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Joseph N S Eisenberg - One of the best experts on this subject based on the ideXlab platform.
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mass gatherings and Diarrheal Disease transmission among rural communities in coastal ecuador
American Journal of Epidemiology, 2019Co-Authors: Philip A Collender, Joseph N S Eisenberg, James Trostle, Christa Morris, Rose Glennfiner, Andres Acevedo, Howard H Chang, Justin V RemaisAbstract:Mass gatherings exacerbate infectious Disease risks by creating crowded, high-contact conditions and straining the capacity of local infrastructure. While mass gatherings have been extensively studied in the context of epidemic Disease transmission, the role of gatherings in incidence of high-burden, endemic infections has not been previously studied. Here, we examine Diarrheal incidence among 17 communities in Esmeraldas, Ecuador, in relation to recurrent gatherings characterized using ethnographic data collected during and after the epidemiologic surveillance period (2004-2007). Using distributed-lag generalized estimating equations, adjusted for seasonality, trend, and heavy rainfall events, we found significant increases in diarrhea risk in host villages, peaking 2 weeks after an event's conclusion (incidence rate ratio, 1.21; confidence interval, adjusted for false coverage rate of ≤0.05: 1.02, 1.43). Stratified analysis revealed heightened risks associated with events where crowding and travel were most likely (2-week-lag incidence rate ratio, 1.51; confidence interval, adjusted for false coverage rate of ≤0.05: 1.09, 2.10). Our findings suggest that community-scale mass gatherings might play an important role in endemic Diarrheal Disease transmission and could be an important focus for interventions to improve community health in low-resource settings.
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a space time point process model for analyzing and predicting case patterns of Diarrheal Disease in northwestern ecuador
Spatial and Spatio-temporal Epidemiology, 2014Co-Authors: Jaeil Ahn, Joseph N S Eisenberg, Darlene Bhavnani, Timothy D Johnson, Bhramar MukherjeeAbstract:We consider modeling case-patterns under a complex spatial and longitudinal sampling design as conducted via a serial case–control study of Diarrheal Disease in northwestern Ecuador. We build a two-stage space-time model to understand the role of spatially and temporally referenced covariates that reflect social and natural environments in the sampled region, after accounting for unmeasured residual heterogeneities. All Diarrheal case events are collected from 21 sampled communities in Esmeraldes province in Ecuador, during seven sampling cycles from 2003 to 2008. The region of interest comprises 158 communities along a river basin. Prediction of case counts at unsampled communities at a future time is of interest along with estimation of risk-related parameters. We propose a computationally feasible two-stage Bayesian approach to estimate the risk-related parameters and conduct predictive inference. We first apply the log Gaussian Cox process (LGCP), commonly used to model spatial clustering of point patterns, to accommodate temporal variation within the sampled communities. Prediction of the number of cases at unsampled communities at a future time is obtained by a Disease mapping model conditional on the expected case counts from Stage I.
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ask when not just whether it s a risk how regional context influences local causes of Diarrheal Disease
American Journal of Epidemiology, 2014Co-Authors: Jason E Goldstick, James Trostle, Joseph N S EisenbergAbstract:Contemporary epidemiology is enriched when it incorporates ecological concepts about systems and dependencies. With regard to Diarrheal Disease, the causes of which are many and interacting, the dynamics of within- and between-community Disease transmission have distinct components but are also linked in important ways. However, few investigators have studied how regional-scale Disease dynamics affect local patterns of Diarrheal Disease transmission. Characterizing this dependence is important for identifying local- and regional-level transmission pathways. We used data from active surveillance of Diarrheal Disease prevalence gathered from February 2004 through July 2007 in 21 neighboring Ecuadorian villages to estimate how Disease prevalence in spatially and temporally proximate villages modulates the influences of village-level risk and protective factors. We found that the impact of local, village-level interventions such as improved latrines and water treatment can be quite different under conditions of high and low regional Disease prevalence. In particular, water treatment was effective only when regional Disease prevalence was low, suggesting that person-to-person spread, not waterborne spread, is probably responsible for most between-village transmission in this region. Additional regional-scale data could enhance our understanding of how regional-scale transmission affects local-scale dynamics.
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impact of rainfall on Diarrheal Disease risk associated with unimproved water and sanitation
American Journal of Tropical Medicine and Hygiene, 2014Co-Authors: Darlene Bhavnani, Jason E Goldstick, William Cevallos, Gabriel Trueba, Joseph N S EisenbergAbstract:Diarrheal Disease remains a leading cause of morbidity in areas with limited access to safe water and sanitation. As water and sanitation interventions continue to be implemented, it will be important to understand the ecological context in which they can prevent diarrhea. We conducted six serial case control studies in Ecuador to estimate the risk of diarrhea from unimproved water and sanitation and the potential for effect modification by rainfall. Unimproved water source and unimproved sanitation increased the adjusted odds of diarrhea (odds ratio [OR] = 3.6, 95% confidence interval [95% CI] = 1.7–7.8 and OR = 1.7, 95% CI = 1.2–2.5, respectively). The OR associated with an unimproved water source was highest after maximum rainfall (OR = 6.8, 95% CI = 1.9–24.5), whereas the OR associated with unimproved sanitation was highest after minimal rainfall (OR = 2.9, 95% CI = 1.3–6.6). Our finding that use of safe water sources and improved sanitation facilities are most protective under opposing rainfall conditions highlights the need for integrated interventions to reduce the burden of Diarrheal Disease.
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synergistic effects between rotavirus and coinfecting pathogens on Diarrheal Disease evidence from a community based study in northwestern ecuador
American Journal of Epidemiology, 2012Co-Authors: Darlene Bhavnani, Jason E Goldstick, William Cevallos, Gabriel Trueba, Joseph N S EisenbergAbstract:In developing countries where Diarrheal Disease is a leading cause of morbidity and mortality in children under 5 years of age, enteric coinfection is common. There is little understanding, however, of the biologic interaction between coinfecting pathogens. The authors investigated the potential for synergistic interaction between coinfecting pathogens on diarrhea pathogenesis using an epidemiologic framework. They conducted community-based, case-control studies in 22 communities in northwestern Ecuador between 2003 and 2008. Risk ratios of diarrhea associated with single infections and coinfections were estimated. Interaction between coinfecting pathogens was assessed through departure from risk ratio additivity and multiplicativity after adjustment for age. On the additive scale, the authors found departure from the null value of 0 for rotavirus-Giardia coinfections (interaction contrast ratio = 8.0, 95% confidence interval: 3.1, 18.9) and for rotavirus-Escherichia coli coinfections (interaction contrast ratio = 9.9, 95% confidence interval: 2.6, 28.4). On the multiplicative scale, they found departure from the value of 1 for rotavirus-Giardia coinfections (multiplicative interaction = 3.6, 95% confidence interval: 1.3, 8.7). This research provides epidemiologic evidence for synergism between rotavirus and other enteric pathogens. During coinfection, the pathogenic potential of each organism appears to be enhanced. The potential for pathogenesis to be more severe in the presence of a rotavirus coinfection amplifies the need for rotavirus vaccination.
Mark D Sobsey - One of the best experts on this subject based on the ideXlab platform.
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a randomized controlled trial of the plastic housing biosand filter and its impact on Diarrheal Disease in copan honduras
American Journal of Tropical Medicine and Hygiene, 2012Co-Authors: Anna Fabiszewski M De Aceituno, Christine E. Stauber, Adam Walters, Rony Meza E Sanchez, Mark D SobseyAbstract:Point of use drinking water treatment with the BioSand filter (BSF) allows people to treat their water in the home. The purpose of this research was to document the ability of the Hydraid plastic-housing BSF to reduce Diarrheal Disease in households who received a BSF in a randomized controlled trial. The trial of the Hydraid plastic-housing BSF was carried out in rural, mountainous communities in Copan, Honduras during April of 2008 to February of 2009. A logistic regression adjusting for clustering showed that the incidence of Diarrheal Disease in children under 5 years was reduced by approximately 45% (odds ratio = 0.55, 95% confidence interval = 0.28, 1.10) in households that had a BSF compared with those households without a BSF, but this finding fluctuated depending on season and was not statistically significant. Households with a BSF had significantly better drinking water quality regardless of water source or season.
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A Randomized Controlled Trial of the Concrete Biosand Filter and Its Impact on Diarrheal Disease in Bonao, Dominican Republic
The American journal of tropical medicine and hygiene, 2009Co-Authors: Christine E. Stauber, Dana Loomis, Gloria M. Ortiz, Mark D SobseyAbstract:A number of household water treatment and safe storage technologies, such as chlorine disinfection, solar disinfection, and ceramic filtration, have been documented for their ability to reduce Diarrheal Disease and improve microbial water quality. The biosand filter (BSF) is a promising household water treatment technology in use by > 500,000 people globally. The purpose of this research was to document the ability of BSFs to improve water quality and to reduce Diarrheal Disease in user compared with non-user households in a randomized controlled trial in Bonao, Dominican Republic, during 2005-2006. During the 6-month intervention period, 75 BSF households had significantly improved drinking water quality on average compared with 79 control households ( P < 0.001). Based on random intercepts logis- tic regression, BSF households had 0.53 times the odds of Diarrheal Disease as control households, indicating a significant protective effect of the BSF against waterborne Diarrheal Disease. 1 Diarrheal Diseases make up 4% of the global bur- den of Disease. A recent review suggested that the environment and environmental risk factors play an important role in the global burden of Diseases. This review estimated that 94% of Diarrheal Diseases are attributed to a "reasonably modifiable environment" and suggested that interventions can be made in water, sanitation, and hygiene in an attempt to decrease the burden of Diarrheal Disease. 2
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escherichia coli in household drinking water and Diarrheal Disease risk evidence from cambodia
Water Science and Technology, 2008Co-Authors: Joe Brown, S Proum, Mark D SobseyAbstract:Escherichia coli counts in household drinking water may or may not reliably indicate the presence of diarrheogenic pathogens originating in feces. The extent to which a bacterial indicator like E. coli predicts risks from all classes of pathogens (viruses and parasites as well as bacteria), especially in tropical waters, is uncertain. To investigate the association between E. coli in household drinking water and Diarrheal Diseases in Cambodia, we conducted a 22 week cohort study in a rural village in Kandal Province. Episodes of diarrhea (all) and bloody diarrhea (dysentery), water quality, water sources, and other covariates were monitored biweekly in 180 households. Households used a variety of water treatment, storage, and handling practices.Results suggest a weak but positive association between E. coli counts in household drinking water and diarrhea and for diarrhea with blood (dysentery), after adjusting for clustering within households and within individuals over time. Compared to households with 1,000 E. coli per 100 ml sample (LPR = 1.2, 95% CI 1.1-1.2 for Diarrheal Disease; LPR = 1.2, 95% CI 1.0-1.3 for dysentery). Unlike the results of some previous studies, Diarrheal Disease risks did not increase progressively in magnitude with increasing concentration of E. coli in drinking water.
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Local drinking water filters reduce Diarrheal Disease in Cambodia: A randomized, controlled trial of the ceramic water purifier
American Journal of Tropical Medicine and Hygiene, 2008Co-Authors: Joe Brown, Mark D Sobsey, Dana LoomisAbstract:A randomized, controlled intervention trial of two household-scale drinking water filters was conducted in a rural village in Cambodia. After collecting four weeks of baseline data on household water quality, Diarrheal Disease, and other data related to water use and handling practices, households were randomly assigned to one of three groups of 60 households: those receiving a ceramic water purifier (CWP), those receiving a second filter employing an iron-rich ceramic (CWP-Fe), and a control group receiving no intervention. Households were followed for 18 weeks post-baseline with biweekly follow-up. Households using either filter reported significantly less Diarrheal Disease during the study compared with a control group of households without filters as indicated by longitudinal prevalence ratios CWP: 0.51 (95% confidence interval [CI]: 0.41-0.63); CWP-Fe: 0.58 (95% CI: 0.47-0.71), an effect that was observed in all age groups and both sexes after controlling for clustering within households and within individuals over time.
Hans J Overgaard - One of the best experts on this subject based on the ideXlab platform.
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a cluster randomized controlled trial to reduce Diarrheal Disease and dengue entomological risk factors in rural primary schools in colombia
PLOS Neglected Tropical Diseases, 2016Co-Authors: Hans J Overgaard, Neal Alexander, Maria Ines Matiz, Juan Felipe Jaramillo, Victor Alberto Olano, Sandra Vargas, Diana Sarmiento, Audrey LenhartAbstract:Background As many neglected tropical Diseases are co-endemic and have common risk factors, integrated control can efficiently reduce Disease burden and relieve resource-strained public health budgets. Diarrheal Diseases and dengue fever are major global health problems sharing common risk factors in water storage containers. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of Diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Integrating improved water management and educational strategies for both Diseases in the school environment can potentially improve the health situation for students and the larger community. The objective of this trial was to investigate whether interventions targeting diarrhea and dengue risk factors would significantly reduce absence due to Diarrheal Disease and dengue entomological risk factors in schools. Methodology/Principal Findings A factorial cluster randomized controlled trial was carried out in 34 rural primary schools (1,301 pupils) in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Schools were randomized to one of four study arms: diarrhea interventions (DIA), dengue interventions (DEN), combined diarrhea and dengue interventions (DIADEN), and control (CON). Interventions had no apparent effect on pupil school absence due to Diarrheal Disease (p = 0.45) or on adult female Aedes aegypti density (p = 0.32) (primary outcomes). However, the dengue interventions reduced the Breteau Index on average by 78% (p = 0.029), with Breteau indices of 10.8 and 6.2 in the DEN and DIADEN arms, respectively compared to 37.5 and 46.9 in the DIA and CON arms, respectively. The diarrhea interventions improved water quality as assessed by the amount of Escherichia coli colony forming units (CFU); the ratio of Williams mean E. coli CFU being 0.22, or 78% reduction (p = 0.008). Conclusions/Significance Integrated control of dengue and diarrhea has never been conducted before. This trial presents an example for application of control strategies that may affect both Diseases and the first study to apply such an approach in school settings. The interventions were well received and highly appreciated by students and teachers. An apparent absence of effect in primary outcome indicators could be the result of pupils being exposed to risk factors outside the school area and mosquitoes flying in from nearby uncontrolled breeding sites. Integrated interventions targeting these Diseases in a school context remain promising because of the reduced mosquito breeding and improved water quality, as well as educational benefits. However, to improve outcomes in future integrated approaches, simultaneous interventions in communities, in addition to schools, should be considered; using appropriate combinations of site-specific, effective, acceptable, and affordable interventions. Trial Registration ClinicalTrials.gov no. ISRCTN40195031
Dana Loomis - One of the best experts on this subject based on the ideXlab platform.
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A Randomized Controlled Trial of the Concrete Biosand Filter and Its Impact on Diarrheal Disease in Bonao, Dominican Republic
The American journal of tropical medicine and hygiene, 2009Co-Authors: Christine E. Stauber, Dana Loomis, Gloria M. Ortiz, Mark D SobseyAbstract:A number of household water treatment and safe storage technologies, such as chlorine disinfection, solar disinfection, and ceramic filtration, have been documented for their ability to reduce Diarrheal Disease and improve microbial water quality. The biosand filter (BSF) is a promising household water treatment technology in use by > 500,000 people globally. The purpose of this research was to document the ability of BSFs to improve water quality and to reduce Diarrheal Disease in user compared with non-user households in a randomized controlled trial in Bonao, Dominican Republic, during 2005-2006. During the 6-month intervention period, 75 BSF households had significantly improved drinking water quality on average compared with 79 control households ( P < 0.001). Based on random intercepts logis- tic regression, BSF households had 0.53 times the odds of Diarrheal Disease as control households, indicating a significant protective effect of the BSF against waterborne Diarrheal Disease. 1 Diarrheal Diseases make up 4% of the global bur- den of Disease. A recent review suggested that the environment and environmental risk factors play an important role in the global burden of Diseases. This review estimated that 94% of Diarrheal Diseases are attributed to a "reasonably modifiable environment" and suggested that interventions can be made in water, sanitation, and hygiene in an attempt to decrease the burden of Diarrheal Disease. 2
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Local drinking water filters reduce Diarrheal Disease in Cambodia: A randomized, controlled trial of the ceramic water purifier
American Journal of Tropical Medicine and Hygiene, 2008Co-Authors: Joe Brown, Mark D Sobsey, Dana LoomisAbstract:A randomized, controlled intervention trial of two household-scale drinking water filters was conducted in a rural village in Cambodia. After collecting four weeks of baseline data on household water quality, Diarrheal Disease, and other data related to water use and handling practices, households were randomly assigned to one of three groups of 60 households: those receiving a ceramic water purifier (CWP), those receiving a second filter employing an iron-rich ceramic (CWP-Fe), and a control group receiving no intervention. Households were followed for 18 weeks post-baseline with biweekly follow-up. Households using either filter reported significantly less Diarrheal Disease during the study compared with a control group of households without filters as indicated by longitudinal prevalence ratios CWP: 0.51 (95% confidence interval [CI]: 0.41-0.63); CWP-Fe: 0.58 (95% CI: 0.47-0.71), an effect that was observed in all age groups and both sexes after controlling for clustering within households and within individuals over time.
Michael Emch - One of the best experts on this subject based on the ideXlab platform.
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influence of latrine proximity and type on tubewell water quality and Diarrheal Disease in bangladesh
Annals of The Association of American Geographers, 2013Co-Authors: Veronica Escamilla, Mohammad Yunus, Peter S K Knappett, Peter Kim Streatfield, Michael EmchAbstract:Diarrheal Diseases are endemic in Bangladesh, where sanitation is poor, and untreated drinking water extracted from shallow (<43 m) tubewells could partially contribute to Disease propagation. This study measures the effects of local population–environment context on tubewell water quality and Diarrheal Disease incidence. The study site includes six villages in Matlab, Bangladesh, with approximately 12,000 residents. Study data include monthly Escherichia coli concentrations for 100 wells, monthly Diarrheal events for all children under five, and a detailed water and sanitation infrastructure database created through a submeter accuracy Global Positioning System survey. We developed sanitation metrics to measure the relationship between tubewell water fecal contamination and estimates of human fecal loadings at varying scales. The relationship between childhood diarrhea and E. coli in drinking water was measured for households that obtained drinking water from survey wells. Results show that tubewells sur...
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Diarrheal Disease risk in rural bangladesh decreases as tubewell density increases a zero inflated and geographically weighted analysis
International Journal of Health Geographics, 2011Co-Authors: Margaret Carrel, Mohammad Yunus, Veronica Escamilla, Jane P Messina, Sophia Giebultowicz, Jennifer Winston, Kim P Streatfield, Michael EmchAbstract:This study investigates the impact of tubewell user density on cholera and shigellosis events in Matlab, Bangladesh between 2002 and 2004. Household-level demographic, health, and water infrastructure data were incorporated into a local geographic information systems (GIS) database. Geographically-weighted regression (GWR) models were constructed to identify spatial variation of relationships across the study area. Zero-inflated negative binomial regression models were run to simultaneously measure the likelihood of increased magnitude of Disease events and the likelihood of zero cholera or shigellosis events. The aim of this study was to examine the effect of tubewell density on both the occurrence of Diarrheal Disease and the magnitude of Diarrheal Disease incidence. In Matlab, households with greater tubewell density were more likely to report zero cholera or shigellosis events. Results for both cholera and shigellosis GWR models suggest that tubewell density effects are spatially stationary and the use of non-spatial statistical methods is appropriate. Increasing the amount of drinking water available to households through increased density of tubewells contributed to lower reports of cholera and shigellosis events in rural Bangladesh. Our findings demonstrate the importance of tubewell installation and access to groundwater in reducing Diarrheal Disease events in the developing world.
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Diarrheal Disease risk in Matlab, Bangladesh.
Social science & medicine (1982), 1999Co-Authors: Michael EmchAbstract:The objective of this research project is to assess risk for Diarrheal Disease in rural Bangladesh by analyzing the complex and dynamic interaction of biological, socioeconomic, cultural/behavioral and environmental factors over time and space. Risk factors of cholera and non-cholera water Diarrheal Disease are calculated to compare the relative importance of risk for several independent variables. Diarrheal Disease data were collected for people who were hospitalized at the International Centre for Diarrhoeal Disease Research (ICDDR) hospital from January 1, 1992 to December 31, 1994. Using laboratory and hospital records, cases were assigned to one of two diarrhea Disease categories (cholera or non-cholera watery diarrhea) that were used as dependent variables in the analysis stage of the research. Age-matched individuals were randomly chosen from the community to be controls. Information was collected for independent variables that were hypothesized to be related to watery diarrhea. This information was collected by administering questionnaires, obtaining secondary data from the ICDDR's demographic surveillance system records and community health worker record books and calculating variables using a geographic information system database. Sanitation and water availability and use are extremely important in the effort to reduce secondary cholera and non-cholera, watery diarrhea transmission. Water use and availability variables were more important for non-cholera watery Diarrheal risk than for cholera but nevertheless they were important for both. Socioeconomic status is an important indirect cause of both of these Diseases because poverty is the root cause of many of the other variables, such as lack of sanitation and clean water. Flood-control was related to both types of diarrhea but it is not understood why. Since the Bangladesh Flood Action Plan will continue to build and maintains flood-control embankments, it is important to investigate whether there is a pattern to this relationship throughout the country and to investigate why the relationship exists.