Evidence map›Paper›PMID 38507184›Full record

Trial reportJournal of epidemiology and global health2024

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.

Jesse D Contreras, Mahfuza Islam, Andrew Mertens, Amy J Pickering, Benjamin F Arnold, Jade Benjamin-Chung, Alan E Hubbard, Mahbubur Rahman, Leanne Unicomb, Stephen P Luby and 2 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of epidemiology and global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Jesse D ContrerasDepartment of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48103, USA.ORCID http://orcid.org/0000-0002-9766-2945
Mahfuza IslamDepartment of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA.ORCID http://orcid.org/0000-0003-2810-9211
Andrew MertensDivision of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA.ORCID http://orcid.org/0000-0002-1050-6721
Amy J PickeringDepartment of Civil and Environmental Engineering, University of California, Berkeley, Berkeley, CA, 94720, USA.ORCID http://orcid.org/0000-0001-6193-2221
Benjamin F ArnoldFrancis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, 94158, USA.ORCID http://orcid.org/0000-0001-6105-7295
Jade Benjamin-ChungChan Zuckerberg Biohub, San Francisco, CA, 94158, USA.ORCID http://orcid.org/0000-0003-3631-3132
Alan E HubbardDivision of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA.ORCID http://orcid.org/0000-0002-3769-0127
Mahbubur RahmanEnvironmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, 1212, Bangladesh.ORCID http://orcid.org/0000-0003-0520-2683
Leanne UnicombEnvironmental Health and WASH, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, 1212, Bangladesh.ORCID http://orcid.org/0000-0002-7757-5641
Stephen P LubyWoods Institute for the Environment, Stanford University, Stanford, CA, 94305, USA.ORCID http://orcid.org/0000-0001-5385-899X
John M ColfordDivision of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA.ORCID http://orcid.org/0000-0002-3288-6956
Ayse ErcumenDepartment of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27695, USA. aercume@ncsu.edu.ORCID http://orcid.org/0000-0001-6002-1514

Funding

Translational Research Support CoreP30ES025128 · NIEHS · NORTH CAROLINA STATE UNIVERSITY RALEIGH · PI Andrew R. Binder · 2015 to 2026
$18.3M
Effects of sanitation on pathogen transmission and child health in BangladeshR01HD078912 · NICHD · UNIVERSITY OF CALIFORNIA BERKELEY · PI COLFORD, JOHN M · 2014 to 2017
$2.2M
Bill and Melinda Gates Foundation 0PPGD759NICHD NIH HHS R01 HD078912NIEHS NIH HHS P30 ES025128NIH HHS R01HD078912
6 · The paper itself

Abstract

backgroundThe WASH benefits Bangladesh trial multi-component sanitation intervention reduced diarrheal disease among children < 5 years. Intervention components included latrine upgrades, child feces management tools, and behavioral promotion. It remains unclear which components most impacted diarrhea.

methodsWe conducted mediation analysis within a subset of households (n = 720) from the sanitation and control arms. Potential mediators were categorized into indicators of latrine quality, latrine use practices, and feces management practices. We estimated average causal mediation effects (ACME) as prevalence differences (PD), defined as the intervention's effect on diarrhea through its effect on the mediator.

resultsThe intervention improved all indicators compared to controls. We found significant mediation through multiple latrine use and feces management practice indicators. The strongest mediators during monsoon seasons were reduced open defecation among children aged < 3 and 3-8 years, and increased disposal of child feces into latrines. The strongest mediators during dry seasons were access to a flush/pour-flush latrine, reduced open defecation among children aged 3-8 years, and increased disposal of child feces into latrines. Individual mediation effects were small (PD = 0.5-2 percentage points) compared to the overall intervention effect but collectively describe significant mediation pathways. DISCUSSION: The effect of the WASH Benefits Bangladesh sanitation intervention on diarrheal disease was mediated through improved child feces management and reduced child open defecation. Although the intervention significantly improved latrine quality, relatively high latrine quality at baseline may have limited benefits from additional improvements. Targeting safe child feces management may increase the health benefits of rural sanitation interventions.

Indexed as

DiarrheaFecesRural PopulationSanitationToilet FacilitiesBangladeshChildChild, PreschoolCluster AnalysisFemaleHumansInfantMaleMediation AnalysisChild fecesDiarrheal diseaseInterventionLatrineMediationSanitation

Identifiers

PMID38507184
PMCPMC11444030

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Registered trials

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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.