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Thomas Clasen
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University

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Article
Published: 19 July 2021
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Background: Behaviors related to water, sanitation, and hygiene (WASH) are key drivers of infectious disease transmission, and experiences of WASH are potential influencers of mental well-being. Important knowledge gaps exist related to the content and delivery of effective WASH programs and their associated health impacts, particularly within the contexts of government programs implemented at scale. Methods: We developed and tested a demand-side intervention called Andilaye, which aimed to change behaviors related to sanitation, personal hygiene, and household environmental sanitation. This theory-informed intervention was delivered through the existing Ethiopian Health Extension Programme (HEP). It was a multilevel intervention with a catalyzing event at community level and behavior change activities at group and household level. We randomly selected and assigned 50 kebeles (sub-districts) from three woredas (districts), half to receive the Andilaye intervention, and half the standard of care sanitation and hygiene programming (i.e., community-led total sanitation and hygiene [CLTSH]). We collected data on WASH access, behavioral outcomes, and mental well-being. Results: A total of 1,589 households were enrolled into the study at baseline; 1,472 households (94%) participated in an endline assessment two years after baseline, and approximately 14 months after the initiation of a multi-level intervention. The intervention did not improve construction of latrines (prevalence ratio [PR] 0.99; 95% CI: 0.82, 1.21) or handwashing stations with water (PR: 0.96; 95% CI: 0.72, 1.26), or the removal of animal feces from the compound (PR=1.10; 95% CI: 0.95, 1.28). Nor did it impact anxiety (PR 0.90; 95% CI: 0.72, 1.11), depression (PR: 0.83; 95% CI: 0.64, 1.07), emotional distress (PR: 0.86; 95% CI: 0.67, 1.09) or well-being (PR: 0.90; 95% CI: 0.74, 1.10) scores. Discussion: We report limited impact of the intervention, as delivered, on changes inbehavior and mental well-being. The effectiveness of the intervention was limited by poor intervention fidelity. While sanitation and hygiene improvements have been documented in Ethiopia, behavioral slippage, or regression to unimproved practices, in communities previously declared open defecation free is widespread. Evidence from this trial may help address knowledge gaps related to challenges associated with scalable alternatives to CLTSH and inform sanitation and hygiene programming and policy in Ethiopia and beyond.

ACS Style

Matthew C. Freeman; Maryann G. Delea; Jedidiah S. Snyder; Joshua V. Garn; Mulusew Belew; Bethany A. Caruso; Thomas F. Clasen; Gloria D. Sclar; Yihenew Tesfaye; Mulat Woreta; Kassahun Zewudie; Abebe Gebremariam. The impact of a demand-side sanitation and hygiene promotion intervention on sustained behavior change and health in Amhara, Ethiopia: a cluster-randomized trial. 2021, 1 .

AMA Style

Matthew C. Freeman, Maryann G. Delea, Jedidiah S. Snyder, Joshua V. Garn, Mulusew Belew, Bethany A. Caruso, Thomas F. Clasen, Gloria D. Sclar, Yihenew Tesfaye, Mulat Woreta, Kassahun Zewudie, Abebe Gebremariam. The impact of a demand-side sanitation and hygiene promotion intervention on sustained behavior change and health in Amhara, Ethiopia: a cluster-randomized trial. . 2021; ():1.

Chicago/Turabian Style

Matthew C. Freeman; Maryann G. Delea; Jedidiah S. Snyder; Joshua V. Garn; Mulusew Belew; Bethany A. Caruso; Thomas F. Clasen; Gloria D. Sclar; Yihenew Tesfaye; Mulat Woreta; Kassahun Zewudie; Abebe Gebremariam. 2021. "The impact of a demand-side sanitation and hygiene promotion intervention on sustained behavior change and health in Amhara, Ethiopia: a cluster-randomized trial." , no. : 1.

Journal article
Published: 02 June 2021 in The American Journal of Tropical Medicine and Hygiene
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Water, sanitation, and hygiene (WASH) practices emerged as a critical component to controlling and preventing the spread of the COVID-19 pandemic. We conducted 131 semistructured phone interviews with households in rural Odisha, India, to understand behavior changes made in WASH practices as a result of the pandemic and challenges that would prevent best practices. Interviews were conducted from May through July 2020 with 73 heads of household, 37 caregivers of children < 5 years old, and 21 members of village water and sanitation committees in villages with community-level piped water and high levels of latrine ownership. The majority of respondents (86%, N = 104) reported a change in their handwashing practice due to COVID-19, typically describing an increase in handwashing frequency, more thorough washing method, and/or use of soap. These improved handwashing practices remained in place a few months after the pandemic began and were often described as a new consistent practice after additional daily actions (such as returning home), suggesting new habit formation. Few participants (13%) reported barriers to handwashing. Some respondents also detailed improvements in other WASH behaviors, including village-level cleaning of water tanks and/or treatment of piped water (48% of villages), household water treatment and storage (17% of respondents), and household cleaning (41% of respondents). However, there was minimal change in latrine use and child feces management practices as a result of the pandemic. We provide detailed thematic summaries of qualitative responses to allow for richer insights into these WASH behavior changes during the pandemic. The results also highlight the importance of ensuring communities have adequate WASH infrastructure to enable the practice of safe behaviors and strengthen resilience during a large-scale health crisis.

ACS Style

Valerie Bauza; Gloria D. Sclar; Alokananda Bisoyi; Fiona Majorin; Apurva Ghugey; Thomas Clasen. Water, Sanitation, and Hygiene Practices and Challenges during the COVID-19 Pandemic: A Cross-Sectional Study in Rural Odisha, India. The American Journal of Tropical Medicine and Hygiene 2021, 104, 2264 -2274.

AMA Style

Valerie Bauza, Gloria D. Sclar, Alokananda Bisoyi, Fiona Majorin, Apurva Ghugey, Thomas Clasen. Water, Sanitation, and Hygiene Practices and Challenges during the COVID-19 Pandemic: A Cross-Sectional Study in Rural Odisha, India. The American Journal of Tropical Medicine and Hygiene. 2021; 104 (6):2264-2274.

Chicago/Turabian Style

Valerie Bauza; Gloria D. Sclar; Alokananda Bisoyi; Fiona Majorin; Apurva Ghugey; Thomas Clasen. 2021. "Water, Sanitation, and Hygiene Practices and Challenges during the COVID-19 Pandemic: A Cross-Sectional Study in Rural Odisha, India." The American Journal of Tropical Medicine and Hygiene 104, no. 6: 2264-2274.

Review
Published: 19 April 2021 in International Journal of Environmental Research and Public Health
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Municipal solid waste (MSW) can pose a threat to public health if it is not safely managed. Despite prior research, uncertainties remain and refurbished evidence is needed along with new approaches. We conducted a systematic review of recently published literature to update and expand the epidemiological evidence on the association between MSW management practices and resident populations’ health risks. Studies published from January 2005 to January 2020 were searched and reviewed following PRISMA guidelines. Eligible MSW treatment or disposal sites were defined as landfills, dumpsites, incinerators, waste open burning, transfer stations, recycling sites, composting plants, and anaerobic digesters. Occupational risks were not assessed. Health effects investigated included mortality, adverse birth and neonatal outcomes, cancer, respiratory conditions, gastroenteritis, vector-borne diseases, mental health conditions, and cardiovascular diseases. Studies reporting on human biomonitoring for exposure were eligible as well. Twenty-nine studies were identified that met the inclusion criteria of our protocol, assessing health effects only associated with proximity to landfills, incinerators, and dumpsites/open burning sites. There was some evidence of an increased risk of adverse birth and neonatal outcomes for residents near each type of MSW site. There was also some evidence of an increased risk of mortality, respiratory diseases, and negative mental health effects associated with residing near landfills. Additionally, there was some evidence of increased risk of mortality associated with residing near incinerators. However, in many cases, the evidence was inadequate to establish a strong relationship between a specific exposure and outcomes, and the studies rarely assessed new generation technologies. Evidence gaps remain, and recommendations for future research are discussed.

ACS Style

Giovanni Vinti; Valerie Bauza; Thomas Clasen; Kate Medlicott; Terry Tudor; Christian Zurbrügg; Mentore Vaccari. Municipal Solid Waste Management and Adverse Health Outcomes: A Systematic Review. International Journal of Environmental Research and Public Health 2021, 18, 4331 .

AMA Style

Giovanni Vinti, Valerie Bauza, Thomas Clasen, Kate Medlicott, Terry Tudor, Christian Zurbrügg, Mentore Vaccari. Municipal Solid Waste Management and Adverse Health Outcomes: A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18 (8):4331.

Chicago/Turabian Style

Giovanni Vinti; Valerie Bauza; Thomas Clasen; Kate Medlicott; Terry Tudor; Christian Zurbrügg; Mentore Vaccari. 2021. "Municipal Solid Waste Management and Adverse Health Outcomes: A Systematic Review." International Journal of Environmental Research and Public Health 18, no. 8: 4331.

Journal article
Published: 11 March 2021 in International Journal of Environmental Research and Public Health
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We conducted 131 semi-structured phone interviews with householders in rural Odisha, India to explore participants’ COVID-19 related knowledge, perceptions, and preventative actions, as well as how the pandemic affected their daily life, economic and food security, and the village-level response. Interviews were conducted with 73 heads of household, 37 primary caregivers, and 21 members of village water and sanitation committees from 43 rural villages in Ganjam and Gajapati districts in Odisha state. The study took place between May–July 2020 throughout various lockdown restrictions and at a time when many migrant workers were returning to their villages and cases were rising. Most respondents could name at least one correct symptom of COVID-19 (75%), but there was lower knowledge about causes of the disease and high-risk groups, and overall COVID-19 knowledge was lowest among caregivers. Respondents reported high compliance with important preventative measures, including staying home as much as possible (94%), social distancing (91%), washing hands frequently (96%), and wearing a facial mask (95%). Additionally, many respondents reported job loss (31%), financial challenges (93%), challenges related to staying home whether as a preventative measure or due to lockdowns (57%), changes in types and/or amount of food consumed (61%), and adverse emotional effects as a result of the pandemic and lockdown. We also provide detailed summaries of qualitative responses to allow for deeper insights into the lived experience of villagers during this pandemic. Although the research revealed high compliance with preventative measures, the pandemic and associated lockdowns also led to many challenges and hardships faced in daily life particularly around job loss, economic security, food security, and emotional wellbeing. The results underscore the vulnerability of marginalized populations to the pandemic and the need for measures that increase resilience to large-scale shocks.

ACS Style

Valerie Bauza; Gloria Sclar; Alokananda Bisoyi; Ajilé Owens; Apurva Ghugey; Thomas Clasen. Experience of the COVID-19 Pandemic in Rural Odisha, India: Knowledge, Preventative Actions, and Impacts on Daily Life. International Journal of Environmental Research and Public Health 2021, 18, 2863 .

AMA Style

Valerie Bauza, Gloria Sclar, Alokananda Bisoyi, Ajilé Owens, Apurva Ghugey, Thomas Clasen. Experience of the COVID-19 Pandemic in Rural Odisha, India: Knowledge, Preventative Actions, and Impacts on Daily Life. International Journal of Environmental Research and Public Health. 2021; 18 (6):2863.

Chicago/Turabian Style

Valerie Bauza; Gloria Sclar; Alokananda Bisoyi; Ajilé Owens; Apurva Ghugey; Thomas Clasen. 2021. "Experience of the COVID-19 Pandemic in Rural Odisha, India: Knowledge, Preventative Actions, and Impacts on Daily Life." International Journal of Environmental Research and Public Health 18, no. 6: 2863.

Research article
Published: 08 March 2021 in PLOS Neglected Tropical Diseases
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Poor water, sanitation and hygiene (WaSH) conditions are hypothesized to contribute to environmental enteric dysfunction (EED), a subclinical condition that may be associated with chronic undernutrition and impaired linear growth. We evaluated the effect of a combined water and sanitation intervention on biomarkers of EED, and then assessed associations of biomarkers of EED with height-for-age z-scores (HAZ), in children under five. We conducted a sub-study within a matched cohort study of a household-level water and sanitation infrastructure intervention in rural Odisha, India, in which we had observed an effect of the intervention on HAZ. We collected stool samples (N = 471) and anthropometry data (N = 209) for children under age 5. We analyzed stool samples for three biomarkers of EED: myeloperoxidase (MPO), neopterin (NEO), and α1-anti-trypsin (AAT). We used linear mixed models to estimate associations between the intervention and each biomarker of EED and between each biomarker and HAZ. The intervention was inversely associated with AAT (-0.25 log μg/ml, p = 0.025), suggesting a protective effect on EED, but was not associated with MPO or NEO. We observed an inverse association between MPO and HAZ (-0.031 per 1000 ng/ml MPO, p = 0.0090) but no association between either NEO or AAT and HAZ. Our results contribute evidence that a transformative WaSH infrastructure intervention may reduce intestinal permeability, but not intestinal inflammation and immune activation, in young children. Our study also adds to observational evidence of associations between intestinal inflammation and nutritional status, as measured by HAZ, in young children. Trial Registration: ClinicalTrials.gov (NCT02441699).

ACS Style

Sheela S. Sinharoy; Heather E. Reese; Ira Praharaj; Howard H. Chang; Thomas Clasen. Effects of a combined water and sanitation intervention on biomarkers of child environmental enteric dysfunction and associations with height-for-age z-score: A matched cohort study in rural Odisha, India. PLOS Neglected Tropical Diseases 2021, 15, e0009198 .

AMA Style

Sheela S. Sinharoy, Heather E. Reese, Ira Praharaj, Howard H. Chang, Thomas Clasen. Effects of a combined water and sanitation intervention on biomarkers of child environmental enteric dysfunction and associations with height-for-age z-score: A matched cohort study in rural Odisha, India. PLOS Neglected Tropical Diseases. 2021; 15 (3):e0009198.

Chicago/Turabian Style

Sheela S. Sinharoy; Heather E. Reese; Ira Praharaj; Howard H. Chang; Thomas Clasen. 2021. "Effects of a combined water and sanitation intervention on biomarkers of child environmental enteric dysfunction and associations with height-for-age z-score: A matched cohort study in rural Odisha, India." PLOS Neglected Tropical Diseases 15, no. 3: e0009198.

Public health
Published: 08 January 2021 in BMJ Open
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IntroductionIncreasing urban populations have led to the growth of informal settlements, with contaminated environments linked to poor human health through a range of interlinked pathways. Here, we describe the design and methods for the Revitalising Informal Settlements and their Environments (RISE) study, a transdisciplinary randomised trial evaluating impacts of an intervention to upgrade urban informal settlements in two Asia-Pacific countries.Methods and analysisRISE is a cluster randomised controlled trial among 12 settlements in Makassar, Indonesia, and 12 in Suva, Fiji. Six settlements in each country have been randomised to receive the intervention at the outset; the remainder will serve as controls and be offered intervention delivery after trial completion. The intervention involves a water-sensitive approach, delivering site-specific, modular, decentralised infrastructure primarily aimed at improving health by decreasing exposure to environmental faecal contamination. Consenting households within each informal settlement site have been enrolled, with longitudinal assessment to involve health and well-being surveys, and human and environmental sampling. Primary outcomes will be evaluated in children under 5 years of age and include prevalence and diversity of gastrointestinal pathogens, abundance and diversity of antimicrobial resistance (AMR) genes in gastrointestinal microorganisms and markers of gastrointestinal inflammation. Diverse secondary outcomes include changes in microbial contamination; abundance and diversity of pathogens and AMR genes in environmental samples; impacts on ecological biodiversity and microclimates; mosquito vector abundance; anthropometric assessments, nutrition markers and systemic inflammation in children; caregiver-reported and self-reported health symptoms and healthcare utilisation; and measures of individual and community psychological, emotional and economic well-being. The study aims to provide proof-of-concept evidence to inform policies on upgrading of informal settlements to improve environments and human health and well-being.EthicsStudy protocols have been approved by ethics boards at Monash University, Fiji National University and Hasanuddin University.Trial registration numberACTRN12618000633280; Pre-results.

ACS Style

Karin Leder; John J Openshaw; Pascale Allotey; Ansariadi Ansariadi; S Fiona Barker; Kerrie Burge; Thomas F Clasen; Steven L Chown; Grant A Duffy; Peter A Faber; Genie Fleming; Andrew B Forbes; Matthew French; Chris Greening; Rebekah Henry; Ellen Higginson; David W Johnston; Rachael Lappan; Audrie Lin; Stephen P Luby; David McCarthy; Joanne E O'toole; Diego Ramirez-Lovering; Daniel D Reidpath; Julie A Simpson; Sheela S Sinharoy; Rohan Sweeney; Ruzka R Taruc; Autiko Tela; Amelia R Turagabeci; Jane Wardani; Tony Wong; Rebekah Brown. Study design, rationale and methods of the Revitalising Informal Settlements and their Environments (RISE) study: a cluster randomised controlled trial to evaluate environmental and human health impacts of a water-sensitive intervention in informal settlements in Indonesia and Fiji. BMJ Open 2021, 11, e042850 .

AMA Style

Karin Leder, John J Openshaw, Pascale Allotey, Ansariadi Ansariadi, S Fiona Barker, Kerrie Burge, Thomas F Clasen, Steven L Chown, Grant A Duffy, Peter A Faber, Genie Fleming, Andrew B Forbes, Matthew French, Chris Greening, Rebekah Henry, Ellen Higginson, David W Johnston, Rachael Lappan, Audrie Lin, Stephen P Luby, David McCarthy, Joanne E O'toole, Diego Ramirez-Lovering, Daniel D Reidpath, Julie A Simpson, Sheela S Sinharoy, Rohan Sweeney, Ruzka R Taruc, Autiko Tela, Amelia R Turagabeci, Jane Wardani, Tony Wong, Rebekah Brown. Study design, rationale and methods of the Revitalising Informal Settlements and their Environments (RISE) study: a cluster randomised controlled trial to evaluate environmental and human health impacts of a water-sensitive intervention in informal settlements in Indonesia and Fiji. BMJ Open. 2021; 11 (1):e042850.

Chicago/Turabian Style

Karin Leder; John J Openshaw; Pascale Allotey; Ansariadi Ansariadi; S Fiona Barker; Kerrie Burge; Thomas F Clasen; Steven L Chown; Grant A Duffy; Peter A Faber; Genie Fleming; Andrew B Forbes; Matthew French; Chris Greening; Rebekah Henry; Ellen Higginson; David W Johnston; Rachael Lappan; Audrie Lin; Stephen P Luby; David McCarthy; Joanne E O'toole; Diego Ramirez-Lovering; Daniel D Reidpath; Julie A Simpson; Sheela S Sinharoy; Rohan Sweeney; Ruzka R Taruc; Autiko Tela; Amelia R Turagabeci; Jane Wardani; Tony Wong; Rebekah Brown. 2021. "Study design, rationale and methods of the Revitalising Informal Settlements and their Environments (RISE) study: a cluster randomised controlled trial to evaluate environmental and human health impacts of a water-sensitive intervention in informal settlements in Indonesia and Fiji." BMJ Open 11, no. 1: e042850.

Commentary
Published: 01 October 2020 in Environmental Health Perspectives
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Background:Two of the most important causes of global disease fall in the realm of environmental health: household air pollution (HAP) and poor water, sanitation, and hygiene (WASH) conditions. Interventions, such as clean cookstoves, household water treatment, and improved sanitation facilities, have great potential to yield reductions in disease burden. However, in recent trials and implementation efforts, interventions to improve HAP and WASH conditions have shown few of the desired health gains, raising fundamental questions about current approaches.Objectives:We describe how the failure to consider the complex systems that characterize diverse real-world conditions may doom promising new approaches prematurely. We provide examples of the application of systems approaches, including system dynamics, network analysis, and agent-based modeling, to the global environmental health priorities of HAP and WASH research and programs. Finally, we offer suggestions on how to approach systems science.Methods:Systems science applied to environmental health can address major challenges by a) enhancing understanding of existing system structures and behaviors that accelerate or impede aims; b) developing understanding and agreement on a problem among stakeholders; and c) guiding intervention and policy formulation. When employed in participatory processes that engage study populations, policy makers, and implementers, systems science helps ensure that research is responsive to local priorities and reflect real-world conditions. Systems approaches also help interpret unexpected outcomes by revealing emergent properties of the system due to interactions among variables, yielding complex behaviors and sometimes counterintuitive results.Discussion:Systems science offers powerful and underused tools to accelerate our ability to identify barriers and facilitators to success in environmental health interventions. This approach is especially useful in the context of implementation research because it explicitly accounts for the interaction of processes occurring at multiple scales, across social and environmental dimensions, with a particular emphasis on linkages and feedback among these processes. https://doi.org/10.1289/EHP7010

ACS Style

Joshua Rosenthal; Raphael E. Arku; Jill Baumgartner; Joe Brown; Thomas Clasen; Joseph N.S. Eisenberg; Peter Hovmand; Pamela Jagger; Douglas A. Luke; Ashlinn Quinn; Gautam N. Yadama. Systems Science Approaches for Global Environmental Health Research: Enhancing Intervention Design and Implementation for Household Air Pollution (HAP) and Water, Sanitation, and Hygiene (WASH) Programs. Environmental Health Perspectives 2020, 128, 105001 .

AMA Style

Joshua Rosenthal, Raphael E. Arku, Jill Baumgartner, Joe Brown, Thomas Clasen, Joseph N.S. Eisenberg, Peter Hovmand, Pamela Jagger, Douglas A. Luke, Ashlinn Quinn, Gautam N. Yadama. Systems Science Approaches for Global Environmental Health Research: Enhancing Intervention Design and Implementation for Household Air Pollution (HAP) and Water, Sanitation, and Hygiene (WASH) Programs. Environmental Health Perspectives. 2020; 128 (10):105001.

Chicago/Turabian Style

Joshua Rosenthal; Raphael E. Arku; Jill Baumgartner; Joe Brown; Thomas Clasen; Joseph N.S. Eisenberg; Peter Hovmand; Pamela Jagger; Douglas A. Luke; Ashlinn Quinn; Gautam N. Yadama. 2020. "Systems Science Approaches for Global Environmental Health Research: Enhancing Intervention Design and Implementation for Household Air Pollution (HAP) and Water, Sanitation, and Hygiene (WASH) Programs." Environmental Health Perspectives 128, no. 10: 105001.

Epidemiology
Published: 15 September 2020 in Journal of the American Heart Association
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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.

ACS Style

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 Style

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 (18):1.

Chicago/Turabian Style

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. 2020. "Past Sodium Intake, Contemporary Sodium Intake, and Cardiometabolic Health in Southwest Coastal Bangladesh." Journal of the American Heart Association 9, no. 18: 1.

Journal article
Published: 15 May 2020 in International Journal of Environmental Research and Public Health
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Qualitative research has documented menstruator’s challenges, particularly in water and sanitation poor environments, but quantitative assessment is limited. We created and validated a culturally-grounded measure of Menstrual Insecurity to assess women’s menstruation-related concerns and negative experiences. With cross-sectional data from 878 menstruating women in rural Odisha, India, we carried out Exploratory (EFA) and Confirmatory (CFA) Factor Analyses to reduce a 40-item pool and identify and confirm the scale factor structure. A 19-item, five factor model best fit the data (EFA: root mean square error of approximation (RMSEA) = 0.027; comparative fit index (CFI) = 0.994; Tucker-Lewis index (TLI) = 0.989; CFA: RMSEA = 0.058; CFI = 0.937; TLI = 0.925). Sub-scales included: Management, Menstrual Cycle Concerns, Symptoms, Restrictions, and Menstruation-Related Bodily Concerns. Those without access to a functional latrine, enclosed bathing space, water source within their compound, or who used reusable cloth had significantly higher overall Menstrual Insecurity scores (greater insecurity) than those with these facilities or using disposable pads. Post-hoc exploratory analysis found that women reporting experiencing tension at menstrual onset or difficulty doing work had significantly higher Menstrual Insecurity scores. This validated tool is useful for measuring Menstrual Insecurity, assessing health inequities and correlates of Menstrual Insecurity, and informing program design.

ACS Style

Bethany A. Caruso; Gerard Portela; Shauna McManus; Thomas Clasen. Assessing Women’s Menstruation Concerns and Experiences in Rural India: Development and Validation of a Menstrual Insecurity Measure. International Journal of Environmental Research and Public Health 2020, 17, 3468 .

AMA Style

Bethany A. Caruso, Gerard Portela, Shauna McManus, Thomas Clasen. Assessing Women’s Menstruation Concerns and Experiences in Rural India: Development and Validation of a Menstrual Insecurity Measure. International Journal of Environmental Research and Public Health. 2020; 17 (10):3468.

Chicago/Turabian Style

Bethany A. Caruso; Gerard Portela; Shauna McManus; Thomas Clasen. 2020. "Assessing Women’s Menstruation Concerns and Experiences in Rural India: Development and Validation of a Menstrual Insecurity Measure." International Journal of Environmental Research and Public Health 17, no. 10: 3468.

Journal article
Published: 27 April 2020 in International Journal of Environmental Research and Public Health
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Characterizing child immunological responses to enteric infections with antibody detection in serum can be challenging in resource-constrained field settings, because sample collection requires trained individuals and its invasive procedure may lead to low response rates, especially among children. Saliva may present a promising non-invasive alternative. The objectives of this research were to compare salivary antibody levels in children to enteric infections and biomarkers of environmental enteric dysfunction (EED). We collected saliva samples from children aged one to six years enrolled in a sanitation trial in Maputo, Mozambique, and characterized salivary secretory immunoglobulin A (SIgA) concentrations with enzyme-linked immunosorbent assays. We used multilevel linear models to analyze cross-sectional associations between salivary SIgA and the number of concurrent enteric pathogen infections, as well as EED biomarkers in matched stool samples. Median salivary SIgA concentrations in this study population were 54 μg/mL (inter-quartile range (IQR): 34, 85 μg/mL), and SIgA levels were similar between children of different ages. SIgA was lower in children experiencing a higher number of concurrent infections −0.04 log μg/mL (95% confidence interval (CI): −0.08 to −0.005 log μg/mL), but was not associated with any of the included EED biomarkers. Contrary to evidence from high-income countries that suggests salivary SIgA increases rapidly with age in young children, the high prevalence of enteric infections may have led to a suppression of immunological development in this study sample and could in part explain the similar SIgA levels between children of different ages.

ACS Style

Frederick G. B. Goddard; Jacqueline Knee; Trent Sumner; Rassul Nalá; Thomas Clasen; Joe Brown. Child Salivary SIgA and Its Relationship to Enteric Infections and EED Biomarkers in Maputo, Mozambique. International Journal of Environmental Research and Public Health 2020, 17, 3035 .

AMA Style

Frederick G. B. Goddard, Jacqueline Knee, Trent Sumner, Rassul Nalá, Thomas Clasen, Joe Brown. Child Salivary SIgA and Its Relationship to Enteric Infections and EED Biomarkers in Maputo, Mozambique. International Journal of Environmental Research and Public Health. 2020; 17 (9):3035.

Chicago/Turabian Style

Frederick G. B. Goddard; Jacqueline Knee; Trent Sumner; Rassul Nalá; Thomas Clasen; Joe Brown. 2020. "Child Salivary SIgA and Its Relationship to Enteric Infections and EED Biomarkers in Maputo, Mozambique." International Journal of Environmental Research and Public Health 17, no. 9: 3035.

Journal article
Published: 01 April 2020 in Environmental Health Perspectives
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Background:Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention.Objective:This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda).Methods:We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to <80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤2.5μm (PM2.5), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682).Conclusions:This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407

ACS Style

Thomas Clasen; William Checkley; Jennifer L. Peel; Kalpana Balakrishnan; John P. McCracken; Ghislaine Rosa; Lisa M. Thompson; Dana Boyd Barr; Maggie L. Clark; Michael A. Johnson; Lance A. Waller; Lindsay M. Jaacks; Kyle Steenland; J. Jaime Miranda; Howard H. Chang; Dong-Yun Kim; Eric D. Mccollum; Victor G. Davila-Roman; Aris Papageorghiou; Joshua P. Rosenthal; HAPIN investigators. Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution. Environmental Health Perspectives 2020, 128, 047008 .

AMA Style

Thomas Clasen, William Checkley, Jennifer L. Peel, Kalpana Balakrishnan, John P. McCracken, Ghislaine Rosa, Lisa M. Thompson, Dana Boyd Barr, Maggie L. Clark, Michael A. Johnson, Lance A. Waller, Lindsay M. Jaacks, Kyle Steenland, J. Jaime Miranda, Howard H. Chang, Dong-Yun Kim, Eric D. Mccollum, Victor G. Davila-Roman, Aris Papageorghiou, Joshua P. Rosenthal, HAPIN investigators. Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution. Environmental Health Perspectives. 2020; 128 (4):047008.

Chicago/Turabian Style

Thomas Clasen; William Checkley; Jennifer L. Peel; Kalpana Balakrishnan; John P. McCracken; Ghislaine Rosa; Lisa M. Thompson; Dana Boyd Barr; Maggie L. Clark; Michael A. Johnson; Lance A. Waller; Lindsay M. Jaacks; Kyle Steenland; J. Jaime Miranda; Howard H. Chang; Dong-Yun Kim; Eric D. Mccollum; Victor G. Davila-Roman; Aris Papageorghiou; Joshua P. Rosenthal; HAPIN investigators. 2020. "Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution." Environmental Health Perspectives 128, no. 4: 047008.

Journal article
Published: 01 April 2020 in Environmental Health Perspectives
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High quality personal exposure data is fundamental to understanding the health implications of household energy interventions, interpreting analyses across assigned study arms, and characterizing exposure-response relationships for household air pollution. This paper describes the exposure data collection for the Household Air Pollution Intervention Network (HAPIN), a multicountry randomized controlled trial of liquefied petroleum gas stoves and fuel among 3,200 households in India, Rwanda, Guatemala, and Peru. The primary objectives of the exposure assessment are to estimate the exposure contrast achieved following a clean fuel intervention and to provide data for analyses of exposure-response relationships across a range of personal exposures. Exposure measurements are being conducted over the 3-y time frame of the field study. We are measuring fine particulate matter [PM < 2.5 μ m in aerodynamic diameter ( PM 2.5 )] with the Enhanced Children's MicroPEM™ (RTI International), carbon monoxide (CO) with the USB-EL-CO (Lascar Electronics), and black carbon with the OT21 transmissometer (Magee Scientific) in pregnant women, adult women, and children < 1 year of age, primarily via multiple 24-h personal assessments (three, six, and three measurements, respectively) over the course of the 18-month follow-up period using lightweight monitors. For children we are using an indirect measurement approach, combining data from area monitors and locator devices worn by the child. For a subsample (up to 10%) of the study population, we are doubling the frequency of measurements in order to estimate the accuracy of subject-specific typical exposure estimates. In addition, we are conducting ambient air monitoring to help characterize potential contributions of PM 2.5 exposure from background concentration. Stove use monitors (Geocene) are being used to assess compliance with the intervention, given that stove stacking (use of traditional stoves in addition to the intervention gas stove) may occur. The tools and approaches being used for HAPIN to estimate personal exposures build on previous efforts and take advantage of new technologies. In addition to providing key personal exposure data for this study, we hope the application and learnings from our exposure assessment will help inform future efforts to characterize exposure to household air pollution and for other contexts. https://doi.org/10.1289/EHP6422.

ACS Style

Michael A. Johnson; Kyle Steenland; Ricardo Piedrahita; Maggie L. Clark; Ajay Pillarisetti; Kalpana Balakrishnan; Jennifer L. Peel; Luke P. Naeher; Jiawen Liao; Daniel Wilson; Jeremy Sarnat; Lindsay J. Underhill; Vanessa Burrowes; John P. McCracken; Ghislaine Rosa; Joshua Rosenthal; Sankar Sambandam; Oscar De Leon; Miles A. Kirby; Katherine Kearns; William Checkley; Thomas Clasen; HAPIN investigators. Air Pollutant Exposure and Stove Use Assessment Methods for the Household Air Pollution Intervention Network (HAPIN) Trial. Environmental Health Perspectives 2020, 128, 047009 .

AMA Style

Michael A. Johnson, Kyle Steenland, Ricardo Piedrahita, Maggie L. Clark, Ajay Pillarisetti, Kalpana Balakrishnan, Jennifer L. Peel, Luke P. Naeher, Jiawen Liao, Daniel Wilson, Jeremy Sarnat, Lindsay J. Underhill, Vanessa Burrowes, John P. McCracken, Ghislaine Rosa, Joshua Rosenthal, Sankar Sambandam, Oscar De Leon, Miles A. Kirby, Katherine Kearns, William Checkley, Thomas Clasen, HAPIN investigators. Air Pollutant Exposure and Stove Use Assessment Methods for the Household Air Pollution Intervention Network (HAPIN) Trial. Environmental Health Perspectives. 2020; 128 (4):047009.

Chicago/Turabian Style

Michael A. Johnson; Kyle Steenland; Ricardo Piedrahita; Maggie L. Clark; Ajay Pillarisetti; Kalpana Balakrishnan; Jennifer L. Peel; Luke P. Naeher; Jiawen Liao; Daniel Wilson; Jeremy Sarnat; Lindsay J. Underhill; Vanessa Burrowes; John P. McCracken; Ghislaine Rosa; Joshua Rosenthal; Sankar Sambandam; Oscar De Leon; Miles A. Kirby; Katherine Kearns; William Checkley; Thomas Clasen; HAPIN investigators. 2020. "Air Pollutant Exposure and Stove Use Assessment Methods for the Household Air Pollution Intervention Network (HAPIN) Trial." Environmental Health Perspectives 128, no. 4: 047009.

Preprint content
Published: 03 March 2020
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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.

ACS Style

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 Style

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.

Chicago/Turabian Style

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. 2020. "Microbiological water quality of Managed Aquifer Recharge systems in the salinity-prone southwest coastal Bangladesh." , no. : 1.

Dataset
Published: 18 February 2020 in http://isrctn.com/
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ACS Style

Gloria Sclar; Thomas F. Clasen. Evaluation of a behavioral intervention to improve child feces management practices in Odisha, India. http://isrctn.com/ 2020, 1 .

AMA Style

Gloria Sclar, Thomas F. Clasen. Evaluation of a behavioral intervention to improve child feces management practices in Odisha, India. http://isrctn.com/. 2020; ():1.

Chicago/Turabian Style

Gloria Sclar; Thomas F. Clasen. 2020. "Evaluation of a behavioral intervention to improve child feces management practices in Odisha, India." http://isrctn.com/ , no. : 1.

Journal article
Published: 01 January 2020 in ERJ Open Research
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Pneumonia is both a treatable and preventable disease but remains a leading cause of death in children worldwide. Household air pollution caused by burning biomass fuels for cooking has been identified as a potentially preventable risk factor for pneumonia in low- and middle-income countries. We are conducting a randomised controlled trial of a clean energy intervention in 3200 households with pregnant women living in Guatemala, India, Peru and Rwanda. Here, we describe the protocol to ascertain the incidence of severe pneumonia in infants born to participants during the first year of the study period using three independent algorithms: the presence of cough or difficulty breathing and hypoxaemia (≤92% in Guatemala, India and Rwanda and ≤86% in Peru); presence of cough or difficulty breathing along with at least one World Health Organization-defined general danger sign and consolidation on chest radiography or lung ultrasound; and pneumonia confirmed to be the cause of death by verbal autopsy. Prior to the study launch, we identified health facilities in the study areas where cases of severe pneumonia would be referred. After participant enrolment, we posted staff at each of these facilities to identify children enrolled in the trial seeking care for severe pneumonia. To ensure severe pneumonia cases are not missed, we are also conducting home visits to all households and providing education on pneumonia to the mother. Severe pneumonia reduction due to mitigation of household air pollution could be a key piece of evidence that sways policymakers to invest in liquefied petroleum gas distribution programmes.

ACS Style

Suzanne M. Simkovich; Lindsay J. Underhill; Miles A. Kirby; Dina Goodman; Mary E. Crocker; Shakir Hossen; John P. McCracken; Oscar De León; Lisa M. Thompson; Sarada S. Garg; Kalpana Balakrishnan; Gurusamy Thangavel; Ghislaine Rosa; Jennifer L. Peel; Thomas F. Clasen; Eric D. Mccollum; William Checkley. Design and conduct of facility-based surveillance for severe childhood pneumonia in the Household Air Pollution Intervention Network (HAPIN) trial. ERJ Open Research 2020, 6, 1 .

AMA Style

Suzanne M. Simkovich, Lindsay J. Underhill, Miles A. Kirby, Dina Goodman, Mary E. Crocker, Shakir Hossen, John P. McCracken, Oscar De León, Lisa M. Thompson, Sarada S. Garg, Kalpana Balakrishnan, Gurusamy Thangavel, Ghislaine Rosa, Jennifer L. Peel, Thomas F. Clasen, Eric D. Mccollum, William Checkley. Design and conduct of facility-based surveillance for severe childhood pneumonia in the Household Air Pollution Intervention Network (HAPIN) trial. ERJ Open Research. 2020; 6 (1):1.

Chicago/Turabian Style

Suzanne M. Simkovich; Lindsay J. Underhill; Miles A. Kirby; Dina Goodman; Mary E. Crocker; Shakir Hossen; John P. McCracken; Oscar De León; Lisa M. Thompson; Sarada S. Garg; Kalpana Balakrishnan; Gurusamy Thangavel; Ghislaine Rosa; Jennifer L. Peel; Thomas F. Clasen; Eric D. Mccollum; William Checkley. 2020. "Design and conduct of facility-based surveillance for severe childhood pneumonia in the Household Air Pollution Intervention Network (HAPIN) trial." ERJ Open Research 6, no. 1: 1.

Journal article
Published: 18 December 2019 in International Journal of Environmental Research and Public Health
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Community-level action may be required to achieve the levels of sanitation uptake necessary for health gains. Evidence suggests that collective action is influenced by collective efficacy (CE)—a group’s belief in its abilities to organize and execute action to achieve common goals. The extent to which it is necessary to fully contextualize existing CE measurement tools, in order to conduct meaningful assessments of the factors influencing CE perceptions, is not well understood. This study examines the value added of contextualizing an existing CE measurement tool using qualitative formative research. We employed a modified grounded theory approach to develop a contextualized CE framework based on qualitative data from rural Cambodian villages. The resulting framework included sub-constructs that were pertinent for the rural Cambodian context for which an existing, hypothesized framework did not account: perceived risks/benefits, action knowledge, shared needs/benefits, and external accountability. Complex confirmatory factor analyses indicated that contextualized models fit the data better than hypothesized models for women and men. This study demonstrates that inductive, qualitative research allows community-derived factors to enhance existing tools for context-specific CE measurement. Additional research is needed to determine which CE factors transcend contexts and could, thus, form the foundation of a general CE measurement tool.

ACS Style

Allison P. Salinger; Gloria D. Sclar; James Dumpert; Davin Bun; Thomas Clasen; Maryann G. DeLea. Sanitation and Collective Efficacy in Rural Cambodia: The Value Added of Qualitative Formative Work for the Contextualization of Measurement Tools. International Journal of Environmental Research and Public Health 2019, 17, 1 .

AMA Style

Allison P. Salinger, Gloria D. Sclar, James Dumpert, Davin Bun, Thomas Clasen, Maryann G. DeLea. Sanitation and Collective Efficacy in Rural Cambodia: The Value Added of Qualitative Formative Work for the Contextualization of Measurement Tools. International Journal of Environmental Research and Public Health. 2019; 17 (1):1.

Chicago/Turabian Style

Allison P. Salinger; Gloria D. Sclar; James Dumpert; Davin Bun; Thomas Clasen; Maryann G. DeLea. 2019. "Sanitation and Collective Efficacy in Rural Cambodia: The Value Added of Qualitative Formative Work for the Contextualization of Measurement Tools." International Journal of Environmental Research and Public Health 17, no. 1: 1.

Opinion
Published: 28 August 2019 in BMC Medicine
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Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations’ Sustainable Development Goals, and the bold new target of safely managed water, sanitation and hygiene for all by 2030, these results warrant the attention of researchers, policy-makers and practitioners. Here we report the conclusions of an expert meeting convened by the World Health Organization and the Bill and Melinda Gates Foundation to discuss these findings, and present five key consensus messages as a basis for wider discussion and debate in the WASH and nutrition sectors. We judge these trials to have high internal validity, constituting good evidence that these specific interventions had no effect on childhood linear growth, and mixed effects on childhood diarrhea. These results suggest that, in settings such as these, more comprehensive or ambitious WASH interventions may be needed to achieve a major impact on child health. These results are important because such basic interventions are often deployed in low-income rural settings with the expectation of improving child health, although this is rarely the sole justification. Our view is that these three new trials do not show that WASH in general cannot influence child linear growth, but they do demonstrate that these specific interventions had no influence in settings where stunting remains an important public health challenge. We support a call for transformative WASH, in so much as it encapsulates the guiding principle that – in any context – a comprehensive package of WASH interventions is needed that is tailored to address the local exposure landscape and enteric disease burden.

ACS Style

Oliver Cumming; Benjamin F. Arnold; Radu Ban; Thomas Clasen; Joanna Esteves Mills; Matthew C. Freeman; Bruce Gordon; Raymond Guiteras; Guy Howard; Paul R. Hunter; Richard B. Johnston; Amy J. Pickering; Andrew J. Prendergast; Annette Prüss-Ustün; Jan Willem Rosenboom; Dean Spears; Shelly Sundberg; Jennyfer Wolf; Clair Null; Stephen P. Luby; Jean H. Humphrey; John M. Colford Jr.. The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement. BMC Medicine 2019, 17, 1 -9.

AMA Style

Oliver Cumming, Benjamin F. Arnold, Radu Ban, Thomas Clasen, Joanna Esteves Mills, Matthew C. Freeman, Bruce Gordon, Raymond Guiteras, Guy Howard, Paul R. Hunter, Richard B. Johnston, Amy J. Pickering, Andrew J. Prendergast, Annette Prüss-Ustün, Jan Willem Rosenboom, Dean Spears, Shelly Sundberg, Jennyfer Wolf, Clair Null, Stephen P. Luby, Jean H. Humphrey, John M. Colford Jr.. The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement. BMC Medicine. 2019; 17 (1):1-9.

Chicago/Turabian Style

Oliver Cumming; Benjamin F. Arnold; Radu Ban; Thomas Clasen; Joanna Esteves Mills; Matthew C. Freeman; Bruce Gordon; Raymond Guiteras; Guy Howard; Paul R. Hunter; Richard B. Johnston; Amy J. Pickering; Andrew J. Prendergast; Annette Prüss-Ustün; Jan Willem Rosenboom; Dean Spears; Shelly Sundberg; Jennyfer Wolf; Clair Null; Stephen P. Luby; Jean H. Humphrey; John M. Colford Jr.. 2019. "The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement." BMC Medicine 17, no. 1: 1-9.

Journal article
Published: 28 June 2019 in International Journal of Environmental Research and Public Health
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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.

ACS Style

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 Style

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 (13):2289.

Chicago/Turabian Style

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. 2019. "Groundwater Chemistry and Blood Pressure: A Cross-Sectional Study in Bangladesh." International Journal of Environmental Research and Public Health 16, no. 13: 2289.

Review
Published: 27 June 2019 in International Journal of Environmental Research and Public Health
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Interventions implementing clean fuels to mitigate household air pollution in low- and middle-income countries have focused on environmental and health outcomes, but few have evaluated time savings. We performed a systematic review, searching for studies of clean fuel interventions that measured time use. A total of 868 manuscripts were identified that met the search criteria, but only 2 met the inclusion criteria. Both were cross-sectional and were conducted in rural India. The first surveyed the female head of household (141 using biogas and 58 using biomass) and reported 1.2 h saved per day collecting fuel and 0.7 h saved cooking, resulting in a combined 28.9 days saved over an entire year. The second surveyed the head of household (37 using biogas and 68 using biomass, 13% female) and reported 1.5 h saved per day collecting fuel, or 22.8 days saved over a year. Based on these time savings, we estimated that clean fuel use could result in a 3.8% or 4.7% increase in daily income, respectively, not including time or costs for fuel procurement. Clean fuel interventions could save users time and money. Few studies have evaluated this potential benefit, suggesting that prospective studies or randomized controlled trials are needed to adequately measure gains.

ACS Style

Suzanne M. Simkovich; Kendra N. Williams; Suzanne Pollard; David Dowdy; Sheela Sinharoy; Thomas F. Clasen; Elisa Puzzolo; William Checkley. A Systematic Review to Evaluate the Association between Clean Cooking Technologies and Time Use in Low- and Middle-Income Countries. International Journal of Environmental Research and Public Health 2019, 16, 2277 .

AMA Style

Suzanne M. Simkovich, Kendra N. Williams, Suzanne Pollard, David Dowdy, Sheela Sinharoy, Thomas F. Clasen, Elisa Puzzolo, William Checkley. A Systematic Review to Evaluate the Association between Clean Cooking Technologies and Time Use in Low- and Middle-Income Countries. International Journal of Environmental Research and Public Health. 2019; 16 (13):2277.

Chicago/Turabian Style

Suzanne M. Simkovich; Kendra N. Williams; Suzanne Pollard; David Dowdy; Sheela Sinharoy; Thomas F. Clasen; Elisa Puzzolo; William Checkley. 2019. "A Systematic Review to Evaluate the Association between Clean Cooking Technologies and Time Use in Low- and Middle-Income Countries." International Journal of Environmental Research and Public Health 16, no. 13: 2277.

Randomized controlled trial
Published: 03 June 2019 in PLOS Medicine
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Unsafe drinking water and household air pollution (HAP) are major causes of morbidity and mortality among children under 5 in low and middle-income countries. Household water filters and higher-efficiency biomass-burning cookstoves have been widely promoted to improve water quality and reduce fuel use, but there is limited evidence of their health effects when delivered programmatically at scale. In a large-scale program in Western Province, Rwanda, water filters and portable biomass-burning natural draft rocket-style cookstoves were distributed between September and December 2014 and promoted to over 101,000 households in the poorest economic quartile in 72 (of 96) randomly selected sectors in Western Province. To assess the effects of the intervention, between August and December, 2014, we enrolled 1,582 households that included a child under 4 years from 174 randomly selected village-sized clusters, half from intervention sectors and half from nonintervention sectors. At baseline, 76% of households relied primarily on an improved source for drinking water (piped, borehole, protected spring/well, or rainwater) and over 99% cooked primarily on traditional biomass-burning stoves. We conducted follow-up at 3 time-points between February 2015 and March 2016 to assess reported diarrhea and acute respiratory infections (ARIs) among children <5 years in the preceding 7 days (primary outcomes) and patterns of intervention use, drinking water quality, and air quality. The intervention reduced the prevalence of reported child diarrhea by 29% (prevalence ratio [PR] 0.71, 95% confidence interval [CI] 0.59-0.87, p = 0.001) and reported child ARI by 25% (PR 0.75, 95% CI 0.60-0.93, p = 0.009). Overall, more than 62% of households were observed to have water in their filters at follow-up, while 65% reported using the intervention stove every day, and 55% reported using it primarily outdoors. Use of both the intervention filter and intervention stove decreased throughout follow-up, while reported traditional stove use increased. The intervention reduced the prevalence of households with detectable fecal contamination in drinking water samples by 38% (PR 0.62, 95% CI 0.57-0.68, p < 0.0001) but had no significant impact on 48-hour personal exposure to log-transformed fine particulate matter (PM2.5) concentrations among cooks (β = -0.089, p = 0.486) or children (β = -0.228, p = 0.127). The main limitations of this trial include the unblinded nature of the intervention, limited PM2.5 exposure measurement, and a reliance on reported intervention use and reported health outcomes. Our findings indicate that the intervention improved household drinking water quality and reduced caregiver-reported diarrhea among children <5 years. It also reduced caregiver-reported ARI despite no evidence of improved air quality. Further research is necessary to ascertain longer-term intervention use and benefits and to explore the potential synergistic effects between diarrhea and ARI. Clinical Trials.gov NCT02239250.

ACS Style

Miles A. Kirby; Corey L. Nagel; Ghislaine Rosa; Laura D. Zambrano; Sanctus Musafiri; Jean De Dieu Ngirabega; Evan A. Thomas; Thomas Clasen. Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda. PLOS Medicine 2019, 16, e1002812 .

AMA Style

Miles A. Kirby, Corey L. Nagel, Ghislaine Rosa, Laura D. Zambrano, Sanctus Musafiri, Jean De Dieu Ngirabega, Evan A. Thomas, Thomas Clasen. Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda. PLOS Medicine. 2019; 16 (6):e1002812.

Chicago/Turabian Style

Miles A. Kirby; Corey L. Nagel; Ghislaine Rosa; Laura D. Zambrano; Sanctus Musafiri; Jean De Dieu Ngirabega; Evan A. Thomas; Thomas Clasen. 2019. "Effects of a large-scale distribution of water filters and natural draft rocket-style cookstoves on diarrhea and acute respiratory infection: A cluster-randomized controlled trial in Western Province, Rwanda." PLOS Medicine 16, no. 6: e1002812.