prevalence of SARS-CoV-2 in Communities Through Wastewater Surveillance—a Potential Approach for Estimation of Disease Burden. Current Pollution Reports. 2021; 7 (2):160-166.
Chicago/Turabian StyleProsun Bhattacharya; Manish Kumar; Tahmidul Islam; Rehnuma Haque; Sudip Chakraborty; Arslan Ahmad; Nabeel Khan Niazi; Zeynep Cetecioglu; David Nilsson; Julian Ijumulana; Tom van der Voorn; Jakariya; Maqsud Hossain; Firoz Ahmed; Mahbubur Rahman; Nargis Akter; Dara Johnston; Kazi Matin Ahmed. 2021. "Prevalence of SARS-CoV-2 in Communities Through Wastewater Surveillance—a Potential Approach for Estimation of Disease Burden." Current Pollution Reports 7, no. 2: 160-166.
Community health workers (CHWs) are key to implementing community-based health interventions and quality can be enhanced by better understanding their lived experiences. The WASH Benefits, Bangladesh trial engaged 540 female CHWs to promote varying health intervention packages. We report on factors influencing their lived experiences during the trial, to aid future recruitment, training and retention of CHWs. Nine focus groups and 18 in-depth interviews were conducted with CHWs. Focus groups and interviews were transcribed and thematic content analysis performed to summarize the results. All CHWs described experiencing positive working conditions and many benefits both socially and financially; these contributed to their retention and job satisfaction. Their honorarium was commonly applied towards their children’s education and invested for income generation. CHWs gained self-confidence as women, to move unaccompanied in the community and speak in public. They earned respect from the community and their family members who helped them manage their family obligations during work and were viewed as a resource for advice on health and social issues. Many participated in family decision-making from which they were previously excluded. Health programs should foster a positive experience among their CHWs to aid the recruitment, retention and development of this important human resource.
Mahbubur Rahman; Tania Jahir; Farzana Yeasmin; Farzana Begum; Mosammot Mobashara; Khobair Hossain; Rizwana Khan; Rezwana Hossain; Fosiul Nizame; Anika Jain; Elli Leontsini; Leanne Unicomb; Stephen Luby; Peter Winch. The Lived Experiences of Community Health Workers Serving in a Large-Scale Water, Sanitation, and Hygiene Intervention Trial in Rural Bangladesh. International Journal of Environmental Research and Public Health 2021, 18, 3389 .
AMA StyleMahbubur Rahman, Tania Jahir, Farzana Yeasmin, Farzana Begum, Mosammot Mobashara, Khobair Hossain, Rizwana Khan, Rezwana Hossain, Fosiul Nizame, Anika Jain, Elli Leontsini, Leanne Unicomb, Stephen Luby, Peter Winch. The Lived Experiences of Community Health Workers Serving in a Large-Scale Water, Sanitation, and Hygiene Intervention Trial in Rural Bangladesh. International Journal of Environmental Research and Public Health. 2021; 18 (7):3389.
Chicago/Turabian StyleMahbubur Rahman; Tania Jahir; Farzana Yeasmin; Farzana Begum; Mosammot Mobashara; Khobair Hossain; Rizwana Khan; Rezwana Hossain; Fosiul Nizame; Anika Jain; Elli Leontsini; Leanne Unicomb; Stephen Luby; Peter Winch. 2021. "The Lived Experiences of Community Health Workers Serving in a Large-Scale Water, Sanitation, and Hygiene Intervention Trial in Rural Bangladesh." International Journal of Environmental Research and Public Health 18, no. 7: 3389.
Faecal-oral infections are a major component of the disease burden in low-income contexts, with inadequate sanitation seen as a contributing factor. However, demonstrating health effects of sanitation interventions – particularly in urban areas – has proved challenging and there is limited empirical evidence to support sanitation decisions that maximise health gains. This study aimed to develop, apply and validate a systems modelling approach to inform sanitation infrastructure and service decision-making in urban environments by examining enteric pathogen inputs, transport and reduction by various sanitation systems, and estimating corresponding exposure and public health impacts. The health effects of eight sanitation options were assessed in a low-income area in Dhaka, Bangladesh, with a focus on five target pathogens (Shigella, Vibrio cholerae, Salmonella Typhi, norovirus GII and Giardia). Relative to the sanitation base case in the study site (24% septic tanks, 5% holding tanks and 71% toilets discharging directly to open drains), comprehensive coverage of septic tanks was estimated to reduce the disease burden in disability-adjusted life years (DALYs) by 48–72%, while complete coverage of communal scale anaerobic baffled reactors was estimated to reduce DALYs by 67–81%. Despite these improvements, a concerning health risk persists with these systems as a result of effluent discharge to open drains, particularly when the systems are poorly managed. Other sanitation options, including use of constructed wetlands and small bore sewerage, demonstrated further reductions in local health risk, though several still exported pathogens into neighbouring areas, simply transferring risk to downstream communities. The study revealed sensitivity to and a requirement for further evidence on log reduction values for different sanitation systems under varying performance conditions, pathogen flows under flooding conditions as well as pathogen shedding and human exposure in typical low-income urban settings. Notwithstanding variability and uncertainties in input parameters, systems modelling can be a feasible and customisable approach to consider the relative health impact of different sanitation options across various contexts, and stands as a valuable tool to guide urban sanitation decision-making.
Tim Foster; Jay Falletta; Nuhu Amin; Mahbubur Rahman; Pengbo Liu; Suraja Raj; Freya Mills; Susan Petterson; Guy Norman; Christine Moe; Juliet Willetts. Modelling faecal pathogen flows and health risks in urban Bangladesh: Implications for sanitation decision making. International Journal of Hygiene and Environmental Health 2021, 233, 113669 .
AMA StyleTim Foster, Jay Falletta, Nuhu Amin, Mahbubur Rahman, Pengbo Liu, Suraja Raj, Freya Mills, Susan Petterson, Guy Norman, Christine Moe, Juliet Willetts. Modelling faecal pathogen flows and health risks in urban Bangladesh: Implications for sanitation decision making. International Journal of Hygiene and Environmental Health. 2021; 233 ():113669.
Chicago/Turabian StyleTim Foster; Jay Falletta; Nuhu Amin; Mahbubur Rahman; Pengbo Liu; Suraja Raj; Freya Mills; Susan Petterson; Guy Norman; Christine Moe; Juliet Willetts. 2021. "Modelling faecal pathogen flows and health risks in urban Bangladesh: Implications for sanitation decision making." International Journal of Hygiene and Environmental Health 233, no. : 113669.
Background We compared the relationship of past and contemporary sodium (Na) intake with cardiometabolic biomarkers. Methods and Results A total of 1191 participants' data from a randomized controlled trial in coastal Bangladesh were analyzed. Participants provided 24‐hour urine Na (24UNa) data for 5 monthly visits. Their fasting blood glucose, total cholesterol, triglycerides, high‐density lipoprotein, blood pressure, and 24‐hour urine protein were measured at the fifth visit. Participants' mean 24UNa over the first 4 visits was the past Na, and 24UNa of the fifth visit was the contemporary Na intake. We estimated the prevalence ratios of elevated cardiometabolic biomarkers and metabolic syndrome across 24UNa tertiles by multilevel logistic regression using participant‐, household‐, and community‐level random intercepts. Models were adjusted for age, sex, body mass index, smoking, physical activity, alcohol consumption, sleep hours, religion, and household wealth. Compared with participants in tertile 1 of past urine Na, those in tertile 3 had 1.46 (95% CI, 1.08–1.99) times higher prevalence of prediabetes or diabetes mellitus, 5.49 (95% CI, 2.73–11.01) times higher prevalence of large waist circumference, and 1.60 (95% CI, 1.04–2.46) times higher prevalence of metabolic syndrome. Compared with participants in tertile 1 of contemporary urine Na, those in tertile 3 had 1.93 (95% CI, 1.24–3.00) times higher prevalence of prediabetes or diabetes mellitus, 3.14 (95% CI, 1.45–6.83) times higher prevalence of proteinuria, and 2.23 (95% CI, 1.34–3.71) times higher prevalence of large waist circumference. Conclusions Both past and contemporary Na intakes were associated with higher cardiometabolic disease risk.
Abu Mohd Naser; Mahbubur Rahman; Leanne Unicomb; Solaiman Doza; Shahjada Selim; Monjila Chaity; Stephen P. Luby; Shuchi Anand; Lisa Staimez; Thomas F. Clasen; Unjali P. Gujral; Matthew O. Gribble; K. M. Venkat Narayan. Past Sodium Intake, Contemporary Sodium Intake, and Cardiometabolic Health in Southwest Coastal Bangladesh. Journal of the American Heart Association 2020, 9, 1 .
AMA StyleAbu Mohd Naser, Mahbubur Rahman, Leanne Unicomb, Solaiman Doza, Shahjada Selim, Monjila Chaity, Stephen P. Luby, Shuchi Anand, Lisa Staimez, Thomas F. Clasen, Unjali P. Gujral, Matthew O. Gribble, K. M. Venkat Narayan. Past Sodium Intake, Contemporary Sodium Intake, and Cardiometabolic Health in Southwest Coastal Bangladesh. Journal of the American Heart Association. 2020; 9 (18):1.
Chicago/Turabian StyleAbu Mohd Naser; Mahbubur Rahman; Leanne Unicomb; Solaiman Doza; Shahjada Selim; Monjila Chaity; Stephen P. Luby; Shuchi Anand; Lisa Staimez; Thomas F. Clasen; Unjali P. Gujral; Matthew O. Gribble; K. M. Venkat Narayan. 2020. "Past Sodium Intake, Contemporary Sodium Intake, and Cardiometabolic Health in Southwest Coastal Bangladesh." Journal of the American Heart Association 9, no. 18: 1.
We compared the sodium intake and systolic blood pressure (SBP) relationship from complete 24-h urine samples determined by several methods: self-reported no-missed urine, creatinine index ≥0.7, measured 24-h urine creatinine (mCER) within 25% and 15% of Kawasaki predicted urine creatinine, and sex-specific mCER ranges (mCER 15–25 mg/kg/24-h for men; 10–20 mg/kg/24-h for women). We pooled 10,031 BP and 24-h urine sodium data from 2143 participants. We implemented multilevel linear models to illustrate the shape of the sodium–BP relationship using the restricted cubic spline (RCS) plots, and to assess the difference in mean SBP for a 100 mmol increase in 24-h urine sodium. The RCS plot illustrated an initial steep positive sodium–SBP relationship for all methods, followed by a less steep positive relationship for self-reported no-missed urine, creatinine index ≥0.7, and sex-specific mCER ranges; and a plateaued relationship for the two Kawasaki methods. Each 100 mmol/24-h increase in urinary sodium was associated with 0.64 (95% CI: 0.34, 0.94) mmHg higher SBP for self-reported no-missed urine, 0.68 (95% CI: 0.27, 1.08) mmHg higher SBP for creatinine index ≥0.7, 0.87 (95% CI: 0.07, 1.67) mmHg higher SBP for mCER within 25% Kawasaki predicted urine creatinine, 0.98 (95% CI: −0.07, 2.02) mmHg change in SBP for mCER within 15% Kawasaki predicted urine creatinine, and 1.96 (95% CI: 0.93, 2.99) mmHg higher SBP for sex-specific mCER ranges. Studies examining 24-h urine sodium in relation to health outcomes will have different results based on how urine collections are deemed as complete.
Abu Mohd Naser; Feng J. He; Mahbubur Rahman; K. M. Venkat Narayan; Norm R. C. Campbell. Urinary Sodium Excretion and Blood Pressure Relationship across Methods of Evaluating the Completeness of 24-h Urine Collections. Nutrients 2020, 12, 2772 .
AMA StyleAbu Mohd Naser, Feng J. He, Mahbubur Rahman, K. M. Venkat Narayan, Norm R. C. Campbell. Urinary Sodium Excretion and Blood Pressure Relationship across Methods of Evaluating the Completeness of 24-h Urine Collections. Nutrients. 2020; 12 (9):2772.
Chicago/Turabian StyleAbu Mohd Naser; Feng J. He; Mahbubur Rahman; K. M. Venkat Narayan; Norm R. C. Campbell. 2020. "Urinary Sodium Excretion and Blood Pressure Relationship across Methods of Evaluating the Completeness of 24-h Urine Collections." Nutrients 12, no. 9: 2772.
Background We evaluated the impact of low-cost water, sanitation, and handwashing (WSH) and child nutrition interventions on enteropathogen carriage in the WASH Benefits cluster-randomized controlled trial in rural Bangladesh. Methods We analyzed 1411 routine fecal samples from children 14 ± 2 months old in the WSH (n = 369), nutrition counseling plus lipid-based nutrient supplement (n = 353), nutrition plus WSH (n = 360), and control (n = 329) arms for 34 enteropathogens using quantitative polymerase chain reaction. Outcomes included the number of co-occurring pathogens; cumulative quantity of 4 stunting-associated pathogens; and prevalence and quantity of individual pathogens. Masked analysis was by intention-to-treat. Results Three hundred twenty-six (99.1%) control children had 1 or more enteropathogens detected (mean, 3.8 ± 1.8). Children receiving WSH interventions had lower prevalence and quantity of individual viruses than controls (prevalence difference for norovirus: –11% [95% confidence interval {CI}, –5% to –17%]; sapovirus: –9% [95% CI, –3% to –15%]; and adenovirus 40/41: –9% [95% CI, –2% to –15%]). There was no difference in bacteria, parasites, or cumulative quantity of stunting-associated pathogens between controls and any intervention arm. Conclusions WSH interventions were associated with fewer enteric viruses in children aged 14 months. Different strategies are needed to reduce enteric bacteria and parasites at this critical young age.
Jessica A Grembi; Audrie Lin; Abdul Karim; Ohedul Islam; Rana Miah; Benjamin F Arnold; Elizabeth T Rogawski McQuade; Shahjahan Ali; Ziaur Rahman; Zahir Hussain; Abul K Shoab; Syeda L Famida; Saheen Hossen; Palash Mutsuddi; Mahbubur Rahman; Leanne Unicomb; Rashidul Haque; Mami Taniuchi; Jie Liu; James A Platts-Mills; Susan P Holmes; Christine P Stewart; Jade Benjamin-Chung; John M Colford; Eric R Houpt; Stephen P Luby. Effect of Water, Sanitation, Handwashing, and Nutrition Interventions on Enteropathogens in Children 14 Months Old: A Cluster-Randomized Controlled Trial in Rural Bangladesh. The Journal of Infectious Diseases 2020, 1 .
AMA StyleJessica A Grembi, Audrie Lin, Abdul Karim, Ohedul Islam, Rana Miah, Benjamin F Arnold, Elizabeth T Rogawski McQuade, Shahjahan Ali, Ziaur Rahman, Zahir Hussain, Abul K Shoab, Syeda L Famida, Saheen Hossen, Palash Mutsuddi, Mahbubur Rahman, Leanne Unicomb, Rashidul Haque, Mami Taniuchi, Jie Liu, James A Platts-Mills, Susan P Holmes, Christine P Stewart, Jade Benjamin-Chung, John M Colford, Eric R Houpt, Stephen P Luby. Effect of Water, Sanitation, Handwashing, and Nutrition Interventions on Enteropathogens in Children 14 Months Old: A Cluster-Randomized Controlled Trial in Rural Bangladesh. The Journal of Infectious Diseases. 2020; ():1.
Chicago/Turabian StyleJessica A Grembi; Audrie Lin; Abdul Karim; Ohedul Islam; Rana Miah; Benjamin F Arnold; Elizabeth T Rogawski McQuade; Shahjahan Ali; Ziaur Rahman; Zahir Hussain; Abul K Shoab; Syeda L Famida; Saheen Hossen; Palash Mutsuddi; Mahbubur Rahman; Leanne Unicomb; Rashidul Haque; Mami Taniuchi; Jie Liu; James A Platts-Mills; Susan P Holmes; Christine P Stewart; Jade Benjamin-Chung; John M Colford; Eric R Houpt; Stephen P Luby. 2020. "Effect of Water, Sanitation, Handwashing, and Nutrition Interventions on Enteropathogens in Children 14 Months Old: A Cluster-Randomized Controlled Trial in Rural Bangladesh." The Journal of Infectious Diseases , no. : 1.
Supporting caregivers’ mental wellbeing and ability to provide psychosocial stimulation may promote early childhood development. This paper describes the systematic approach of developing an integrated stimulation intervention, identifying the feasibility and challenges faced throughout the period. We developed an integrated curriculum by culturally adapting three interventions (Reach Up, Thinking Healthy, and general nutrition advice) and piloted this curriculum (Mar–April 2017) in courtyard groups sessions and individual home visits with pregnant women (n = 11) and lactating mothers (of children n = 29). We conducted qualitative interviews with the participants (n = 8) and the community health workers who delivered the intervention (n = 2). Most participants reported willingness to attend the sessions if extended for 1 year, and recommended additional visual cues and interactive role-play activities to make the sessions more engaging. Participants and community health workers found it difficult to understand the concept of “unhealthy thoughts” in the curriculum. This component was then revised to include a simplified behavior-focused story. Community health workers reported difficulty balancing the required content of the integrated curriculum but were able to manage after the contents were reduced. The revised intervention is likely feasible to deliver to a group of pregnant and lactating mothers in a low-resource setting.
Fahmida Akter; Mahbubur Rahman; Helen O. Pitchik; Peter J. Winch; Lia C. H. Fernald; Tarique Mohammad Nurul Huda; Tania Jahir; Ruhul Amin; Jyoti Bhushan Das; Khobair Hossain; Abul Kashem Shoab; Rizwana Khan; Farzana Yeasmin; Jesmin Sultana; Stephen P. Luby; Fahmida Tofail. Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh. International Journal of Environmental Research and Public Health 2020, 17, 6233 .
AMA StyleFahmida Akter, Mahbubur Rahman, Helen O. Pitchik, Peter J. Winch, Lia C. H. Fernald, Tarique Mohammad Nurul Huda, Tania Jahir, Ruhul Amin, Jyoti Bhushan Das, Khobair Hossain, Abul Kashem Shoab, Rizwana Khan, Farzana Yeasmin, Jesmin Sultana, Stephen P. Luby, Fahmida Tofail. Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh. International Journal of Environmental Research and Public Health. 2020; 17 (17):6233.
Chicago/Turabian StyleFahmida Akter; Mahbubur Rahman; Helen O. Pitchik; Peter J. Winch; Lia C. H. Fernald; Tarique Mohammad Nurul Huda; Tania Jahir; Ruhul Amin; Jyoti Bhushan Das; Khobair Hossain; Abul Kashem Shoab; Rizwana Khan; Farzana Yeasmin; Jesmin Sultana; Stephen P. Luby; Fahmida Tofail. 2020. "Adaptation and Integration of Psychosocial Stimulation, Maternal Mental Health and Nutritional Interventions for Pregnant and Lactating Women in Rural Bangladesh." International Journal of Environmental Research and Public Health 17, no. 17: 6233.
BackgroundSoil-transmitted helminths (STH) and Giardia duodenalis are responsible for a large burden of disease globally. In low-resource settings, household finished floors (e.g., concrete floors) may reduce transmission of STH and G. duodenalis.MethodsIn a prospective cohort of children nested within two randomised trials in rural Bangladesh and Kenya, we estimated associations between household finished flooring and STH and G. duodenalis prevalence. In 2015-2016, we collected stool samples from children aged 2-16 years in rural Bangladesh and Kenya. We detected STH infection using qPCR (Bangladesh N=2,800; Kenya N=3,094) and detected G. duodenalis using qPCR in Bangladesh (N=6,894) and ELISA in Kenya (N=8,899). We estimated adjusted prevalence ratios (aPRs) using log-linear models adjusted for potential confounders.FindingsAt enrolment, 10% of households in Bangladesh and 5% in Kenya had finished floors. In both countries, household finished flooring was associated with lower Ascaris lumbricoides prevalence (Bangladesh aPR: 0.33, 95% CI 0.14, 0.78; Kenya aPR: 0.62, 95% CI 0.39, 0.98) and any STH (Bangladesh aPR: 0.73, 95% CI 0.52, 1.01; Kenya aPR: 0.57, 95% CI 0.37, 0.88). Household finished floors were also associated with lower Necator americanus prevalence in Bangladesh (aPR: 0.52, 95% CI 0.29, 0.94) and G. duodenalis prevalence in both countries (Bangladesh aPR: 0.78, 95% CI 0.64, 0.95; Kenya: aPR: 0.82, 95% CI 0.70, 0.97).InterpretationIn low-resource settings, living in households with finished floors over a two-year period was associated with lower prevalence of G. duodenalis and certain STH in children.FundingBill & Melinda Gates Foundation grant OPPGD759
Jade Benjamin-Chung; Yoshika S. Crider; Andrew Mertens; Ayse Ercumen; Amy J. Pickering; Audrie Lin; Lauren Steinbaum; Jenna Swarthout; Mahbubur Rahman; Sarker M. Parvez; Rashidul Haque; Sammy M. Njenga; Jimmy Kihara; Clair Null; Stephen P. Luby; John M. Colford Jr.; Benjamin F. Arnold. Household finished flooring and soil-transmitted helminth and Giardia infections among children in rural Bangladesh and Kenya: a prospective cohort study. 2020, 1 .
AMA StyleJade Benjamin-Chung, Yoshika S. Crider, Andrew Mertens, Ayse Ercumen, Amy J. Pickering, Audrie Lin, Lauren Steinbaum, Jenna Swarthout, Mahbubur Rahman, Sarker M. Parvez, Rashidul Haque, Sammy M. Njenga, Jimmy Kihara, Clair Null, Stephen P. Luby, John M. Colford Jr., Benjamin F. Arnold. Household finished flooring and soil-transmitted helminth and Giardia infections among children in rural Bangladesh and Kenya: a prospective cohort study. . 2020; ():1.
Chicago/Turabian StyleJade Benjamin-Chung; Yoshika S. Crider; Andrew Mertens; Ayse Ercumen; Amy J. Pickering; Audrie Lin; Lauren Steinbaum; Jenna Swarthout; Mahbubur Rahman; Sarker M. Parvez; Rashidul Haque; Sammy M. Njenga; Jimmy Kihara; Clair Null; Stephen P. Luby; John M. Colford Jr.; Benjamin F. Arnold. 2020. "Household finished flooring and soil-transmitted helminth and Giardia infections among children in rural Bangladesh and Kenya: a prospective cohort study." , no. : 1.
Managed aquifer recharge (MAR), a hydro-geological intervention designed to dilute groundwater salinity, pumps pond water treated through a slow sand filter into the underground aquifers. We evaluated the microbiological safety of the resulting MAR water at sites from three districts in southwest coastal Bangladesh. We collected monthly paired pond-MAR water samples from July 2016-June 2017 and enumerated fecal coliforms and E. coli using the IDEXX quanti-tray technique, by the most probable number (MPN) method. We used WHO risk categories for microbiological quality; no risk (10 MPN per 100 mL water). We estimated the difference in mean log10 MPN in pond and MAR water using linear mixed effect models with random intercepts and cluster adjusted robust standard error. Almost all pond water samples (292/299, 98%) had moderate- to high-risk level (>10 MPN) fecal coliforms and E. coli (283/299, 95%). In contrast, 81% (242/300) of MAR water samples had no or low risk level fecal coliforms (0-10 MPN), of which 60% (179/300) had no fecal coliforms. We detected no or low risk level E. coli in 94% (283/300) of MAR water samples of these 80% (240/300) had no E. coli. MAR samples had lower mean log10 MPN fecal coliforms (-2.37; 95% CI: -2.56, -2.19) and E. coli (-2.26; 95% CI: - 2.43, -2.09) than pond water; microbial reductions remained consistent during the wet (May-October) and dry seasons. MAR-systems provided water with reduced fecal indicator bacteria compared to infiltered pond water.
Solaiman Doza; Abu Mohd Naser; Mahbubur Rahman; Momenul Haque Mondol; Golam Kibria Khan; Nasir Uddin; Mohammed Shahid Gazi; Gazi Raisul Alam; Mohammed Rabiul Karim; Kazi Matin Ahmed; Stephen P. Luby; Thomas Clasen; Leanne Unicomb. Microbiological water quality of Managed Aquifer Recharge systems in the salinity-prone southwest coastal Bangladesh. 2020, 1 .
AMA StyleSolaiman Doza, Abu Mohd Naser, Mahbubur Rahman, Momenul Haque Mondol, Golam Kibria Khan, Nasir Uddin, Mohammed Shahid Gazi, Gazi Raisul Alam, Mohammed Rabiul Karim, Kazi Matin Ahmed, Stephen P. Luby, Thomas Clasen, Leanne Unicomb. Microbiological water quality of Managed Aquifer Recharge systems in the salinity-prone southwest coastal Bangladesh. . 2020; ():1.
Chicago/Turabian StyleSolaiman Doza; Abu Mohd Naser; Mahbubur Rahman; Momenul Haque Mondol; Golam Kibria Khan; Nasir Uddin; Mohammed Shahid Gazi; Gazi Raisul Alam; Mohammed Rabiul Karim; Kazi Matin Ahmed; Stephen P. Luby; Thomas Clasen; Leanne Unicomb. 2020. "Microbiological water quality of Managed Aquifer Recharge systems in the salinity-prone southwest coastal Bangladesh." , no. : 1.
Background: We assessed the association of groundwater chemicals with systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods: Blood pressure data for ≥35-year-olds were from the Bangladesh Demographic and Health Survey in 2011. Groundwater chemicals in 3534 well water samples from Bangladesh were measured by the British Geological Survey (BGS) in 1998-1999. Participants who reported groundwater as their primary source of drinking water were assigned chemical measures from the nearest BGS well. Survey-adjusted linear regression methods were used to assess the association of each groundwater chemical with the log-transformed blood pressure of the participants. Models were adjusted for age, sex, body mass index, smoking status, geographical region, household wealth, rural or urban residence, and educational attainment, and further adjusted for all other groundwater chemicals. Results: One standard deviation (SD) increase in groundwater magnesium was associated with a 0.992 (95% confidence interval (CI): 0.986, 0.998) geometric mean ratio (GMR) of SBP and a 0.991 (95% CI: 0.985, 0.996) GMR of DBP when adjusted for covariates except groundwater chemicals. When additionally adjusted for groundwater chemicals, one SD increase in groundwater magnesium was associated with a 0.984 (95% CI: 0.972, 0.997) GMR of SBP and a 0.990 (95% CI: 0.979, 1.000) GMR of DBP. However, associations were attenuated following Bonferroni-correction for multiple chemical comparisons in the full-adjusted model. Groundwater concentrations of calcium, potassium, silicon, sulfate, barium, zinc, manganese, and iron were not associated with SBP or DBP in the full-adjusted models. Conclusions: Groundwater magnesium had a weak association with lower SBP and DBP of the participants.
Abu Mohd Naser; Thomas F. Clasen; Stephen P. Luby; Mahbubur Rahman; Leanne Unicomb; Kazi Matin Ahmed; Solaiman Doza; Shadassa Ourshalimian; Howard H. Chang; Jennifer D. Stowell; K. M. Venkat Narayan; Mohammad Shamsudduha; Shivani A. Patel; Bethany O’Shea; Matthew O. Gribble. Groundwater Chemistry and Blood Pressure: A Cross-Sectional Study in Bangladesh. International Journal of Environmental Research and Public Health 2019, 16, 2289 .
AMA StyleAbu Mohd Naser, Thomas F. Clasen, Stephen P. Luby, Mahbubur Rahman, Leanne Unicomb, Kazi Matin Ahmed, Solaiman Doza, Shadassa Ourshalimian, Howard H. Chang, Jennifer D. Stowell, K. M. Venkat Narayan, Mohammad Shamsudduha, Shivani A. Patel, Bethany O’Shea, Matthew O. Gribble. Groundwater Chemistry and Blood Pressure: A Cross-Sectional Study in Bangladesh. International Journal of Environmental Research and Public Health. 2019; 16 (13):2289.
Chicago/Turabian StyleAbu Mohd Naser; Thomas F. Clasen; Stephen P. Luby; Mahbubur Rahman; Leanne Unicomb; Kazi Matin Ahmed; Solaiman Doza; Shadassa Ourshalimian; Howard H. Chang; Jennifer D. Stowell; K. M. Venkat Narayan; Mohammad Shamsudduha; Shivani A. Patel; Bethany O’Shea; Matthew O. Gribble. 2019. "Groundwater Chemistry and Blood Pressure: A Cross-Sectional Study in Bangladesh." International Journal of Environmental Research and Public Health 16, no. 13: 2289.
We hypothesized that drinking water, sanitation, handwashing (WSH) and nutritional interventions would improve environmental enteric dysfunction (EED), a potential contributor to stunting. Within a subsample of a cluster-randomized controlled trial in rural Bangladesh, we enrolled pregnant women in four arms: control, combined WSH, child nutrition counseling plus lipid-based nutrient supplements (N), and combined nutrition plus WSH (N+WSH). Among the birth cohort, we measured biomarkers of gut inflammation (myeloperoxidase, neopterin), permeability (alpha-1-antitrypsin, lactulose, mannitol), and repair (regenerating gene 1β) at median ages 3, 14, and 28 months. Analysis was intention-to-treat. We assessed 1512 children. At age 3 months, compared to controls, neopterin was reduced by nutrition (-0.21 log nmol/L, CI -0.37, -0.05) and N+WSH (-0.20 log nmol/L, CI -0.34, -0.06) interventions; similar reductions were observed at 14 months. At 3 months, all interventions reduced lactulose and mannitol (-0.60 to -0.69 log mmol/L). At 28 months, myeloperoxidase was elevated in the WSH (0.23 log ng/ml, CI 0.06, 0.39) and nutrition (0.27 log ng/ml, CI 0.07, 0.47) arms and lactulose was higher in the WSH arm (0.30 log mmol/L, CI 0.07, 0.53). Reductions in permeability and inflammation at ages 3 and 14 months suggest that the interventions promoted healthy intestinal maturation; however, by 28 months the WSH and nutrition arms showed elevated EED biomarkers. These results underscore the importance of better understanding the pathophysiology of EED and targeting interventions early in childhood during the critical period when they are likely to have the largest benefit to intestinal health.(ClinicalTrials.gov NCT01590095).
Audrie Lin; Shahjahan Ali; Benjamin F Arnold; Ziaur Rahman; Mohammad Alauddin; Jessica Grembi; Andrew N Mertens; Syeda L Famida; Salma Akther; Saheen Hossen; Palash Mutsuddi; Abul K Shoab; Zahir Hussain; Mahbubur Rahman; Leanne Unicomb; Sania Ashraf; Abu Mohd Naser; Sarker M Parvez; Ayse Ercumen; Jade Benjamin-Chung; Rashidul Haque; Tahmeed Ahmed; Iqbal Hossain; Nuzhat Choudhury; Kaniz Jannat; Sarah T Alauddin; Sandra G Minchala; Rabije Cekovic; Alan E Hubbard; Christine P Stewart; Kathryn G Dewey; John M Colford; Stephen P Luby. Effects of water, sanitation, handwashing, and nutritional interventions on environmental enteric dysfunction in young children: a cluster-randomized controlled trial in rural Bangladesh. Clinical Infectious Diseases 2019, 1 .
AMA StyleAudrie Lin, Shahjahan Ali, Benjamin F Arnold, Ziaur Rahman, Mohammad Alauddin, Jessica Grembi, Andrew N Mertens, Syeda L Famida, Salma Akther, Saheen Hossen, Palash Mutsuddi, Abul K Shoab, Zahir Hussain, Mahbubur Rahman, Leanne Unicomb, Sania Ashraf, Abu Mohd Naser, Sarker M Parvez, Ayse Ercumen, Jade Benjamin-Chung, Rashidul Haque, Tahmeed Ahmed, Iqbal Hossain, Nuzhat Choudhury, Kaniz Jannat, Sarah T Alauddin, Sandra G Minchala, Rabije Cekovic, Alan E Hubbard, Christine P Stewart, Kathryn G Dewey, John M Colford, Stephen P Luby. Effects of water, sanitation, handwashing, and nutritional interventions on environmental enteric dysfunction in young children: a cluster-randomized controlled trial in rural Bangladesh. Clinical Infectious Diseases. 2019; ():1.
Chicago/Turabian StyleAudrie Lin; Shahjahan Ali; Benjamin F Arnold; Ziaur Rahman; Mohammad Alauddin; Jessica Grembi; Andrew N Mertens; Syeda L Famida; Salma Akther; Saheen Hossen; Palash Mutsuddi; Abul K Shoab; Zahir Hussain; Mahbubur Rahman; Leanne Unicomb; Sania Ashraf; Abu Mohd Naser; Sarker M Parvez; Ayse Ercumen; Jade Benjamin-Chung; Rashidul Haque; Tahmeed Ahmed; Iqbal Hossain; Nuzhat Choudhury; Kaniz Jannat; Sarah T Alauddin; Sandra G Minchala; Rabije Cekovic; Alan E Hubbard; Christine P Stewart; Kathryn G Dewey; John M Colford; Stephen P Luby. 2019. "Effects of water, sanitation, handwashing, and nutritional interventions on environmental enteric dysfunction in young children: a cluster-randomized controlled trial in rural Bangladesh." Clinical Infectious Diseases , no. : 1.
BackgroundSoil transmitted helminths (STH) infect >1.5 billion people. Mass drug administration (MDA) reduces infection; however, drug resistance is emerging and reinfection occurs rapidly. We conducted a randomized controlled trial in Bangladesh (WASH Benefits,NCT01590095) to assess whether water, sanitation, hygiene and nutrition interventions, alone and combined, reduce STH in a setting with ongoing MDA.Methodology/Principal FindingsWe randomized clusters of pregnant women into water treatment, sanitation, handwashing, combined water+sanitation+handwashing (WSH), nutrition, nutrition+WSH (N+WSH) or control arms. After 2.5 years of intervention, we enumerated STH infections in children aged 2-12 years with Kato-Katz. We estimated intention-to-treat intervention effects on infection prevalence and intensity. Participants and field staff were not blinded; laboratory technicians and data analysts were blinded.In 2012-2013, we randomized 5551 women in 720 clusters. In 2015-2016, we enrolled 7795 children of 4102 available women for STH follow-up and collected stool from 7187. Prevalence among controls was 36.8% forA. lumbricoides, 9.2% for hookworm and 7.5% forT. trichiura. Most infections were low-intensity. Compared to controls, the water intervention reduced hookworm (prevalence ratio [PR]=0.69 (0.50, 0.95), prevalence difference [PD]=−2.83 (−5.16, −0.50)) but did not affect other STH. Sanitation improvements reducedT. trichiura(PR=0.71 (0.52, 0.98), PD=−2.17 (−4.03, −0.38)), had a similar borderline effect on hookworm and no effect onA. lumbricoides. Handwashing and nutrition interventions did not reduce any STH. WSH and N+WSH reduced hookworm prevalence by 29-33% (2-3 percentage points) and marginally reducedA. lumbricoides. Effects on infection intensity were similar.Conclusions/SignificanceIn a low-intensity infection setting with MDA, we found modest but sustained hookworm reduction from water treatment, sanitation and combined WSH interventions. Interventions more effectively reduced STH species with no persistent environmental reservoirs. Our findings highlight waterborne transmission for hookworm and suggest that water treatment and sanitation improvements can augment MDA programs to interrupt STH transmission.Author summarySoil-transmitted helminths (STH) infect >1.5 billion people worldwide. Mass-administration of deworming drugs is the cornerstone of global strategy for STH control but treated individuals often rapidly get reinfected and there is also concern about emerging drug resistance. Interventions to treat drinking water, wash hands at critical times and isolate human feces from the environment through improved sanitation could reduce STH transmission by reducing the spread of ova from the feces of infected individuals into the environment and subsequently to new hosts, while nutrition improvements could reduce host susceptibility to infection. Existing evidence on the effect of these interventions on STH is scarce. In a setting with ongoing mass-drug administration, we assessed the effect of individual and combined water, sanitation, handwashing and nutrition interventions on STH infection in children. Approximately 2.5 years after delivering interventions, we found reductions in STH infection from water treatment and sanitation interventions; there was no reduction from the handwashing and nutrition interventions. While the reductions were modest in magnitude compared to cure rates achieved by deworming drugs, they indicated sustained reduction in environmental transmission. The reductions were more pronounced for STH species that do not have persistent environmental reservoirs. These findings suggest that water treatment and sanitation interventions can augment mass-drug administration programs in striving toward elimination of STH.
Ayse Ercumen; Jade Benjamin-Chung; Benjamin F. Arnold; Audrie Lin; Alan E. Hubbard; Christine Stewart; Zahidur Rahman; Sarker Masud Parvez; Leanne Unicomb; Mahbubur Rahman; Rashidul Haque; John M. Colford; Stephen P. Luby. Effects of water, sanitation, handwashing and nutritional interventions on soil-transmitted helminth infections in young children: a cluster-randomized controlled trial in rural Bangladesh. 2019, 512509 .
AMA StyleAyse Ercumen, Jade Benjamin-Chung, Benjamin F. Arnold, Audrie Lin, Alan E. Hubbard, Christine Stewart, Zahidur Rahman, Sarker Masud Parvez, Leanne Unicomb, Mahbubur Rahman, Rashidul Haque, John M. Colford, Stephen P. Luby. Effects of water, sanitation, handwashing and nutritional interventions on soil-transmitted helminth infections in young children: a cluster-randomized controlled trial in rural Bangladesh. . 2019; ():512509.
Chicago/Turabian StyleAyse Ercumen; Jade Benjamin-Chung; Benjamin F. Arnold; Audrie Lin; Alan E. Hubbard; Christine Stewart; Zahidur Rahman; Sarker Masud Parvez; Leanne Unicomb; Mahbubur Rahman; Rashidul Haque; John M. Colford; Stephen P. Luby. 2019. "Effects of water, sanitation, handwashing and nutritional interventions on soil-transmitted helminth infections in young children: a cluster-randomized controlled trial in rural Bangladesh." , no. : 512509.
BackgroundAnemia in young children is a global health problem. Risk factors include poor nutrient intake and poor water quality, sanitation, or hygiene.ObjectiveWe evaluated the effects of water quality, sanitation, handwashing, and nutrition interventions on micronutrient status and anemia among children in rural Kenya and Bangladesh.DesignWe nested substudies within 2 cluster-randomized controlled trials enrolling pregnant women and following their children for 2 y. These substudies included 4 groups: water, sanitation, and handwashing (WSH); nutrition (N), including lipid-based nutrient supplements (LNSs; ages 6–24 mo) and infant and young child feeding (IYCF) counseling; WSH+N; and control. Hemoglobin and micronutrient biomarkers were measured after 2 y of intervention and compared between groups using generalized linear models with robust SEs.ResultsIn Kenya, 699 children were assessed at a mean ± SD age of 22.1 ± 1.8 mo, and in Bangladesh 1470 participants were measured at a mean ± SD age of 28.0 ± 1.9 mo. The control group anemia prevalences were 48.8% in Kenya and 17.4% in Bangladesh. There was a lower prevalence of anemia in the 2 N intervention groups in both Kenya [N: 36.2%; prevalence ratio (PR): 0.74; 95% CI: 0.58, 0.94; WSH+N: 27.3%; PR: 0.56; 95% CI: 0.42, 0.75] and Bangladesh (N: 8.7%; PR: 0.50; 95% CI: 0.32, 0.78; WSH+N: 7.9%, PR: 0.46; 95% CI: 0.29, 0.73). In both trials, the 2 N groups also had significantly lower prevalences of iron deficiency, iron deficiency anemia, and low vitamin B-12 and, in Kenya, a lower prevalence of folate and vitamin A deficiencies. In Bangladesh, the WSH group had a lower prevalence of anemia (12.8%; PR: 0.74; 95% CI: 0.54, 1.00) than the control group, whereas in Kenya, the WSH+N group had a lower prevalence of anemia than did the N group (PR: 0.75; 95% CI: 0.53, 1.07), but this was not significant (P = 0.102).ConclusionsIYCF counseling with LNSs reduced the risks of anemia, iron deficiency, and low vitamin B-12. Effects on folate and vitamin A varied between studies. Improvements in WSH also reduced the risk of anemia in Bangladesh but did not provide added benefit over the nutrition-specific intervention.These trials were registered at clinicaltrials.gov as NCT01590095 (Bangladesh) and NCT01704105 (Kenya).
Christine P Stewart; Kathryn G Dewey; Audrie Lin; Amy J Pickering; Kendra A Byrd; Kaniz Jannat; Shahjahan Ali; Gouthami Rao; Holly N Dentz; Marion Kiprotich; Charles D Arnold; Benjamin F Arnold; Lindsay H Allen; Setareh Shahab-Ferdows; Ayse Ercumen; Jessica Grembi; Abu Mohd Naser; Mahbubur Rahman; Leanne Unicomb; John M Colford; Stephen P Luby; Clair Null. Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh. The American Journal of Clinical Nutrition 2019, 109, 148 -164.
AMA StyleChristine P Stewart, Kathryn G Dewey, Audrie Lin, Amy J Pickering, Kendra A Byrd, Kaniz Jannat, Shahjahan Ali, Gouthami Rao, Holly N Dentz, Marion Kiprotich, Charles D Arnold, Benjamin F Arnold, Lindsay H Allen, Setareh Shahab-Ferdows, Ayse Ercumen, Jessica Grembi, Abu Mohd Naser, Mahbubur Rahman, Leanne Unicomb, John M Colford, Stephen P Luby, Clair Null. Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh. The American Journal of Clinical Nutrition. 2019; 109 (1):148-164.
Chicago/Turabian StyleChristine P Stewart; Kathryn G Dewey; Audrie Lin; Amy J Pickering; Kendra A Byrd; Kaniz Jannat; Shahjahan Ali; Gouthami Rao; Holly N Dentz; Marion Kiprotich; Charles D Arnold; Benjamin F Arnold; Lindsay H Allen; Setareh Shahab-Ferdows; Ayse Ercumen; Jessica Grembi; Abu Mohd Naser; Mahbubur Rahman; Leanne Unicomb; John M Colford; Stephen P Luby; Clair Null. 2019. "Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh." The American Journal of Clinical Nutrition 109, no. 1: 148-164.
We analyzed data from a stepped wedge randomized trial to evaluate how urinary Na, K, Ca and Mg excretion are associated with the change in blood pressure (BP) among the adult population. We followed up a cohort of 1,191 participants (>20 years old) from 540 households in 16 communities of southwest coastal Bangladesh for five visits during December 2016 - April 2017 when they were exposed to high salinity drinking water. In all visits, we measured participants’ BP (N=5,746) and 24-hour urinary Na, K, Ca and Mg. We used multilevel linear regression models to determine the association among change in urinary excretion of Na, K, Ca and Mg with differences in mean systolic blood pressure (SBP) and diastolic blood pressure (DBP). Models included participant-, household-, and community-level random intercepts and were adjusted for age, sex, BMI, physical activity, smoking status, and household wealth. We restricted analysis among participants who had complete 24-hour urine collection based on measured versus expected urinary creatinine ratio of >=0.7 (N=5,103). The median urinary 24 hours Na excretion was 164 mmol, K was 34 mmol, Ca was 126 mg, and Mg was 83 mg in visit 1. The mean population SBP was 115.6 mmHg in visit 1 and 110.2 in visit 5, and the mean DBP was 68.9 mmHg in visit 1 and 65.9 in visit 5. Compared to visit 1, we found 85% higher urinary Ca in visit 3 and 57% higher urinary Mg in visit 5. We found 100 mmol per 24 hours increase in urinary Na was associated with 1.74 (95% CI: 0.85, 2.62) mmHg higher SBP and 0.51 (95% CI: -0.06, 1.08) mmHg higher DBP, and 50 mmol per 24 hours increase in urinary K was associated with 2.39 (95% CI: 0.84, 3.94) mmHg lower SBP and 0.79 (95% CI: -1.76, 0.17) mmHg lower DBP. We found 100 mg per 24 hours increase in urinary Ca was associated with 0.29 (95% CI: 0.02, 0.60) mmHg lower SBP and 0.32 (0.07, 0.57) mmHg lower DBP, and 100 mg per 24 hours increase in urinary Mg was associated with 1.09 (95% CI: 0.55, 1.64) mmHg lower SBP and 0.41 (0.07, 0.76) mmHg lower DBP. We found SBP lowering effect of urinary Mg increased if urinary Ca was lower (p = 0.048). We found urinary K, Ca, and Mg are associated with lower BP in coastal Bangladesh. Our results suggest a high intake of these beneficial minerals alongside Na reduction may successfully lower mean BP of the population.
Abu Mohd Naser Titu; Mahbubur Rahman; Leanne Unicomb; Solaiman Doza; Kazi Matin Uddin Ahmed; Shahjada Selim; Shuchi Anand; Howard Chang; Stephen Luby; Thomas Clasen; Matthew Gribble; Km Venkat Narayan. Abstract P224: Urinary Excretion of Sodium, Potassium, Calcium and Magnesium and Blood Pressure Among a Population of ≥ 20-Year-Olds: Evidence From Southwest Coastal Bangladesh. Hypertension 2018, 72, 1 .
AMA StyleAbu Mohd Naser Titu, Mahbubur Rahman, Leanne Unicomb, Solaiman Doza, Kazi Matin Uddin Ahmed, Shahjada Selim, Shuchi Anand, Howard Chang, Stephen Luby, Thomas Clasen, Matthew Gribble, Km Venkat Narayan. Abstract P224: Urinary Excretion of Sodium, Potassium, Calcium and Magnesium and Blood Pressure Among a Population of ≥ 20-Year-Olds: Evidence From Southwest Coastal Bangladesh. Hypertension. 2018; 72 (Suppl_1):1.
Chicago/Turabian StyleAbu Mohd Naser Titu; Mahbubur Rahman; Leanne Unicomb; Solaiman Doza; Kazi Matin Uddin Ahmed; Shahjada Selim; Shuchi Anand; Howard Chang; Stephen Luby; Thomas Clasen; Matthew Gribble; Km Venkat Narayan. 2018. "Abstract P224: Urinary Excretion of Sodium, Potassium, Calcium and Magnesium and Blood Pressure Among a Population of ≥ 20-Year-Olds: Evidence From Southwest Coastal Bangladesh." Hypertension 72, no. Suppl_1: 1.
Researchers typically report more on the impact of public health interventions and less on the degree to which interventions were followed implementation fidelity. We developed and measured fidelity indicators for the WASH Benefits Bangladesh study, a large-scale efficacy trial, in order to identify gaps between intended and actual implementation. Community health workers (CHWs) delivered individual and combined water, sanitation, handwashing (WSH) and child nutrition interventions to 4169 enrolled households in geographically matched clusters. Households received free enabling technologies (insulated water storage container; sani-scoop, potty, double-pit, pour-flush latrine; handwashing station, soapy-water storage bottle), and supplies (chlorine tablets, lipid-based nutrient supplements, laundry detergent sachets) integrated with parallel behavior-change promotion. Behavioral objectives were drinking treated, safely stored water, safe feces disposal, handwashing with soap at key times, and age-appropriate nutrition behaviors. We administered monthly surveys and spot-checks to households from randomly selected clusters for 6 months early in the trial. If any fidelity measures fell below set benchmarks, a rapid response mechanism was triggered. In the first 3 months, functional water seals were detected in 33% (14/42) of latrines in the sanitation only arm; 35% (14/40) for the combined WSH arm; and 60% (34/57) for the combined WSH and Nutrition arm, all falling below the pre-set benchmark of 80%. Other fidelity indicators met the 65 to 80% uptake benchmarks. Rapid qualitative investigations determined that households concurrently used their own latrines with broken water seals in parallel with those provided by the trial. In consultation with the households, we closed pre-existing latrines without water seals, increased the CHWs’ visit frequency to encourage correct maintenance of latrines with water seals, and discouraged water-seal removal or breakage. At the sixth assessment, 86% (51/59) of households were in sanitation only; 92% (72/78) in the combined WSH; and 93% (71/76) in the combined WSH and Nutrition arms had latrines with functional water seals. An intensive implementation fidelity monitoring and rapid response system proved beneficial for this efficacy trial. To implement a routine program at scale requires further research into an adaptation of fidelity monitoring that supports program effectiveness. WASH Benefits Bangladesh: ClinicalTrials.gov, ID: NCT01590095. Registered on 30 April 2012.
Mahbubur Rahman; Sania Ashraf; Leanne Unicomb; A. K. M. Mainuddin; Sarker Masud Parvez; Farzana Begum; Kishor Kumar Das; Abu Mohd. Naser; Faruqe Hussain; Thomas Clasen; Stephen P. Luby; Elli Leontsini; Peter J. Winch. WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial. Trials 2018, 19, 360 .
AMA StyleMahbubur Rahman, Sania Ashraf, Leanne Unicomb, A. K. M. Mainuddin, Sarker Masud Parvez, Farzana Begum, Kishor Kumar Das, Abu Mohd. Naser, Faruqe Hussain, Thomas Clasen, Stephen P. Luby, Elli Leontsini, Peter J. Winch. WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial. Trials. 2018; 19 (1):360.
Chicago/Turabian StyleMahbubur Rahman; Sania Ashraf; Leanne Unicomb; A. K. M. Mainuddin; Sarker Masud Parvez; Farzana Begum; Kishor Kumar Das; Abu Mohd. Naser; Faruqe Hussain; Thomas Clasen; Stephen P. Luby; Elli Leontsini; Peter J. Winch. 2018. "WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial." Trials 19, no. 1: 360.
Water, sanitation, and hygiene (WASH) efficacy trials deliver interventions to the target population under optimal conditions to estimate their effects on outcomes of interest, to inform subsequent selection for inclusion in routine programs. A systematic and intensive approach to intervention delivery is required to achieve the high-level uptake necessary to measure efficacy. We describe the intervention delivery system adopted in the WASH Benefits Bangladesh study, as part of a three-paper series on WASH Benefits Intervention Delivery and Performance. Community Health Workers (CHWs) delivered individual and combined WASH and nutrition interventions to 4169 enrolled households in geographically matched clusters. Households were provided with free enabling technologies and supplies, integrated with parallel behaviour-change promotion. Behavioural objectives were drinking treated, safely stored water, safe feces disposal, handwashing with soap at key times, and age-appropriate nutrition behaviours (birth to 24 months). The intervention delivery system built on lessons learned from prior WASH intervention effectiveness, implementation, and formative research studies. We recruited local CHWs, residents of the study villages, through transparent merit-based selection methods, and consultation with community leaders. CHW supervisors received training on direct intervention delivery, then trained their assigned CHWs. CHWs in turn used the technologies in their own homes. Each CHW counseled six to eight intervention households spread across a 0.2–2.2-km radius, with a 1:12 supervisor-to-CHW ratio. CHWs met monthly with supervisor-trainers to exchange experiences and adapt technology and behaviour-change approaches to evolving conditions. Intervention uptake was tracked through fidelity measures, with a priori benchmarks necessary for an efficacy study. Sufficient levels of uptake were attained by the fourth intervention assessment month and sustained throughout the intervention period. Periodic internal CHW monitoring resulted in discontinuation of a small number of low performers. The intensive intervention delivery system required for an efficacy trial differs in many respects from the system for a routine program. To implement a routine program at scale requires further research on how to optimize the supervisor-to-CHW-to-intervention household ratios, as well as other program costs without compromising program effectiveness. ClinicalTrials.gov, ID: NCC01590095. Registered on 2 May 2012.
Leanne Unicomb; Farzana Begum; Elli Leontsini; Mahbubur Rahman; Sania Ashraf; Abu Mohd Naser; Fosiul A. Nizame; Kaniz Jannat; Faruqe Hussain; Sarker Masud Parvez; Shaila Arman; Moshammot Mobashara; Stephen P. Luby; Peter J. Winch. WASH Benefits Bangladesh trial: management structure for achieving high coverage in an efficacy trial. Trials 2018, 19, 359 .
AMA StyleLeanne Unicomb, Farzana Begum, Elli Leontsini, Mahbubur Rahman, Sania Ashraf, Abu Mohd Naser, Fosiul A. Nizame, Kaniz Jannat, Faruqe Hussain, Sarker Masud Parvez, Shaila Arman, Moshammot Mobashara, Stephen P. Luby, Peter J. Winch. WASH Benefits Bangladesh trial: management structure for achieving high coverage in an efficacy trial. Trials. 2018; 19 (1):359.
Chicago/Turabian StyleLeanne Unicomb; Farzana Begum; Elli Leontsini; Mahbubur Rahman; Sania Ashraf; Abu Mohd Naser; Fosiul A. Nizame; Kaniz Jannat; Faruqe Hussain; Sarker Masud Parvez; Shaila Arman; Moshammot Mobashara; Stephen P. Luby; Peter J. Winch. 2018. "WASH Benefits Bangladesh trial: management structure for achieving high coverage in an efficacy trial." Trials 19, no. 1: 359.
Uptake matters for evaluating the health impact of water, sanitation and hygiene (WASH) interventions. Many large-scale WASH interventions have been plagued by low uptake. For the WASH Benefits Bangladesh efficacy trial, high uptake was a prerequisite. We assessed the degree of technology and behavioral uptake among participants in the trial, as part of a three-paper series on WASH Benefits Intervention Delivery and Performance. This study is a cluster randomized trial comprised of geographically matched clusters among four districts in rural Bangladesh. We randomly allocated 720 clusters of 5551 pregnant women to individual or combined water, sanitation, handwashing, and nutrition interventions, or a control group. Behavioral objectives included; drinking chlorine-treated, safely stored water; use of a hygienic latrine and safe feces disposal at the compound level; handwashing with soap at key times; and age-appropriate nutrition behaviors (pregnancy to 24 months) including a lipid-based nutrition supplement (LNS). Enabling technologies and behavior change were promoted by trained local community health workers through periodic household visits. To monitor technology and behavioral uptake, we conducted surveys and spot checks in 30–35 households per intervention arm per month, over a 20-month period, and structured observations in 324 intervention and 108 control households, approximately 15 months after interventions commenced. In the sanitation arms, observed adult use of a hygienic latrine was high (94–97% of events) while child sanitation practices were moderate (37–54%). In the handwashing arms, handwashing with soap was more common after toilet use (67–74%) than nonintervention arms (18–40%), and after cleaning a child’s anus (61–72%), but was still low before food handling. In the water intervention arms, more than 65% of mothers and index children were observed drinking chlorine-treated water from a safe container. Reported LNS feeding was > 80% in nutrition arms. There was little difference in uptake between single and combined intervention arms. Rigorous implementation of interventions deployed at large scale in the context of an efficacy trial achieved high levels of technology and behavioral uptake in individual and combined WASH and nutrition intervention households. Further work should assess how to achieve similar uptake levels under programmatic conditions. WASH Benefits Bangladesh: ClinicalTrials.gov, identifier: NCT01590095. Registered on April 30, 2012.
Sarker Masud Parvez; Rashidul Azad; Mahbubur Rahman; Leanne Unicomb; Pavani K. Ram; Abu Mohd Naser; Christine P. Stewart; Kaniz Jannat; Musarrat Jabeen Rahman; Elli Leontsini; Peter J. Winch; Stephen P. Luby. Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh. Trials 2018, 19, 358 .
AMA StyleSarker Masud Parvez, Rashidul Azad, Mahbubur Rahman, Leanne Unicomb, Pavani K. Ram, Abu Mohd Naser, Christine P. Stewart, Kaniz Jannat, Musarrat Jabeen Rahman, Elli Leontsini, Peter J. Winch, Stephen P. Luby. Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh. Trials. 2018; 19 (1):358.
Chicago/Turabian StyleSarker Masud Parvez; Rashidul Azad; Mahbubur Rahman; Leanne Unicomb; Pavani K. Ram; Abu Mohd Naser; Christine P. Stewart; Kaniz Jannat; Musarrat Jabeen Rahman; Elli Leontsini; Peter J. Winch; Stephen P. Luby. 2018. "Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh." Trials 19, no. 1: 358.