ArticleEClinicalMedicine2021
A comparison of traditional diarrhoea measurement methods with microbiological and biochemical indicators: A cross-sectional observational study in the Cox's Bazar displaced persons camp.
Article in EClinicalMedicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07272122 (Reducing Filth Fly Populations and Transmission of Diarrhoeal Pathogens in Harsh Settings), which is not on this map. Cited by 12 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Reducing Filth Fly Populations and Transmission of Diarrhoeal Pathogens in Harsh Settings: a Cross-over Trial in South Sudan
Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Is detection of enteropathogens and human or animal faecal markers in the environment associated with subsequent child enteric infections and growth: an individual participant data meta-analysis.The Lancet. Global health · 2024Pooled it
- The impact of diarrhoea measurement methods for under 5s in low- and middle-income countries on estimated diarrhoea rates at the population level: A systematic review and meta-analysis of methodological and primary empirical studies.Tropical medicine & international health : TM & IH · 2022Pooled it
- Fecal sludge and adjacent drinking water as reservoirs of multidrug resistant ESBL-producing pathogenic Escherichia coli in Rohingya Camps, Bangladesh.Scientific reports · 2026Article
- Pathogen-specific predicting factors of childhood diarrhoea and their seasonality: evaluation from Rohingya refugees and host population in Cox's Bazar, Bangladesh.Journal of global health · 2026Article
- Infectious disease research in forcibly displaced populations: A systematic review in low- and middle-income host countries.Journal of migration and health · 2025Review
- Article
- Low cost and real-time surveillance of enteric infection and diarrhoeal disease using rapid diagnostic tests in Cox's Bazar, Bangladesh.Conflict and health · 2024Article
- Multidrug-resistantHeliyon · 2023Article
- Article
- Article
- COVID-19 vaccination refusal trends in Kenya over 2021.Vaccine · 2023Article
- Evaluations of water, sanitation and hygiene interventions should not use diarrhoea as (primary) outcome.BMJ global health · 2022Review
Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWater, Sanitation, and Hygiene (WASH) systems aim to reduce the spread of enteric pathogens, particularly amongst children under five years old. The most common primary outcome of WASH trials is carer-reported diarrhoea. We evaluate different diarrhoea survey instruments as proxy markers of enteric pathogen presence in stool.
methodsWe recruited 800 community-based participants from the Cox's Bazar Displaced Person's Camp in Bangladesh, split evenly between the rainy (July/August 2020) and dry (November/December 2020) periods. Participants were randomized evenly into either a standard survey asking carers if their child under five years old has had diarrhoea in the past fortnight, or a pictorial survey asking carers to pick from a pictorial chart which stools their child under five years old has had in the past fortnight. We collected stools from a random sub-sample of 120. Stools were examined visually, and tested for proteins associated with enteric infection and 16 enteric pathogens. We calculated sensitivities and specificities for each survey type, visual examination, and proteins with respect to enteric pathogen presence.
findingsThe sensitivity of the standard survey for enteric pathogen presence was 0.49[95%CI:0.32,0.66] and the specificity was 0.65[0.41,0.85]. Similar sensitivities and specificities were observed for pictorial survey, visual inspection, and proteins.
interpretationWhile diarrhoea is an important sign in clinical practice it appears that it is a poor proxy for enteric pathogen presence in stool in epidemiological surveys. When enteric infection is of interest, this should be measured directly.
fundingThe project was funded by the National Institutes for Health Research Global Health Research Unit on Improving Health in Slums (16/136/87) and by the University of Warwick.
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