Aybüke Koyuncu1, Mi-Suk Kang Dufour1,2, Constancia Watadzaushe3, Jeffrey Dirawo3, Angela Mushavi4, Nancy Padian1, Frances Cowan3,5, Sandra I McCoy1. 1. University of California Berkeley, Division of Epidemiology and Biostatistics, Berkeley, United States. 2. University of California San Francisco, Division of Prevention Science, San Francisco, United States. 3. Centre for Sexual Health, HIV AIDS Research Zimbabwe, Harare, Zimbabwe. 4. Ministry of Health and Child Care, Harare, Zimbabwe. 5. Liverpool School of Tropical Medicine, United Kingdom.
Abstract
OBJECTIVES: Diarrheal illness is a leading cause of childhood morbidity and mortality and has long-term negative impacts on child development. Although flooring, water, and sanitation have been identified as important routes of transmission of diarrheal pathogens, research examining variability in the association between flooring and diarrheal illness by water and sanitation is limited. METHODS: We utilized cross-sectional data collected for the evaluation of Zimbabwe's Prevention of Mother-to-Child HIV transmission program in 2014 and 2017-18. Mothers of infants 9-18 months of age self-reported the household's source of drinking water and type of sanitation facility, as well as infant diarrheal illness in the four-weeks prior to the survey. Household flooring was assessed using interviewer observation, and households in which the main material of flooring was dirt/earthen were classified as having unimproved flooring and those with solid flooring (e.g. cement) were classified as having improved flooring. RESULTS: Mothers of infants living in households with improved flooring were less likely to report diarrheal illness in the last four weeks (PDa =-4.9%, 95%CI: -8.6, -1.0). The association between flooring and diarrheal illness did not vary by the presence of improved/unimproved water (p RERI =0.91) or sanitation (p RERI =0.76). CONCLUSIONS: Our findings support the hypothesis that household flooring is an important pathway for the transmission of diarrheal pathogens, even in settings where other aspects of sanitation are sub-optimal. Improvements to household flooring do not require behavior change and may be an effective and expeditious strategy for reducing childhood diarrheal illness irrespective of household access to improved water and sanitation. This article is protected by copyright. All rights reserved.
OBJECTIVES:Diarrheal illness is a leading cause of childhood morbidity and mortality and has long-term negative impacts on child development. Although flooring, water, and sanitation have been identified as important routes of transmission of diarrheal pathogens, research examining variability in the association between flooring and diarrheal illness by water and sanitation is limited. METHODS: We utilized cross-sectional data collected for the evaluation of Zimbabwe's Prevention of Mother-to-Child HIV transmission program in 2014 and 2017-18. Mothers of infants 9-18 months of age self-reported the household's source of drinking water and type of sanitation facility, as well as infantdiarrheal illness in the four-weeks prior to the survey. Household flooring was assessed using interviewer observation, and households in which the main material of flooring was dirt/earthen were classified as having unimproved flooring and those with solid flooring (e.g. cement) were classified as having improved flooring. RESULTS: Mothers of infants living in households with improved flooring were less likely to report diarrheal illness in the last four weeks (PDa =-4.9%, 95%CI: -8.6, -1.0). The association between flooring and diarrheal illness did not vary by the presence of improved/unimproved water (p RERI =0.91) or sanitation (p RERI =0.76). CONCLUSIONS: Our findings support the hypothesis that household flooring is an important pathway for the transmission of diarrheal pathogens, even in settings where other aspects of sanitation are sub-optimal. Improvements to household flooring do not require behavior change and may be an effective and expeditious strategy for reducing childhood diarrheal illness irrespective of household access to improved water and sanitation. This article is protected by copyright. All rights reserved.
Authors: Julia Vila-Guilera; Priti Parikh; Hemant Chaturvedi; Lena Ciric; Monica Lakhanpaul Journal: BMC Public Health Date: 2021-07-06 Impact factor: 3.295