Effects of an urban sanitation intervention on childhood enteric infection and diarrhea in Maputo, Mozambique: A controlled before-and-after trial

Data are n (%) or mean (standard deviation) and collected by questionnaire unless otherwise noted.

^* Age range 32–1819 days, IQR 339–1021 days. Age distributions available in Appendix 1—figure 3.

^†Assessed using Simple Poverty Scorecard for Mozambique (http://www.simplepovertyscorecard.com/MOZ_2008_ENG.pdf).

^‡Data collected by direct observation.

^§Calculated as # of people living in the compound divided by the area of the compound in square meters. Source files available in Table 1—source data 1 and Table 1—source code 1.

Prevalence results are presented as (n/N (%)). All effect estimates are presented as prevalence ratios (ratio of ratios) and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors.

*Analysis includes all children measured at baseline and 12-month visits.

^†Analysis includes all children measured at baseline and 24 month visits.

‡Outcome was pre-specified in trial registration. All other outcomes are exploratory.

^§Pathogen outcomes adjusted for child age and sex, caregiver’s education, and household wealth index. Reported diarrhea was also adjusted for baseline presence of a drop-hole cover and reported use of a tap on compound grounds as primary drinking water source. Sample sizes for adjusted analyses are slightly smaller than numbers presented in prevalence estimates due to missing covariate data. Y. enterocolitica, V. cholerae, E. histolytica, and rotavirus were detected in <2% of samples in each arm at each phase. Descriptive data for these pathogens are available in the Appendix 1—table 2. Source files available in Table 2—source data 1 and Table 2—source code 1.

Analysis includes children < 2 years old at baseline and children born into the study after baseline and <2 years old at the time of the 24-month visit. Prevalence results are presented as (n/N (%)). All effect estimates are presented as prevalence ratios (ratio of ratios) and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors.

*Outcome was pre-specified in trial registration. All other outcomes are exploratory.

^†Pathogen outcomes adjusted for child age and sex, caregiver’s education, and household wealth index. Reported diarrhea was also adjusted for baseline presence of a drop-hole cover and reported use of a tap on compound grounds as primary drinking water source. Sample sizes for adjusted analyses are slightly smaller than numbers presented in prevalence estimates due to missing covariate data.

^§Models would not converge due to sparse data. Y. enterocolitica, V. cholerae, E. histolytica, and rotavirus were detected in <2% of samples in each arm at each phase and excluded. Descriptive data for these pathogens are available in the Appendix 1—table 2. Source files available in Table 3—source data 1 and Table 3—source code 1.

*Mean concentration of double-stranded DNA recovered from whole stool was 40.8 ng/μL (SD = 16.5, n = 33 with 57 samples excluded as their concentrations exceeded the upper detection limit of the assay), diaper samples was 28.7 ng/μL (SD = 16.9, n = 61 with 16 samples excluded as concentrations exceeded upper detection limit of assay), and rectal swabs was 26.3 ng/μL (SD = 15.5, n = 195 with 25 samples excluded as concentrations exceeded upper detection limit of assay). Only a subset of each sample type assayed for dsDNA concentration.

Data presented n/N (%) or mean (standard deviation). All bacterial, protozoan, and viral pathogens were measured using the Luminex Gastrointestinal Pathogen panel. STH were measured using the Kato-Katz method. Diarrhea was measured via caregiver report in household surveys.

Results are presented as prevalence (n/N (%)) or mean (standard deviation) at baseline.

*Prevalence (or mean (SD)) for children with repeated observations at baseline and 12-month visits.

^†Prevalence (or mean (SD)) for children with observations at baseline visit and not the 12-month visit.

^‡Standardized mean difference between observations of children with and without repeated measures at baseline and 12-month visits.

^§ Could not be calculated.

Results are presented as prevalence (n/N (%)) or mean (standard deviation) at baseline.

*Prevalence (or mean (SD)) for children with repeated observations at baseline and 24-month visits.

^†Prevalence (or mean (SD)) for children with observations at the baseline visit and not the 24-month visit.

^‡Standardized mean difference between observations of children with and without repeated measures at baseline and 24-month visits.

^§Could not be calculated.

Results are presented as prevalence (n/N (%)) or mean (standard deviation) at 12-month visit.

*Prevalence (or mean (SD)) for children with repeated observations at baseline and 12-month visits.

^†Prevalence (or mean (SD)) for children with observations at the 12-month visit only.

^‡Standardized mean difference between observations of children with and without repeated measures at baseline and 12-month visits.

^§Standardized mean difference between observations from control and intervention children measured at 12-month visit only.

Results are presented as prevalence (n/N (%)) or mean (standard deviation) at 24-month visit.

* Prevalence (or mean (SD)) for children with repeated observations at baseline and 24-month visits.

^†Prevalence (or mean (SD)) for children with observations at the 24-month visit only.

^‡Standardized mean difference between observations of children with and without repeated measures at baseline and 24-month visits.

^§Standardized mean difference between observations from control and intervention children measured at 24-month visit only.

All effect estimates are presented as prevalence ratios (ratio of ratios) with 95% confidence intervals and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors. All models adjusted for child age, sex, caregiver education level, and household wealth.

*Analysis includes all children regardless of caregiver-reported deworming status.

†Analysis is adjusted for reported deworming status. Effect estimates at 12 month are adjusted for baseline deworming confirmation, effect estimates at 24 month are adjusted for baseline and/or 12 month deworming confirmation.

‡Analysis is restricted to children whose caregivers confirmed baseline deworming.

§ Adjusted for time between 12 month deworming and 24 month sample collection, time broken into three intervals: 0–3 months, 4–6 months, and >6 months. The NDC performed 12 month deworming activities at the end of the 12 month phase instead of concurrent to 12 month sample collection resulting in some variation in the amount of time between 12 month deworming and 24 month sample collection among participants. All samples collected during 12 month phase were collected >6 months after deworming and no adjustment for time since deworming was made.

All effect estimates are presented as prevalence ratios (ratio of ratios) with 95% confidence intervals and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors. All infection outcomes are adjusted for child age and sex, caregiver’s education, and household wealth index, and the diarrhea outcome is also adjusted for baseline presence of a drop-hole cover and reported use of a tap on compound grounds as primary drinking water source.

* Results represent effect estimates for the main analyses which included control children irrespective of whether their latrines had been independently upgraded (results also presented in Table 2 in main text).

† Results from sensitivity analyses which exclude control children living in compounds that independently upgraded their latrines to be similar to the intervention.

^*Standardized difference between arms in baseline covariates. † Compared with 12-month unadjusted prevalence ratio (12 month difference-in-difference estimator). ‡ Compared with 12-month prevalence ratio adjusted for a priori covariates child age, sex, caregiver education, and poverty (wealth score).

All effect estimates are presented as prevalence ratios (ratio of ratios) with 95% confidence intervals and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors. All models are adjusted for a priori covariates (age, sex, wealth, caregiver education) and age squared to assess the impact of the age squared term on effect estimates. †Results from main analyses examining intervention effects among all enrolled children at 12 month and 24 month visits. Effect estimates compared with 12 month and 24 month results in Table 2.

*Results from sub-group analyses which compared children born after the intervention was implemented with children of a similar age at baseline. Effect estimates compared with results in Table 3 (24 month sub-group analysis results) and Appendix 1—table 13 (12 month sub-group analysis results).

† Results from sub-group analyses including children with repeated measures at baseline and the 12 month phase or baseline and the 24 month phase. Effect estimates compared with results in Appendix 1—tables 14 and 15.

‡ Results from sub-group analysis comparing children aged >2 years old at baseline and 24 month phase. Effect estimates compared with results in Appendix 1—table 12.

All effect estimates are presented as prevalence ratios (ratio of ratios) with 95% confidence intervals and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors.

*Models are adjusted for a priori covariates age, sex, caregiver’s education, and wealth and presented for comparison with seasonality-adjusted models.

†Models are adjusted for a priori covariates and seasonality using sine/cosine terms based on the date of sample (or survey) collection.

Analysis includes children >2 year old at baseline or the 24 month visit. Prevalence results are presented as (n/N (%)). All effect estimates are presented as prevalence ratios (ratio of ratios) with 95% confidence intervals and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors.

* Pathogen outcomes adjusted for child age and sex, caregiver’s education, and household wealth index, reported diarrhea also adjusted for baseline presence of a drop-hole cover and reported use of a tap on compound grounds as primary drinking water source.

† Models did not converge due to sparse data.

Analysis includes children < 1 year old at baseline and children born into the study after baseline and <1 year old at the time of the 12-month visit. Prevalence results are presented as (n/N (%)). All effect estimates are presented as prevalence ratios (ratio of ratios) with 95% confidence intervals and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors.

*Pathogen outcomes adjusted for child age and sex, caregiver’s education, and household wealth index, reported diarrhea also adjusted for baseline presence of a drop-hole cover and reported use of a tap on compound grounds as primary drinking water source.

† Models did not converge due to sparse data.

Analysis includes children with complete observations at baseline and 12-month visits. Prevalence results are presented as (n/N (%)). All effect estimates are presented as prevalence ratios (ratio of ratios) with 95% confidence intervals and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors.

* Pathogen outcomes adjusted for child age and sex, caregiver’s education, and household wealth index, reported diarrhea also adjusted for baseline presence of a drop-hole cover and reported use of a tap on compound grounds as primary drinking water source.

† Models would not converge due to sparse data.

Analysis includes children with complete observations at baseline and 24-month visits. Prevalence results are presented as (n/N (%)). All effect estimates are presented as prevalence ratios (ratio of ratios) with 95% confidence intervals and estimated using generalized estimating equations to fit Poisson regression models with robust standard errors.

* Pathogen outcomes adjusted for child age and sex, caregiver’s education, and household wealth index, reported diarrhea also adjusted for baseline presence of a drop-hole cover and reported use of a tap on compound grounds as primary drinking water source.

† Models would not converge due to sparse data.