OBJECTIVE: We conducted a longitudinal study to assess the impact of a hand-washing intervention on growth and biomarkers of child health in Nepali slums. This is the first study to evaluate the impact of hand-washing on markers of subclinical, asymptomatic infections associated with childhood growth faltering. METHODS: We recruited a total sample of infants in the target age-range (3-12 months) living in the eight largest Kathmandu slums, allocating them to intervention (n = 45) and control (n = 43) groups. In intervention areas, a small-scale community-based hand-washing program was implemented for six months; in control areas, mothers continued their normal practices. Time series linear regression was used to assess the impact of the intervention on levels of morbidity, mucosal damage, immune stimulation and growth. RESULTS: As expected, children with higher levels of mucosal damage exhibited worse growth over the period of the intervention (P = 0.01, <0.001 and 0.03 for height-for-age, weight-for-age, and weight-for-height z-scores, respectively). We observed a 41% reduction in diarrheal morbidity (P = 0.023) for the intervention group relative to control. However, the hand-washing intervention did not lower levels of mucosal damage or immune stimulation, nor slow growth faltering. CONCLUSIONS: Reducing exposure to pathogens is an important global health priority. This study confirms the importance of hand-washing campaigns for reducing childhood morbidity. Yet our data suggest that promoting hand-washing is necessary but not sufficient to address chronic, subclinical infections. From a human biology standpoint, tackling the root causes of childhood infections is needed to address growth faltering in the context of highly contaminated slum environments.
OBJECTIVE: We conducted a longitudinal study to assess the impact of a hand-washing intervention on growth and biomarkers of child health in Nepali slums. This is the first study to evaluate the impact of hand-washing on markers of subclinical, asymptomatic infections associated with childhood growth faltering. METHODS: We recruited a total sample of infants in the target age-range (3-12 months) living in the eight largest Kathmandu slums, allocating them to intervention (n = 45) and control (n = 43) groups. In intervention areas, a small-scale community-based hand-washing program was implemented for six months; in control areas, mothers continued their normal practices. Time series linear regression was used to assess the impact of the intervention on levels of morbidity, mucosal damage, immune stimulation and growth. RESULTS: As expected, children with higher levels of mucosal damage exhibited worse growth over the period of the intervention (P = 0.01, <0.001 and 0.03 for height-for-age, weight-for-age, and weight-for-height z-scores, respectively). We observed a 41% reduction in diarrheal morbidity (P = 0.023) for the intervention group relative to control. However, the hand-washing intervention did not lower levels of mucosal damage or immune stimulation, nor slow growth faltering. CONCLUSIONS: Reducing exposure to pathogens is an important global health priority. This study confirms the importance of hand-washing campaigns for reducing childhood morbidity. Yet our data suggest that promoting hand-washing is necessary but not sufficient to address chronic, subclinical infections. From a human biology standpoint, tackling the root causes of childhood infections is needed to address growth faltering in the context of highly contaminated slum environments.
Authors: Christine Marie George; Lauren Oldja; Shwapon K Biswas; Jamie Perin; Gwenyth O Lee; Shahnawaz Ahmed; Rashidul Haque; R Bradley Sack; Tahmina Parvin; Ishrat J Azmi; Sazzadul Islam Bhuyian; Kaisar A Talukder; Abu G Faruque Journal: Am J Trop Med Hyg Date: 2015-06-08 Impact factor: 2.345
Authors: Regina I Ejemot-Nwadiaro; John E Ehiri; Dachi Arikpo; Martin M Meremikwu; Julia A Critchley Journal: Cochrane Database Syst Rev Date: 2021-01-06
Authors: Jennyfer Wolf; Sydney Hubbard; Michael Brauer; Argaw Ambelu; Benjamin F Arnold; Robert Bain; Valerie Bauza; Joe Brown; Bethany A Caruso; Thomas Clasen; John M Colford; Matthew C Freeman; Bruce Gordon; Richard B Johnston; Andrew Mertens; Annette Prüss-Ustün; Ian Ross; Jeffrey Stanaway; Jeff T Zhao; Oliver Cumming; Sophie Boisson Journal: Lancet Date: 2022-07-02 Impact factor: 202.731
Authors: Regina I Ejemot-Nwadiaro; John E Ehiri; Dachi Arikpo; Martin M Meremikwu; Julia A Critchley Journal: Cochrane Database Syst Rev Date: 2015-09-03
Authors: Benjamin F Arnold; Clair Null; Stephen P Luby; Leanne Unicomb; Christine P Stewart; Kathryn G Dewey; Tahmeed Ahmed; Sania Ashraf; Garret Christensen; Thomas Clasen; Holly N Dentz; Lia C H Fernald; Rashidul Haque; Alan E Hubbard; Patricia Kariger; Elli Leontsini; Audrie Lin; Sammy M Njenga; Amy J Pickering; Pavani K Ram; Fahmida Tofail; Peter J Winch; John M Colford Journal: BMJ Open Date: 2013-08-30 Impact factor: 2.692
Authors: Audrie Lin; Benjamin F Arnold; Sadia Afreen; Rie Goto; Tarique Mohammad Nurul Huda; Rashidul Haque; Rubhana Raqib; Leanne Unicomb; Tahmeed Ahmed; John M Colford; Stephen P Luby Journal: Am J Trop Med Hyg Date: 2013-04-29 Impact factor: 2.345