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5. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale

Author

Arnold, B. F, Null, C., Luby, S. P, Unicomb, L., Stewart, C. P, Dewey, K. G, Ahmed, T., Ashraf, S., Christensen, G., Clasen, T., Dentz, H. N, Fernald, L. C. H, Haque, R., Hubbard, A. E, Kariger, P., Leontsini, E., Lin, A., Njenga, S. M, Pickering, A. J, Ram, P. K, Tofail, F., Winch, P. J, and Colford, J. M

Subjects
BRII recipient: Arnold
Abstract

Introduction Enteric infections are common during the first years of life in low-income countries and contribute to growth faltering with long-term impairment of health and development. Water quality, sanitation, handwashing and nutritional interventions can independently reduce enteric infections and growth faltering. There is little evidence that directly compares the effects of these individual and combined interventions on diarrhoea and growth when delivered to infants and young children. The objective of the WASH Benefits study is to help fill this knowledge gap.Methods and analysis WASH Benefits includes two cluster-randomised trials to assess improvements in water quality, sanitation, handwashing and child nutrition—alone and in combination—to rural households with pregnant women in Kenya and Bangladesh. Geographically matched clusters (groups of household compounds in Bangladesh and villages in Kenya) will be randomised to one of six intervention arms or control. Intervention arms include water quality, sanitation, handwashing, nutrition, combined water+sanitation+handwashing (WSH) and WSH+nutrition. The studies will enrol newborn children (N=5760 in Bangladesh and N=8000 in Kenya) and measure outcomes at 12 and 24 months after intervention delivery. Primary outcomes include child length-for-age Z-scores and caregiver-reported diarrhoea. Secondary outcomes include stunting prevalence, markers of environmental enteropathy and child development scores (verbal, motor and personal/social). We will estimate unadjusted and adjusted intention-to-treat effects using semiparametric estimators and permutation tests.Ethics and dissemination Study protocols have been reviewed and approved by human subjects review boards at the University of California, Berkeley, Stanford University, the International Centre for Diarrheal Disease Research, Bangladesh, the Kenya Medical Research Institute, and Innovations for Poverty Action. Independent data safety monitoring boards in each country oversee the trials. This study is funded by a grant from the Bill & Melinda Gates Foundation to the University of California, Berkeley.Registration Trial registration identifiers (http://www.clinicaltrials.gov): NCT01590095 (Bangladesh), NCT01704105 (Kenya).

Published
2013

16. [Down City Streets with Father Bob Maguire]

Author

Luby, S and Luby, S

Abstract

Return to overview If the camera was there with the blessing of Father Bob Maguire, people felt safe: my relationship with a marvellous man

Published
2023

30. Analytical performance comparison of four SARS-CoV-2 RT-qPCR primer-probe sets for wastewater samples.

Author

Zhang, S, Li, X, Shi, J, Sivakumar, M, Luby, S, O'Brien, J, Jiang, G, Zhang, S, Li, X, Shi, J, Sivakumar, M, Luby, S, O'Brien, J, and Jiang, G

Abstract

Current studies have confirmed the feasibility of SARS-CoV-2 RNA detection by RT-qPCR assays in wastewater samples as an effective surveillance tool of COVID-19 prevalence in a community. Analytical performance of various RT-qPCR assays has been compared against wastewater samples based on the positive ratio. However, there is no systematic comparison work has been conducted for both analytical sensitivity and quantitative reliability against wastewater, which are essential factors for WBE. In this study, the detection performance of four RT-qPCR primer-probe sets, including CCDC-N, CDC-N1, N-Sarbeco, and E-Sarbeco, was systematically evaluated with pure synthetized plasmids, spiked wastewater mocks and raw wastewater samples. In addition to confirm RT-qPCR results, Nanopore sequencing was employed to delineate at molecular level for the analytical sensitivity and reproducibility of those primer-probe sets. CCDC-N showed high sensitivity and the broadest linearity range for wastewater samples. It was thus recommended to be the most efficient tool in the quantitative analysis of SARS-CoV-2 in wastewater. CDC-N1 had the highest sensitivity for real wastewater and thus would be suitable for the screening of wastewater for the presence of SARS-CoV-2. When applying the primer-probe sets to wastewater samples collected from different Australian catchments, increased active clinical cases were observed with the augment of SARS-CoV-2 RNA quantified by RT-qPCR in wastewater in low prevalence communities.

Published
2022

31. Vertical outbreak of COVID-19 in high-rise buildings: The role of sewer stacks and prevention measures.

Author

Guo, Y, Li, X, Luby, S, Jiang, G, Guo, Y, Li, X, Luby, S, and Jiang, G

Abstract

COVID-19 outbreaks in high-rise buildings suggested the transmission route of fecal-aerosol-inhalation due to the involvement of viral aerosols in sewer stacks. The vertical transmission is likely due to the failure of water traps that allow viral aerosols to spread through sewer stacks. This process can be further facilitated by the chimney effect in vent stack, extract ventilation in bathrooms, or wind-induced air pressure fluctuations. To eliminate the risk of such vertical disease spread, the installation of protective devices is highly encouraged in high-rise buildings. Although the mechanism of vertical pathogen spread through drainage pipeline has been illustrated by tracer gas or microbial experiments and numerical modeling, more research is needed to support the update of regulatory and design standards for sewerage facilities.

Published
2022

38. A prototype of feature-based design for assembly

Author

De Fazio, T. L., Edsall, A. C., Gustavson, R. E., Hernandez, J. A., Hutchins, P. M., Leung, H. -W., Luby, S. C., Metzinger, R. W., Nevins, J. L., Tung, K. K., Whitney, D. E., Goos, G., editor, Hartmanis, J., editor, Barstow, D., editor, Brauer, W., editor, Brinch Hansen, P., editor, Gries, D., editor, Luckham, D., editor, Moler, C., editor, Pnueli, A., editor, Seegmüller, G., editor, Stoer, J., editor, Wirth, N., editor, Sriram, Duvvuru, editor, Logcher, Robert, editor, and Fukuda, Shuichi, editor

Published
1991
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50. A planetary health model for reducing exposure to faecal contamination in urban informal settlements: Baseline findings from Makassar, Indonesia

Author

French, MA, Barker, SF, Taruc, RR, Ansariadi, A, Duffy, GA, Saifuddaolah, M, Agussalim, AZ, Awaluddin, F, Zainal, Z, Wardani, J, Faber, PA, Fleming, G, Ramsay, EE, Henry, R, Lin, A, O'Toole, J, Openshaw, J, Sweeney, R, Sinharoy, SS, Kolotelo, P, Jovanovic, D, Schang, C, Higginson, EE, Prescott, MF, Burge, K, Davis, B, Ramirez-Lovering, D, Reidpath, D, Greening, C, Allotey, P, Simpson, JA, Forbes, A, Chown, SL, McCarthy, D, Johnston, D, Wong, T, Brown, R, Clasen, T, Luby, S, Leder, K, French, MA, Barker, SF, Taruc, RR, Ansariadi, A, Duffy, GA, Saifuddaolah, M, Agussalim, AZ, Awaluddin, F, Zainal, Z, Wardani, J, Faber, PA, Fleming, G, Ramsay, EE, Henry, R, Lin, A, O'Toole, J, Openshaw, J, Sweeney, R, Sinharoy, SS, Kolotelo, P, Jovanovic, D, Schang, C, Higginson, EE, Prescott, MF, Burge, K, Davis, B, Ramirez-Lovering, D, Reidpath, D, Greening, C, Allotey, P, Simpson, JA, Forbes, A, Chown, SL, McCarthy, D, Johnston, D, Wong, T, Brown, R, Clasen, T, Luby, S, and Leder, K

Abstract

BACKGROUND: The intense interactions between people, animals and environmental systems in urban informal settlements compromise human and environmental health. Inadequate water and sanitation services, compounded by exposure to flooding and climate change risks, expose inhabitants to environmental contamination causing poor health and wellbeing and degrading ecosystems. However, the exact nature and full scope of risks and exposure pathways between human health and the environment in informal settlements are uncertain. Existing models are limited to microbiological linkages related to faecal-oral exposures at the individual level, and do not account for a broader range of human-environmental variables and interactions that affect population health and wellbeing. METHODS: We undertook a 12-month health and environmental assessment in 12 flood-prone informal settlements in Makassar, Indonesia. We obtained caregiver-reported health data, anthropometric measurements, stool and blood samples from children < 5 years, and health and wellbeing data for children 5-14 years and adult respondents. We collected environmental data including temperature, mosquito and rat species abundance, and water and sediment samples. Demographic, built environment and household asset data were also collected. We combined our data with existing literature to generate a novel planetary health model of health and environment in informal settlements. RESULTS: Across the 12 settlements, 593 households and 2764 participants were enrolled. Two-thirds (64·1%) of all houses (26·3-82·7% per settlement) had formal land tenure documentation. Cough, fever and diarrhoea in the week prior to the survey were reported among an average of 34.3%, 26.9% and 9.7% of children aged < 5 years, respectively; although proportions varied over time, prevalence among these youngest children was consistently higher than among children 5-14 years or adult respondents. Among children < 5 years, 44·3% experienced stunting, 4

Published
2021

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