@article{contreras_islam_mertens_pickering_arnold_benjamin-chung_hubbard_rahman_unicomb_luby_et al._2024, title={Improved Child Feces Management Mediates Reductions in Childhood Diarrhea from an On-Site Sanitation Intervention: Causal Mediation Analysis of a Cluster-Randomized Trial in Rural Bangladesh}, volume={3}, ISSN={["2210-6014"]}, DOI={10.1007/s44197-024-00210-y}, abstractNote={Abstract}, journal={JOURNAL OF EPIDEMIOLOGY AND GLOBAL HEALTH}, author={Contreras, Jesse D. and Islam, Mahfuza and Mertens, Andrew and Pickering, Amy J. and Arnold, Benjamin F. and Benjamin-Chung, Jade and Hubbard, Alan E. and Rahman, Mahbubur and Unicomb, Leanne and Luby, Stephen P. and et al.}, year={2024}, month={Mar} }
 @article{contreras_islam_mertens_pickering_arnold_benjamin-chung_hubbard_rahman_unicomb_luby_et al._2022, title={Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh}, volume={19}, ISSN={["1549-1676"]}, url={http://dx.doi.org/10.1371/journal.pmed.1004041}, DOI={10.1371/journal.pmed.1004041}, abstractNote={
Background
Diarrhea and acute respiratory infection (ARI) are leading causes of death in children. The WASH Benefits Bangladesh trial implemented a multicomponent sanitation intervention that led to a 39% reduction in the prevalence of diarrhea among children and a 25% reduction for ARI, measured 1 to 2 years after intervention implementation. We measured longer-term intervention effects on these outcomes between 1 to 3.5 years after intervention implementation, including periods with differing intensity of behavioral promotion.
}, number={8}, journal={PLOS MEDICINE}, publisher={Public Library of Science (PLoS)}, author={Contreras, Jesse D. and Islam, Mahfuza and Mertens, Andrew and Pickering, Amy J. and Arnold, Benjamin F. and Benjamin-Chung, Jade and Hubbard, Alan E. and Rahman, Mahbubur and Unicomb, Leanne and Luby, Stephen P. and et al.}, editor={Bhutta, Zulfiqar A.Editor}, year={2022}, month={Aug} }
 @article{contreras_islam_mertens_pickering_kwong_arnold_benjamin-chung_hubbard_alam_sen_et al._2022, title={Influence of community-level sanitation coverage and population density on environmental fecal contamination and child health in a longitudinal cohort in rural Bangladesh}, volume={245}, ISSN={["1618-131X"]}, url={http://dx.doi.org/10.1016/j.ijheh.2022.114031}, DOI={10.1016/j.ijheh.2022.114031}, abstractNote={Household-level sanitation interventions have had limited effects on child health or environmental contamination, potentially due to low community coverage. Higher community-level coverage with safely managed sanitation can reduce opportunities for disease transmission.We estimated associations between community sanitation coverage, environmental fecal contamination, and child health among 360 compounds in the control arm of the WASH Benefits trial in rural Bangladesh (NCT01590095). In each compound, we enumerated E. coli in environmental samples and recorded the 7-day prevalence of caregiver-reported diarrheal disease and acute respiratory infections (ARI) in children under five. We observed indicators of latrine access and quality among all neighboring compounds within 100 m of study compounds. We defined community coverage as the proportion of neighboring compounds with (1) at least one latrine, and (2) exclusively hygienic latrines (improved facility observed to safely contain feces), within both 50 m and 100 m of study compounds. We assessed effect modification by population density and season.Adjusted for confounders, study compounds surrounded by 100% coverage of at least one latrine per compound within 50 m had slightly lower log10E. coli counts in stored water (Δlog = -0.13, 95% CI -0.26, -0.01), child hand rinses (Δlog = -0.13, 95% CI -0.24, -0.02), and caregiver hand rinses (Δlog = -0.16, 95% CI -0.29, -0.03) and marginally lower prevalence of diarrheal disease (prevalence ratio [PR] = 0.82, 95% CI 0.64, 1.04) and ARI (PR = 0.84, 95% CI 0.69, 1.03) compared to compounds surrounded by <100% coverage. Effects were similar but less pronounced at 100 m. At higher population densities, community latrine coverage was associated with larger reductions in E. coli on child and caregiver hands and prevalence of diarrheal disease. Coverage with exclusively hygienic latrines was not associated with any outcome.Higher community sanitation coverage was associated with reduced fecal contamination and improved child health, with stronger effects at highly local scales (50m) and at high population densities. Our findings indicate that the relationship between community sanitation coverage, environmental contamination, and child health varies by definition of coverage, distance, and population density. This work highlights significant uncertainty around how to best measure sanitation coverage and the expected health effects of increasing sanitation coverage using a specific metric. Better understanding of community-level sanitation access is needed to inform policy for implementing sanitation systems that effectively protect community health.}, journal={INTERNATIONAL JOURNAL OF HYGIENE AND ENVIRONMENTAL HEALTH}, publisher={Elsevier BV}, author={Contreras, Jesse D. and Islam, Mahfuza and Mertens, Andrew and Pickering, Amy J. and Kwong, Laura H. and Arnold, Benjamin F. and Benjamin-Chung, Jade and Hubbard, Alan E. and Alam, Mahfuja and Sen, Debashis and et al.}, year={2022}, month={Aug} }
 @article{contreras_islam_mertens_pickering_kwong_arnold_benjamin-chung_hubbard_alam_sen_et al._2021, title={Longitudinal Effects of a Sanitation Intervention on Environmental Fecal Contamination in a Cluster-Randomized Controlled Trial in Rural Bangladesh}, volume={55}, ISSN={["1520-5851"]}, DOI={10.1021/acs.est.1c01114}, abstractNote={Household latrine access generally is not associated with reduced fecal contamination in the environment, but its long-term effectiveness has not been measured. We conducted an environmental assessment nested within the WASH Benefits Bangladesh randomized controlled trial (NCT01590095). We quantified E. coli and fecal coliforms in samples of stored drinking water, child hands, mother hands, soil, and food among a random sample of households from the sanitation and control arms of the trial. Samples were collected during eight quarterly visits approximately 1–3.5 years after intervention initiation. Overall, there were no substantial differences in environmental fecal contamination between households enrolled in the sanitation and control arms. Statistically significant reductions were found in stored water and child hands after pooling across sampling rounds, but the effects were small and not consistent across rounds. In addition, we assessed potential effect modification of intervention effects by follow-up time, season, wealth, community-level latrine density and coverage, population density, and domestic animal ownership. While the intervention had statistically significant effects within some subgroups, there were no consistent patterns of effect modification. Our findings support a growing consensus that on-site latrines are insufficient to prevent fecal contamination in the rural household environment.}, number={12}, journal={ENVIRONMENTAL SCIENCE & TECHNOLOGY}, author={Contreras, Jesse D. and Islam, Mahfuza and Mertens, Andrew and Pickering, Amy J. and Kwong, Laura H. and Arnold, Benjamin F. and Benjamin-Chung, Jade and Hubbard, Alan E. and Alam, Mahfuja and Sen, Debashis and et al.}, year={2021}, month={Jun}, pages={8169–8179} }