Evidence map›Paper›PMID 38365415›Full record

SynthesisThe Lancet. Global health2024

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.

Andrew Mertens, Benjamin F Arnold, Jade Benjamin-Chung, Alexandria B Boehm, Joe Brown, Drew Capone, Thomas Clasen, Erica R Fuhrmeister, Jessica A Grembi, David Holcomb and 17 more

Open access · goldAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
5.3field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 17 citations in OpenAlex.

  1. Trial
  2. Article
  3. Sociodemographic Factors and Childhood Growth: Associations with Environmental Sanitation Phases.International journal of environmental research and public health · 2026
    Article
  4. Article
  5. Review
  6. Article
  7. Article
  8. Review
  9. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

27 authors at 13 institutions in 3 countries.

Andrew MertensDivision of Epidemiology, University of California, Berkeley, CA, USA; Division of Biostatistics, University of California, Berkeley, CA, USA. Electronic address: amertens@berkeley.edu.
Benjamin F ArnoldFrancis I Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA.
Jade Benjamin-ChungDepartment of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.
Alexandria B BoehmDepartment of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA.
Joe BrownDepartment of Environmental Science and Engineering, University of North Carolina, Gillings School of Global Public Health, Michael Hooker Research Center, Chapel Hill, NC, USA.
Drew CaponeDepartment of Environmental and Occupational Health, Indiana University, Bloomington, IN, USA.
Thomas ClasenDepartment of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Erica R FuhrmeisterDepartment of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA.
Jessica A GrembiDepartment of Medicine, Stanford University, Stanford, CA, USA.
David HolcombDepartment of Environmental Science and Engineering, University of North Carolina, Gillings School of Global Public Health, Michael Hooker Research Center, Chapel Hill, NC, USA.
Jackie KneeDepartment of Disease Control, London School of Tropical Medicine & Hygiene, London, UK.
Laura H KwongDivision of Environmental Health Sciences, University of California, Berkeley, CA, USA.
Audrie LinDepartment of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA.
Stephen P LubyDivision of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
Rassul NalaMinistério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique.
Kara NelsonDepartment of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA.
Sammy M NjengaKenya Medical Research Institute, Nairobi, Kenya.
Clair NullMathematica, Princeton, NJ, USA.
Amy J PickeringDepartment of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, CA, USA.
Mahbubur RahmanEnvironmental Interventions Unit, Infectious Diseases Division, Dhaka, Bangladesh.
Heather E ReeseDepartment of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Lauren SteinbaumCalifornia Department of Toxic Substances Control, Sacramento, CA, USA.
Jill R StewartDepartment of Environmental Science and Engineering, University of North Carolina, Gillings School of Global Public Health, Michael Hooker Research Center, Chapel Hill, NC, USA.
Ruwan ThilakaratneDivision of Epidemiology, University of California, Berkeley, CA, USA.
Oliver CummingDepartment of Disease Control, London School of Tropical Medicine & Hygiene, London, UK.
John M ColfordDivision of Epidemiology, University of California, Berkeley, CA, USA.
Ayse ErcumenDepartment of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA.
University of California, Berkeley · USStanford University · USUniversity of North Carolina at Chapel Hill · USEmory University · USCalifornia Department of Toxic Substances Control · USIndiana University Bloomington · USKenya Medical Research Institute · KEMathematica Policy Research · USMinistry of Health · MZNorth Carolina State University · USUniversity of California, San Francisco · USUniversity of California, Santa Cruz · USUniversity of Washington · US

Funding

Translational Research Support CoreP30ES025128 · NIEHS · NORTH CAROLINA STATE UNIVERSITY RALEIGH · PI Andrew R. Binder · 2015 to 2026
$18.3M
NIEHS NIH HHS P30 ES025128
6 · The paper itself

Abstract

backgroundQuantifying contributions of environmental faecal contamination to child diarrhoea and growth faltering can illuminate causal mechanisms behind modest health benefits in recent water, sanitation, and hygiene (WASH) trials. We aimed to assess associations between environmental detection of enteropathogens and human or animal microbial source tracking markers (MSTM) and subsequent child health outcomes.

methodsIn this individual participant data meta-analysis we searched we searched PubMed, Embase, CAB Direct Global Health, Agricultural and Environmental Science Database, Web of Science, and Scopus for WASH intervention studies with a prospective design and concurrent control that measured enteropathogens or MSTM in environmental samples, or both, and subsequently measured enteric infections, diarrhoea, or height-for-age Z-scores (HAZ) in children younger than 5 years. We excluded studies that only measured faecal indicator bacteria. The initial search was done on Jan 19, 2021, and updated on March 22, 2023. One reviewer (AM) screened abstracts, and two independent reviewers (AM and RT) examined the full texts of short-listed articles. All included studies include at least one author that also contributed as an author to the present Article. Our primary outcomes were the 7-day prevalence of caregiver-reported diarrhoea and HAZ in children. For specific enteropathogens in the environment, primary outcomes also included subsequent child infection with the same pathogen ascertained by stool testing. We estimated associations using covariate-adjusted regressions and pooled estimates across studies.

findingsData from nine published reports from five interventions studies, which included 8603 children (4302 girls and 4301 boys), were included in the meta-analysis. Environmental pathogen detection was associated with increased infection prevalence with the same pathogen and lower HAZ (ΔHAZ -0·09 [95% CI -0·17 to -0·01]) but not diarrhoea (prevalence ratio 1·22 [95% CI 0·95 to 1·58]), except during wet seasons. Detection of MSTM was not associated with diarrhoea (no pooled estimate) or HAZ (ΔHAZ -0·01 [-0·13 to 0·11] for human markers and ΔHAZ -0·02 [-0·24 to 0·21] for animal markers). Soil, children's hands, and stored drinking water were major transmission pathways.

interpretationOur findings support a causal chain from pathogens in the environment to infection to growth faltering, indicating that the lack of WASH intervention effects on child growth might stem from insufficient reductions in environmental pathogen prevalence. Studies measuring enteropathogens in the environment should subsequently measure the same pathogens in stool to further examine theories of change between WASH, faecal contamination, and health. Given that environmental pathogen detection was predictive of infection, programmes targeting specific pathogens (eg, vaccinations and elimination efforts) can environmentally monitor the pathogens of interest for population-level surveillance instead of collecting individual biospecimens.

fundingThe Bill & Melinda Gates Foundation and the UK Foreign and Commonwealth Development Office.

Indexed as

DiarrheaSoilAgricultureAnimalsChildChild, PreschoolFemaleHumansHygieneMaleSanitationSoil

Identifiers

PMID38365415
PMCPMC10882208
OpenAlexW4392183652

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.