1. Epidemiology and Global Health
  2. Medicine
Download icon

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

  1. Jackie Knee
  2. Trent Sumner
  3. Zaida Adriano
  4. Claire Anderson
  5. Farran Bush
  6. Drew Capone
  7. Veronica Casmo
  8. David Holcomb
  9. Pete Kolsky
  10. Amy MacDougall
  11. Evgeniya Molotkova
  12. Judite Monteiro Braga
  13. Celina Russo
  14. Wolf Peter Schmidt
  15. Jill Stewart
  16. Winnie Zambrana
  17. Valentina Zuin
  18. Rassul Nalá
  19. Oliver Cumming
  20. Joe Brown  Is a corresponding author
  1. London School of Hygiene & Tropical Medicine, Faculty of Infectious Tropical Diseases, Disease Control Department, United Kingdom
  2. Georgia Institute of Technology, School of Civil and Environmental Engineering, United States
  3. WE Consult ltd, Mozambique
  4. Georgia Institute of Technology, School of Chemical and Biomolecular Engineering, United States
  5. University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, United States
  6. Instituto Nacional de Saúde, Mozambique
  7. University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Environmental Sciences and Engineering, United States
  8. London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, Department of Medical Statistics, United Kingdom
  9. Georgia Institute of Technology, School of Biological Sciences, United States
  10. Yale-NUS College, Division of Social Science, Singapore
Research Article
Cite this article as: eLife 2021;10:e62278 doi: 10.7554/eLife.62278
10 figures, 19 tables and 2 additional files

Figures

Trial profile.

*Eligible for enrollment at baseline and/or 12 months but traveling at time of visit. †Children removed from 24-month analysis because their compound received an intervention after completion of the baseline phase. Source files available in Figure 1—source data 1 and Figure 1—source code 1.

Appendix 1—figure 1
Proportion of each type of sample collected during the baseline, 12-month, and 24-month phases.

Results stratified by study arm. Rectal swabs were not introduced until the 12-month phase of the study.

Appendix 1—figure 2
Enrollment and stool sample collection profile.

Graphs depict 4-week rolling average of the number of intervention and control children enrolled/visited (solid lines) and the number of stool samples collected (including whole stool, diaper samples, and rectal swabs) during the baseline, 12-month, and 24-month phases. The overall success of stool sample collection was 78% at baseline, 86% at 12 month, and 90% at 24 month. The increase in success rate was due to the introduction of rectal swab collection during the 12-month phase.

Appendix 1—figure 3
Distribution of age (years) of enrolled children at each phase.

Results are presented as kernel density plots and stratified by study arm (intervention=blue, control=green) and phase: (a) Baseline phase, (b) 12-month follow-up, (c) 24-month follow-up, and (d) All phases combined.

Appendix 1—figure 4
Prevalence of pathogens by age at baseline, 12-month, and 24-month phases.

Results are smoothed averages stratified by study arm with 95% confidence intervals represented by shaded areas.

Appendix 1—figure 5
Schematic of communal sanitation block design from the NGO (Water and Sanitation for the Urban Poor).

Pictured: two latrine stalls, two pour-flush toilets, septic tank, elevated water storage tank, laundry basin, door. Not pictured: soakaway pit. Source: Water and Sanitation for the Urban Poor.

Appendix 1—figure 6
Construction of a soakaway pit for discharge of liquid effluent from intervention latrines.
Appendix 1—figure 7
Photo of communal sanitation block as constructed.
Appendix 1—figure 8
Photo of shared latrine as constructed.
Appendix 1—figure 9
Map illustrating locations of intervention (n=208) and control sites (n=287) compounds.

Tables

Table 1
Baseline characteristics of enrolled children, households, and compounds.
ControlIntervention
Nn (%) or mean (SD)Nn (%) or mean (SD)
Child level variables
Age at survey, days*520700 (405)441694 (403)
Sex, female520266 (51%)444227 (51%)
Child is breastfed with or without complementary feeding526169 (32%)448143 (32%)
Child is exclusively breastfed52649 (9.3%)44837 (8.3%)
Child feces reported to be disposed of in a latrine526148 (28%)448141 (31%)
Child wears diapers526342 (65%)447294 (66%)
Caregiver completed primary school528287 (54%)451239 (53%)
Child's mother is alive513503 (98%)435426 (98%)
Respondent is child's mother519368 (71%)443284 (64%)
Household level variables
Household population4415.4 (2.4)3656.1 (3.0)
Household wealth score, 0 (poorer) - 1 (wealthier)4400.45 (0.10)3650.44 (0.10)
Household crowding, >3 persons/room44054 (12%)36560 (17%)
Household floor is covered440426 (97%)365333 (91%)
Household wall made of bricks, concrete, or similar440304 (69%)365215 (59%)
Household drinking water source inside compound435324 (74%)360294 (82%)
Latrine used by household has a ceramic or masonry pedestal432153 (35%)359142 (40%)
Latrine used by household has a drop-hole cover434232 (53%)359224 (62%)
Compound level variables
Number of compound members28714 (6.2)20819 (12)
Number of households2873.8 (2.1)2084.4 (3.7)
Number of water taps in compound2830.98 (0.95)2071.4 (1.6)
Number of latrines in compound2871.0 (0.20)2071.1 (0.57)
Number of people sharing a latrine28514 (6.2)19717 (8.9)
Number of households sharing a latrine2853.7 (1.8)1974.0 (2.8)
Latrine walls made of brick, concrete or similar28272 (26%)20467 (33%)
Compound population density, persons/square meter§2810.071 (0.04)2050.087 (0.05)
Compound has electricity that normally functions287251 (87%)208189 (91%)
Compound is prone to flooding287184 (64%)208120 (58%)
Any animals observed in compound287170 (59%)208132 (63%)
Dog(s) observed28714 (4.9%)20814 (6.7%)
Chicken(s) or duck(s) observed28740 (14%)20830 (14%)
Cat(s) observed287149 (52%)208116 (56%)
  1. 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.

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

    Data collected by direct observation.

  3. §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.

Table 2
Effect of the intervention on bacterial, protozoan, viral, and STH infection and diarrhea at 12 and 24 months post-intervention.
Prevalence12-month Prevalence ratio (95% CI), p-value *24-month Prevalence ratio (95% CI), p-value
Baseline12 month24 monthUnadjustedAdjusted§UnadjustedAdjusted§
Any bacterial or protozoan infection‡
Control313/392 (80%)334/395 (85%)403/459 (88%)........
Intervention278/361 (77%)347/408 (85%)392/462 (85%)1.04 (0.94–1.15), p=0.411.04 (0.94–1.15), p=0.411.00 (0.91–1.10), p=1.00.99 (0.91–1.09), p=0.89
Any STH infection‡
Control170/360 (47%)143/283 (51%)142/253 (56%)........
Intervention138/329 (42%)150/305 (49%)136/292 (47%)1.12 (0.89–1.40), p=0.331.11 (0.89–1.38), p=0.350.94 (0.75–1.17), p=0.590.95 (0.77–1.17), p=0.62
Diarrhea‡
Control67/526 (13%)40/430 (9.3%)53/390 (14%)........
Intervention59/448 (13%)59/436 (14%)53/410 (13%)1.41 (0.80–2.48), p=0.241.69 (0.89–3.21), p=0.110.92 (0.55–1.54), p=0.760.84 (0.47–1.51), p=0.56
Any bacteria
Control271/392 (69%)285/395 (72%)345/459 (75%)........
Intervention227/361 (63%)292/408 (72%)324/462 (70%)1.09 (0.95–1.25), p=0.251.09 (0.95–1.26), p=0.201.03 (0.90–1.18), p=0.691.00 (0.87–1.15), p=0.96
Shigella
Control179/392 (46%)204/395 (52%)269/459 (59%)........
Intervention152/361 (42%)218/408 (53%)245/462 (53%)1.13 (0.91–1.39), p=0.281.12 (0.92–1.38), p=0.270.98 (0.80–1.20), p=0.860.95 (0.79–1.16), p=0.64
ETEC
Control116/392 (30%)142/395 (36%)127/459 (28%)........
Intervention110/361 (30%)143/408 (35%)126/462 (27%)0.93 (0.68–1.28), p=0.660.96 (0.69–1.33), p=0.810.95 (0.67–1.35), p=0.770.83 (0.57–1.19), p=0.31
Campylobacter
Control39/392 (9.9%)32/395 (8.1%)48/459 (10%)........
Intervention21/361 (5.8%)35/408 (8.6%)34/462 (7.4%)1.78 (0.89–3.56), p=0.101.68 (0.82–3.45), p=0.161.20 (0.60–2.39), p=0.601.28 (0.62–2.62), 0.50
C. difficile
Control22/392 (5.6%)13/395 (3.3%)13/459 (2.8%)........
Intervention13/361 (3.6%)17/408 (4.2%)11/462 (2.4%)1.95 (0.71–5.35), p=0.202.09 (0.77–5.64), p=0.151.32 (0.47–3.73), p=0.601.41 (0.46–4.30), p=0.54
E. coli O157
Control13/392 (3.3%)19/395 (4.8%)25/459 (5.5%)........
Intervention18/361 (5.0%)14/408 (3.4%)16/462 (3.5%)0.48 (0.18–1.27), p=0.140.46 (0.18–1.21), p=0.120.43 (0.15–1.29), p=0.130.52 (0.17–1.59), p=0.25
STEC
Control3/392 (0.77%)9/395 (2.3%)17/459 (3.7%)........
Intervention10/361 (2.8%)5/408 (1.2%)15/462 (3.3%)0.14 (0.03–0.67), p=0.0140.15 (0.03–0.70), p=0.0160.23 (0.05–1.03), p=0.0550.24 (0.05–1.01), p=0.052
Any protozoa
Control205/392 (52%)236/395 (60%)303/459 (66%)........
Intervention195/361 (54%)259/408 (63%)296/462 (64%)1.04 (0.87–1.24), p=0.691.03 (0.86–1.22), p=0.760.93 (0.78–1.11), p=0.400.91 (0.76–1.09), p=0.29
Giardia
Control201/392 (51%)230/395 (58%)294/459 (64%)........
Intervention186/361 (52%)251/408 (62%)289/462 (63%)1.06 (0.88–1.27), p=0.551.05 (0.88–1.25), p=0.580.96 (0.80–1.14), p=0.610.93 (0.78–1.11), p=0.44
Cryptosporidium
Control8/392 (2%)8/395 (2%)14/459 (3.0%)........
Intervention16/361 (4.4%)15/408 (3.7%)15/462 (3.3%)0.89 (0.23–3.43), p=0.870.89 (0.24–3.31), p=0.860.46 (0.11–1.93), p=0.290.53 (0.13–2.14), p=0.37
Any virus
Control53/392 (14%)52/395 (13%)59/459 (13%)........
Intervention52/361 (14%)45/408 (11%)62/462 (13%)0.77 (0.45–1.32), p=0.350.75 (0.44–1.27), p=0.290.96 (0.55–1.68), p=0.881.03 (0.57–1.86), p=0.92
Norovirus GI/GII
Control38/392 (9.7%)44/395 (11%)47/459 (10%)........
Intervention39/361 (11%)37/408 (9.1%)55/462 (12%)0.71 (0.38–1.33), p=0.280.68 (0.36–1.27), p=0.231.00 (0.52–1.93), p=0.991.10 (0.55–2.18), p=0.79
Adenovirus 40/41
Control13/392 (3.3%)9/395 (2.3%)7/459 (1.5%)........
Intervention9/361 (2.5%)9/408 (2.2%)6/462 (1.3%)1.34 (0.34–5.23), p=0.681.24 (0.32–4.83), p=0.761.18 (0.23–5.98), p=0.840.97 (0.18–5.19), p=0.97
Coinfection, ≥2 GPP pathogens
Control206/392 (53%)237/395 (60%)302/459 (66%)........
Intervention185/361 (51%)257/408 (63%)282/462 (61%)1.08 (0.90–1.29), p=0.391.08 (0.91–1.29), p=0.370.95 (0.80–1.12), p=0.540.93 (0.79–1.10), p=0.41
Trichuris
Control139/360 (39%)116/283 (41%)124/253 (49%)........
Intervention117/329 (36%)120/305 (39%)117/292 (40%)1.05 (0.82–1.35), p=0.681.01 (0.79–1.28), p=0.960.89 (0.69–1.16), p=0.400.86 (0.67–1.10), p=0.22
Ascaris
Control95/360 (26%)82/283 (29%)78/253 (31%)........
Intervention68/329 (21%)87/305 (29%)56/292 (19%)1.26 (0.87–1.82), p=0.221.33 (0.92–1.93), p=0.130.80 (0.52–1.21), p=290.83 (0.54–1.27), p=0.39
Coinfection, ≥2 STH
Control64/360 (18%)55/283 (19%)60/253 (24%)........
Intervention47/329 (14%)57/305 (19%)37/292 (13%)1.16 (0.76–1.77), p=0.501.17 (0.76–1.79), p=0.490.67 (0.40–1.13), p=0.130.63 (0.37–1.07), p=0.084
  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.

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

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

  3. §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.

Table 3
Effect of intervention on bacterial, protozoan, viral, and STH infection and reported diarrhea in children born into study sites post-intervention (post-baseline) but by 24-month visit compared with children of a similar age at baseline (<2 years old).
Prevalence (<2 years old)Prevalence ratio (95% CI), p-value
Baseline24 month, Born-inUnadjustedAdjusted
Any bacterial or protozoan infection*
Control158/228 (69%)79/106 (75%)....
Intervention129/201 (64%)71/107 (66%)0.96 (0.77–1.21), p=0.740.99 (0.80–1.22), p=0.92
Any STH infection*
Control67/205 (33%)25/68 (37%)....
Intervention52/183 (28%)13/75 (17%)0.52 (0.26–1.05), p=0.0690.51 (0.27–0.95), p=0.035
Diarrhea*
Control46/283 (16%)18/105 (17%)....
Intervention43/238 (18%)22/100 (22%)1.20 (0.57–2.5), p=0.641.37 (0.47–4.03), p=0.57
Any bacteria
Control142/228 (62%)70/106 (66%)....
Intervention102/201 (51%)51/107 (48%)0.89 (0.66–1.20), p=0.440.90 (0.67–1.19), p=0.45
Shigella
Control67/228 (29%)36/106 (34%)....
Intervention49/201 (24%)15/107 (14%)0.48 (0.28–0.83), p=0.0090.49 (0.28–0.85), p=0.011
ETEC
Control70/228 (31%)30/106 (28%)....
Intervention58/201 (29%)24/107 (22%)0.84 (0.46–1.52), p=0.560.85 (0.48–1.51), p=0.58
Campylobacter
Control27/228 (12%)14/106 (13%)....
Intervention14/201 (7%)13/107 (12%)1.75 (0.63–4.87), p=0.291.75 (0.61–4.98), p=0.30
C. difficile
Control20/228 (8.8%)7/106 (6.6%)....
Intervention13/201 (6.5%)7/107 (6.5%)1.33 (0.36–4.86), p=0.671.49 (0.41–5.44), p=0.55
E. coli O157
Control7/228 (3.1%)3/106 (2.8%)....
Intervention9/201 (4.5%)2/107 (1.9%)0.45 (0.06–3.66), p=0.460.53 (0.07–4.24), p=0.55
STEC
Control1/228 (0.44%)2/106 (1.9%)....
Intervention9/201 (4.5%)1/107 (0.93%)0.05 (0.00–1.13), p=0.0590.05 (0.00–1.26), p=0.070
Any protozoa
Control82/228 (36%)47/106 (44%)....
Intervention74/201 (37%)43/107 (40%)0.84 (0.55–1.28), p=0.420.90 (0.62–1.30), p=0.58
Giardia
Control79/228 (35%)44/106 (42%)....
Intervention68/201 (34%)41/107 (38%)0.90 (0.58–1.39), p=0.630.93 (0.64–1.36), p=0.70
Cryptosporidium
Control7/228 (3.1%)5/106 (4.7%)....
Intervention12/201 (6%)5/107 (4.7%)0.45 (0.08–2.57), p=0.370.64 (0.12–3.51), p=0.61
Any virus
Control34/228 (15%)18/106 (17%)....
Intervention36/201 (18%)18/107 (17%)0.83 (0.37–1.83), p=0.640.83 (0.37–1.87), p=0.66
Norovirus GI/GII
Control26/228 (11%)12/106 (11%)....
Intervention26/201 (13%)17/107 (16%)1.24 (0.48–3.17), p=0.661.29 (0.49–3.41), p=0.61
Adenovirus 40/41
Control7/228 (3.1%)4/106 (3.8%)....
Intervention7/201 (3.5%)0/107 (0.0%)..§..§
Coinfection, ≥2 GPP pathogens
Control92/228 (40%)52/106 (49%)....
Intervention74/201 (37%)39/107 (36%)0.82 (0.56–1.21), p=0.330.86 (0.59–1.24), p=0.41
Trichuris
Control48/205 (23%)18/68 (26%)....
Intervention41/183 (22%)5/75 (6.7%)0.25 (0.09–0.68), p=0.0060.24 (0.10–0.60), p=0.002
Ascaris
Control45/205 (22%)16/68 (24%)....
Intervention29/183 (16%)9/75 (12%)0.70 (0.30–1.64), p=0.420.68 (0.30–1.54), p=0.36
Coinfection, ≥2 STH
Control26/205 (13%)9/68 (13%)....
Intervention18/183 (9.8%)1/75 (1.3%)0.13 (0.02–1.08), p=0.0590.12 (0.01–1.02), p=0.052
  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.

  2. 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.

Table 3—source code 1

Intervention effect on children born after implementation.

https://cdn.elifesciences.org/articles/62278/elife-62278-table3-code1-v3.zip
Table 3—source data 1

Intervention effect on children born after implementation.

https://cdn.elifesciences.org/articles/62278/elife-62278-table3-data1-v3.xlsx
Appendix 1—table 1
Number and proportion of sample types collected in each arm at each phase.
Baseline12 month24 month
ControlInterventionControlInterventionControlIntervention
Whole stool377 (96%)351 (97%)361 (91%)380 (93%)307 (67%)333 (72%)
Diarrheal diaper15 (3.8%)10 (2.8%)4 (1.0%)4 (0.98%)32 (7.0%)20 (4.3%)
Rectal swab*0 (0%)0 (0%)30 (7.6%)24 (5.9%)120 (26%)109 (24%)
  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.

Appendix 1—table 2
Age stratified baseline prevalence of health outcomes.
Baseline Prevalence
1–11 months12–23 months24–48 months
Any bacterial or protozoan infection
All children108/208 (52%)179/221 (81%)277/297 (93%)
Control57/109 (52%)101/119 (85%)143/152 (94%)
Intervention51/99 (52%)78/102 (76%)134/145 (92%)
Any STH infection
All children30/185 (16%)89/203 (44%)171/277 (62%)
Control17/93 (18%)50/112 (45%)94/144 (65%)
Intervention13/92 (14%)39/91 (43%)77/133 (58%)
Diarrhea
All children37/258 (14%)52/264 (20%)36/427 (8.4%)
Control19/138 (14%)27/146 (18%)20/234 (8.6%)
Intervention18/120 (15%)25/118 (21%)16/193 (8.3%)
Any bacterial infection
All children94/208 (45%)150/221 (68%)229/297 (77%)
Intervention53/109 (49%)89/119 (75%)117/152 (77%)
All children41/99 (41%)61/102 (60%)112/145 (77%)
Shigella
All children19/208 (9.1%)97/221 (44%)192/297 (65%)
Control10/109 (9.2%)57/119 (48%)101/152 (66%)
Intervention9/99 (9.1%)40/102 (39%)91/145 (63%)
ETEC
All children47/208 (23%)81/221 (37%)90/297 (30%)
Control25/109 (23%)45/119 (38%)43/152 (28%)
Intervention22/99 (22%)36/102 (35%)47/145 (32%)
Campylobacter
All children22/208 (11%)19/221 (8.6%)16/297 (5.4%)
Control14/109 (13%)13/119 (11%)10/152 (6.6%)
Intervention8/99 (8.1%)6/102 (5.9%)6/145 (4.1%)
C. difficile
All children23/208 (11%)10/221 (4.5%)2/297 (0.67%)
Control13/109 (12%)7/119 (5.9%)2/152 (1.3%)
Intervention10/99 (10%)3/102 (2.9%)0/145 (0.0%)
E. coli o157
All children6/208 (2.9%)10/221 (4.5%)15/297 (5%)
Control4/109 (3.7%)3/119 (2.5%)6/152 (4%)
Intervention2/99 (2%)7/102 (6.9%)9/145 (6.2%)
STEC
All children3/208 (1.4%)7/221 (3.2%)3/297 (1%)
Control0/109 (0.0%)1/119 (0.84%)2/152 (1.3%)
Intervention3/99 (3%)6/102 (5.9%)1/145 (0.69%)
Y. enterocolitica
All children0/208 (0.0%)1/221 (0.45%)0/297 (0.0%)
Control0/109 (0.0%)0/119 (0.0%)0/152 (0.0%)
Intervention0/99 (0.0%)1/102 (0.98%)0/145 (0.0%)
V. cholerae
All children0/208 (0.0%)0/221 (0.0%)0/297 (0.0%)
Control0/109 (0.0%)0/119 (0.0%)0/152 (0.0%)
Intervention0/99 (0.0%)0/102 (0.0%)0/145 (0.0%)
Any Protozoa
All children36/208 (17%)120/221 (54%)223/297 (75%)
Control14/109 (13%)68/119 (57%)114/152 (75%)
Intervention22/99 (22%)52/102 (51%)109/145 (75%)
Giardia
All children28/208 (13%)119/221 (54%)219/297 (74%)
Control12/109 (11%)67/119 (56%)113/152 (74%)
Intervention16/99 (16%)52/102 (51%)106/145 (73%)
Cryptosporidium
All children10/208 (4.8%)9/221 (4.1%)5/297 (1.7%)
Control2/109 (1.8%)5/119 (4.2%)1/152 (0.66%)
Intervention8/99 (8.1%)4/102 (3.9%)4/145 (2.8%)
E. histolytica
All children1/208 (0.48%)0/221 (0.0%)3/297 (1%)
Control0/109 (0.0%)0/119 (0.0%)0/152 (0.0%)
Intervention1/99 (1%)0/102 (0.0%)3/145 (2.1%)
Any virus
All children36/208 (17%)34/221 (15%)33/297 (11%)
Control15/109 (14%)19/119 (16%)19/152 (13%)
Intervention21/99 (21%)15/102 (15%)14/145 (9.7%)
Norovirus GI/GII
All children27/208 (13%)25/221 (11%)23/297 (7.7%)
Control12/109 (11%)14/119 (12%)12/152 (7.9%)
Intervention15/99 (15%)11/102 (11%)11/145 (7.6%)
Adenovirus 40/41
All children7/208 (3.4%)7/221 (3.2%)8/297 (2.7%)
Control4/109 (3.7%)3/119 (2.5%)6/152 (4%)
Intervention3/99 (3%)4/102 (3.9%)2/145 (1.4%)
Rotavirus A
All children3/208 (1.4%)5/221 (2.3%)2/297 (0.67%)
Control0/109 (0.0%)2/119 (1.7%)1/152 (0.66%)
Intervention3/99 (3%)3/102 (2.9%)1/145 (0.69%)
Coinfection, ≥2 GPP pathogens
All children48/208 (23%)118/221 (53%)203/297 (68%)
Control23/109 (21%)69/119 (58%)104/152 (68%)
Intervention25/99 (25%)49/102 (48%)99/145 (68%)
Trichuris
All children20/185 (11%)69/203 (34%)150/277 (54%)
Control10/93 (11%)38/112 (34%)82/144 (57%)
Intervention10/92 (11%)31/91 (34%)68/133 (51%)
Ascaris
All children21/185 (11%)53/203 (26%)81/277 (29%)
Control12/93 (13%)33/112 (29%)47/144 (33%)
Intervention9/92 (9.8%)20/91 (22%)34/133 (26%)
Coinfection, ≥2 STH
All children11/185 (6%)33/203 (16%)60/277 (22%)
Control5/93 (5.4%)21/112 (19%)35/144 (24%)
Intervention6/92 (6.5%)12/91 (13%)25/133 (19%)
Number of GPP infections
All children0.94 (1.1)1.8 (1.2)1.9 (0.95)
Control0.88 (1.1)1.8 (1.1)2 (0.93)
Intervention1 (1.1)1.7 (1.3)1.9 (0.98)
Number of STH infections
All children0.23 (0.55)0.61 (0.75)0.86 (0.76)
Control0.24 (0.54)0.64 (0.78)0.9 (0.76)
Intervention0.23 (0.56)0.57 (0.72)0.8 (0.76)
  1. 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.

Appendix 1—table 3
Baseline enrollment characteristics of children with and without repeated measures at the 12-month phase.

Results are presented for all children combined and stratified by study arm.

All childrenControlIntervention
BL and 12M*BL only†Std. diff.‡BL and 12MBL onlyStd. diff.BL and 12MBL onlyStd. diff.
Outcomes
Diarrhea83/609 (14%)43/365 (12%)0.0638/310 (12%)29/216 (13%)0.0345/299 (15%)14/149 (9.4%)0.17
Any bacterial or protozoan infection376/485 (78%)215/268 (80%)0.07184/234 (79%)129/158 (82%)0.08192/251 (76%)86/110 (78%)0.04
Any GPP infection390/485 (80%)225/268 (84%)0.09188/234 (80%)135/158 (85%)0.14202/251 (80%)90/110 (82%)0.03
Any bacterial infection311/485 (64%)187/268 (70%)0.12157/234 (67%)114/158 (72%)0.11154/251 (61%)73/110 (66%)0.10
Shigella200/485 (41%)131/268 (49%)0.15101/234 (43%)78/158 (49%)0.1299/251 (39%)53/110 (48%)0.18
ETEC147/485 (30%)79/268 (29%)0.0268/234 (29%)48/158 (30%)0.0379/251 (31%)31/110 (28%)0.07
Campylobacter37/485 (7.6%)23/268 (8.6%)0.0322/234 (9.4%)17/158 (11%)0.0515/251 (6%)6/110 (5.5%)0.02
C. difficile23/485 (4.7%)12/268 (4.5%)0.0115/234 (6.4%)7/158 (4.4%)0.098/251 (3.2%)5/110 (4.5%)0.07
E. coli O15719/485 (3.9%)12/268 (4.5%)0.039/234 (3.9%)4/158 (2.5%)0.0710/251 (4%)8/110 (7.3%)0.14
STEC7/485 (1.4%)6/268 (2.2%)0.061/234 (0.43%)2/158 (1.3%)0.096/251 (2.4%)4/110 (3.6%)0.07
Any protozoan infection257/485 (53%)143/268 (53%)0.01126/234 (54%)79/158 (50%)0.08131/251 (52%)64/110 (58%)0.12
Giardia247/485 (51%)140/268 (52%)0.03122/234 (52%)79/158 (50%)0.04125/251 (50%)61/110 (55%)0.11
Cryptosporidium20/485 (4.1%)4/268 (1.5%)0.167/234 (3%)1/158 (0.63%)0.1813/251 (5.2%)3/110 (2.7%)0.13
E. histolytica2/485 (0.41%)2/268 (0.75%)0.040/234 (0.0%)0/158 (0.0%). .**2/251 (0.80%)2/110 (1.8%)0.09
Any viral infection66/485 (14%)39/268 (15%)0.0331/234 (13%)22/158 (14%)0.0235/251 (14%)17/110 (15%)0.04
Adenovirus 40/4114/485 (2.9%)8/268 (3%)0.018/234 (3.4%)5/158 (3.2%)0.016/251 (2.4%)3/110 (2.7%)0.02
Norovirus GI/GII50/485 (10%)27/268 (10%)0.0123/234 (9.8%)15/158 (9.5%)0.0127/251 (11%)12/110 (11%)0.00
Rotavirus A5/485 (1%)5/268 (1.9%)0.071/234 (0.43%)2/158 (1.3%)0.094/251 (1.6%)3/110 (2.7%)0.08
Coinfection, ≥2 GPP infections251/485 (52%)140/268 (52%)0.01126/234 (54%)80/158 (51%)0.06125/251 (50%)60/110 (55%)0.10
Any STH infection202/447 (45%)106/242 (44%)0.03106/218 (49%)64/142 (45%)0.0796/229 (42%)42/100 (42%)0.00
Ascaris109/447 (24%)54/242 (22%)0.0565/218 (30%)30/142 (21%)0.2044/229 (19%)24/100 (24%)0.12
Trichuris170/447 (38%)86/242 (36%)0.0585/218 (39%)54/142 (38%)0.0285/229 (37%)32/100 (32%)0.11
Coinfection,≥2 STH infections77/447 (17%)34/242 (14%)0.0944/218 (20%)20/142 (14%)0.1633/229 (14%)14/100 (14%)0.01
Number of GPP infections1.6 (1.1)1.7 (1.1)0.071.6 (1.1)1.6 (1.1)0.021.6 (1.1)1.7 (1.2)0.14
Number of STH infections0.64 (0.77)0.58 (0.73)0.080.7 (0.79)0.59 (0.73)0.140.59 (0.75)0.57 (0.73)0.03
Child-, household-, compound-level characteristics
Child sex, female319/614 (52%)174/350 (50%)0.04169/312 (54%)97/208 (47%)0.15150/302 (50%)77/142 (54%)0.09
Child breastfed206/609 (34%)106/365 (29%)0.10107/310 (35%)62/216 (29%)0.1399/299 (33%)44/149 (30%)0.08
Child exclusively breastfed51/609 (8.4%)35/365 (9.6%)0.0427/310 (8.7%)22/216 (10%)0.0524/299 (8%)13/149 (8.7%)0.03
Child age at survey, days697 (409)697 (396)0.00698 (409)703 (400)0.01696 (409)689 (391)0.02
Child age at sampling, days668 (399)656 (382)0.03661 (397)655 (395)0.02674 (402)657 (364)0.04
Child wears diapers402/609 (66%)234/364 (64%)0.04209/310 (67%)133/216 (62%)0.12193/299 (65%)101/148 (68%)0.08
Child feces disposed in latrine173/609 (28%)116/365 (32%)0.0779/310 (25%)69/216 (32%)0.1494/299 (31%)47/149 (32%)0.00
Caregiver completed primary school333/614 (54%)193/365 (53%)0.03163/312 (52%)124/216 (57%)0.10170/302 (56%)69/149 (46%)0.20
Mother alive576/590 (98%)353/358 (99%)0.07295/301 (98%)208/212 (98%)0.01281/289 (97%)145/146 (99%)0.16
Respondent is child's mother414/605 (68%)238/357 (67%)0.04222/307 (72%)146/212 (69%)0.08192/298 (64%)92/145 (63%)0.02
Household floors covered575/615 (94%)349/368 (95%)0.06300/313 (96%)211/217 (97%)0.08275/302 (91%)138/151 (91%)0.01
Household walls made of sturdy material399/615 (65%)243/368 (66%)0.02216/313 (69%)154/217 (71%)0.04183/302 (61%)89/151 (59%)0.03
Latrine has drop-hole359/604 (59%)193/364 (53%)0.13169/307 (55%)109/214 (51%)0.08190/297 (64%)84/150 (56%)0.16
Latrine has vent-pipe93/605 (15%)44/364 (12%)0.1021/308 (6.8%)12/214 (5.6%)0.0572/297 (24%)32/150 (21%)0.07
Latrine has ceramic or concrete slab or pedestal224/602 (37%)133/363 (37%)0.01101/305 (33%)80/213 (38%)0.09123/297 (41%)53/150 (35%)0.13
Latrine has sturdy walls193/605 (32%)110/363 (30%)0.0384/306 (27%)58/215 (27%)0.01109/299 (36%)52/148 (35%)0.03
Water tap on compound grounds468/606 (77%)285/364 (78%)0.03224/308 (73%)162/214 (76%)0.07244/298 (82%)123/150 (82%)0.00
Household crowding,≥3 persons/room122/615 (20%)45/368 (12%)0.2155/313 (18%)22/217 (10%)0.2267/302 (22%)23/151 (15%)0.18
Compound electricity normally functions556/615 (90%)331/372 (89%)0.05272/313 (87%)195/220 (89%)0.05284/302 (94%)136/152 (89%)0.17
Standing water observed in compound44/605 (7.3%)26/363 (7.2%)0.007/306 (2.3%)7/215 (3.3%)0.0637/299 (12%)19/148 (13%)0.01
Leaking or standing wastewater observed in compound371/605 (61%)233/363 (64%)0.06214/306 (70%)149/215 (69%)0.01157/299 (53%)84/148 (57%)0.09
Any animal observed395/615 (64%)226/372 (61%)0.07189/313 (60%)129/220 (59%)0.04206/302 (68%)97/152 (64%)0.09
Dog observed51/615 (8.3%)23/372 (6.2%)0.0818/313 (5.8%)10/220 (4.5%)0.0533/302 (11%)13/152 (8.6%)0.08
Chicken or duck observed94/615 (15%)36/372 (9.7%)0.1743/313 (14%)27/220 (12%)0.0451/302 (17%)9/152 (5.9%)0.35
Cat observed341/615 (55%)205/372 (55%)0.01167/313 (53%)120/220 (55%)0.02174/302 (58%)85/152 (56%)0.03
Faeces or used diapers observed around compound276/605 (46%)177/363 (49%)0.06166/306 (54%)116/215 (54%)0.01110/299 (37%)61/148 (41%)0.09
Compound floods during rain377/615 (61%)226/372 (61%)0.01211/313 (67%)137/220 (62%)0.11166/302 (55%)89/152 (59%)0.07
Number of household members6.4 (3.3)5.6 (2.6)0.276 (3)5.2 (2.1)0.336.8 (3.5)6.3 (3.1)0.18
Household wealth score, 0–10.43 (0.1)0.44 (0.099)0.100.44 (0.1)0.45 (0.097)0.150.43 (0.1)0.43 (0.1)0.01
Number of households in compound5.2 (4.6)4.7 (4.4)0.114.4 (2.9)3.8 (1.7)0.216.1 (5.6)6 (6.4)0.02
Compound population21 (15)19 (14)0.1817 (8.1)15 (6.1)0.2226 (18)24 (20)0.11
Number of water taps in compound1.5 (2.2)1.2 (1)0.221 (1.1)0.97 (0.83)0.042.1 (2.8)1.4 (1.2)0.30
Number of latrines/drop-holes in compound1.1 (0.63)1.1 (0.65)0.001 (0.24)1 (0.2)0.041.2 (0.86)1.3 (0.97)0.03
Compound population density0.084 (0.046)0.078 (0.045)0.130.076 (0.04)0.07 (0.039)0.140.092 (0.051)0.089 (0.05)0.06
  1. 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.

  2. 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.

  3. § Could not be calculated.

Appendix 1—table 4
Baseline enrollment characteristics of children with and without repeated measures at the 24-month phase.

Results are presented for all children combined and stratified by study arm.

All childrenControlIntervention
BL and 24M*BL onlyStd. Diff.BL and 24MBL onlyStd. Diff.BL and 24MBL onlyStd. Diff.
Outcomes
Diarrhea75/504 (15%)51/470 (11%)0.1235/244 (14%)32/282 (11%)0.0940/260 (15%)19/188 (10%)0.16
Any bacterial or protozoan infection310/394 (79%)281/359 (78%)0.01144/183 (79%)169/209 (81%)0.05166/211 (79%)112/150 (75%)0.09
Any GPP infection322/394 (82%)293/359 (82%)0.00148/183 (81%)175/209 (84%)0.07174/211 (82%)118/150 (79%)0.10
Any bacterial infection251/394 (64%)247/359 (69%)0.11120/183 (66%)151/209 (72%)0.14131/211 (62%)96/150 (64%)0.04
Shigella158/394 (40%)173/359 (48%)0.1674/183 (40%)105/209 (50%)0.2084/211 (40%)68/150 (45%)0.11
ETEC115/394 (29%)111/359 (31%)0.0453/183 (29%)63/209 (30%)0.0362/211 (29%)48/150 (32%)0.06
Campylobacter31/394 (7.9%)29/359 (8.1%)0.0118/183 (9.8%)21/209 (10%)0.0113/211 (6.2%)8/150 (5.3%)0.04
C. difficile18/394 (4.6%)17/359 (4.7%)0.0110/183 (5.5%)12/209 (5.7%)0.018/211 (3.8%)5/150 (3.3%)0.02
E. coli O15717/394 (4.3%)14/359 (3.9%)0.027/183 (3.8%)6/209 (2.9%)0.0510/211 (4.7%)8/150 (5.3%)0.03
STEC6/394 (1.5%)7/359 (1.9%)0.032/183 (1.1%)1/209 (0.48%)0.074/211 (1.9%)6/150 (4%)0.12
Any protozoan infection214/394 (54%)186/359 (52%)0.0596/183 (52%)109/209 (52%)0.01118/211 (56%)77/150 (51%)0.09
Giardia204/394 (52%)183/359 (51%)0.0292/183 (50%)109/209 (52%)0.04112/211 (53%)74/150 (49%)0.08
Cryptosporidium20/394 (5.1%)4/359 (1.1%)0.237/183 (3.8%)1/209 (0.48%)0.2313/211 (6.2%)3/150 (2%)0.21
E. histolytica2/394 (0.51%)2/359 (0.56%)0.010/183 (0.0%)0/209 (0.0%)..§2/211 (0.95%)2/150 (1.3%)0.04
Any viral infection55/394 (14%)50/359 (14%)0.0022/183 (12%)31/209 (15%)0.0833/211 (16%)19/150 (13%)0.09
Adenovirus 40/4114/394 (3.5%)8/359 (2.2%)0.087/183 (3.8%)6/209 (2.9%)0.057/211 (3.3%)2/150 (1.3%)0.13
Norovirus GI/GII42/394 (11%)35/359 (9.8%)0.0315/183 (8.2%)23/209 (11%)0.1027/211 (13%)12/150 (8%)0.16
Rotavirus A3/394 (0.76%)7/359 (1.9%)0.101/183 (0.55%)2/209 (0.96%)0.052/211 (0.95%)5/150 (3.3%)0.17
Coinfection,≥2 GPP infections206/394 (52%)185/359 (52%)0.0297/183 (53%)109/209 (52%)0.02109/211 (52%)76/150 (51%)0.02
Any STH infection156/362 (43%)152/327 (46%)0.0780/171 (47%)90/189 (48%)0.0276/191 (40%)62/138 (45%)0.10
Ascaris85/362 (23%)78/327 (24%)0.0150/171 (29%)45/189 (24%)0.1235/191 (18%)33/138 (24%)0.14
Trichuris128/362 (35%)128/327 (39%)0.0863/171 (37%)76/189 (40%)0.0765/191 (34%)52/138 (38%)0.08
Coinfection,≥2 STH infections57/362 (16%)54/327 (17%)0.0233/171 (19%)31/189 (16%)0.0824/191 (13%)23/138 (17%)0.12
Number of GPP infections1.6 (1.1)1.6 (1.2)0.041.6 (1.1)1.7 (1.1)0.101.6 (1.1)1.6 (1.2)0.01
Number of STH infections0.61 (0.75)0.64 (0.76)0.040.67 (0.78)0.65 (0.75)0.030.55 (0.72)0.63 (0.77)0.10
Child-, household-, compound-level characteristics
Child sex, female260/503 (52%)233/461 (51%)0.02124/241 (51%)142/279 (51%)0.01136/262 (52%)91/182 (50%)0.04
Child breastfed172/504 (34%)140/470 (30%)0.0987/244 (36%)82/282 (29%)0.1485/260 (33%)58/188 (31%)0.04
Child exclusively breastfed35/504 (6.9%)51/470 (11%)0.1419/244 (7.8%)30/282 (11%)0.1016/260 (6.2%)21/188 (11%)0.18
Child age at survey, days698 (403)696 (405)0.01689 (400)709 (410)0.05707 (406)675 (398)0.08
Child age at sampling, days675 (406)651 (379)0.06666 (403)652 (390)0.04682 (409)650 (364)0.08
Child wears diapers343/504 (68%)293/469 (62%)0.12171/244 (70%)171/282 (61%)0.20172/260 (66%)122/187 (65%)0.02
Child feces disposed in latrine138/504 (27%)151/470 (32%)0.1057/244 (23%)91/282 (32%)0.2081/260 (31%)60/188 (32%)0.02
Caregiver completed primary school274/507 (54%)252/472 (53%)0.01131/245 (53%)156/283 (55%)0.03143/262 (55%)96/189 (51%)0.08
Mother alive474/486 (98%)455/462 (98%)0.07232/236 (98%)271/277 (98%)0.03242/250 (97%)184/185 (99%)0.20
Respondent is child's mother337/500 (67%)315/462 (68%)0.02173/241 (72%)195/278 (70%)0.04164/259 (63%)120/184 (65%)0.04
Household floors covered469/507 (93%)455/476 (96%)0.13233/245 (95%)278/285 (98%)0.13236/262 (90%)177/191 (93%)0.09
Household walls made of sturdy material337/507 (66%)305/476 (64%)0.05184/245 (75%)186/285 (65%)0.22153/262 (58%)119/191 (62%)0.08
Latrine has drop-hole294/497 (59%)258/471 (55%)0.09133/239 (56%)145/282 (51%)0.08161/258 (62%)113/189 (60%)0.05
Latrine has vent-pipe80/497 (16%)57/472 (12%)0.1218/239 (7.5%)15/283 (5.3%)0.0962/258 (24%)42/189 (22%)0.04
Latrine has ceramic or concrete slab or pedestal184/494 (37%)173/471 (37%)0.0177/236 (33%)104/282 (37%)0.09107/258 (41%)69/189 (37%)0.10
Latrine has sturdy walls165/501 (33%)138/467 (30%)0.0767/240 (28%)75/281 (27%)0.0398/261 (38%)63/186 (34%)0.08
Water tap on compound grounds389/498 (78%)364/472 (77%)0.02171/239 (72%)215/283 (76%)0.10218/259 (84%)149/189 (79%)0.14
Household crowding,≥3 persons/room114/507 (22%)53/476 (11%)0.3145/245 (18%)32/285 (11%)0.2069/262 (26%)21/191 (11%)0.40
Compound electricity normally functions454/507 (90%)433/480 (90%)0.02214/245 (87%)253/288 (88%)0.02240/262 (92%)180/192 (94%)0.08
Standing water observed in compound39/501 (7.8%)31/467 (6.6%)0.047/240 (2.9%)7/281 (2.5%)0.0332/261 (12%)24/186 (13%)0.02
Leaking or standing wastewater observed in compound308/501 (61%)296/467 (63%)0.04164/240 (68%)199/281 (71%)0.05144/261 (55%)97/186 (52%)0.06
Any animal observed337/507 (66%)284/480 (59%)0.15156/245 (64%)162/288 (56%)0.15181/262 (69%)122/192 (64%)0.12
Dog observed49/507 (9.7%)25/480 (5.2%)0.1717/245 (6.9%)11/288 (3.8%)0.1432/262 (12%)14/192 (7.3%)0.17
Chicken or duck observed71/507 (14%)59/480 (12%)0.0532/245 (13%)38/288 (13%)0.0039/262 (15%)21/192 (11%)0.12
Cat observed294/507 (58%)252/480 (53%)0.11143/245 (58%)144/288 (50%)0.17151/262 (58%)108/192 (56%)0.03
Feces or used diapers observed around compound218/501 (44%)235/467 (50%)0.14120/240 (50%)162/281 (58%)0.1598/261 (38%)73/186 (39%)0.03
Compound floods during rain310/507 (61%)293/480 (61%)0.00166/245 (68%)182/288 (63%)0.10144/262 (55%)111/192 (58%)0.06
Number of household members6.7 (3.4)5.5 (2.6)0.396.3 (3)5.2 (2.2)0.427.1 (3.6)6.1 (3)0.31
Household wealth score, 0–10.43 (0.11)0.44 (0.097)0.120.44 (0.1)0.45 (0.095)0.100.42 (0.11)0.43 (0.1)0.11
Number of households in compound5.3 (4.7)4.7 (4.3)0.134.4 (3.1)3.9 (1.8)0.216.1 (5.7)5.9 (6.2)0.03
Compound population22 (15)18 (14)0.2617 (8.1)15 (6.5)0.2727 (18)23 (19)0.18
Number of water taps in compound1.6 (2.2)1.2 (1.3)0.241 (1)0.99 (0.92)0.022.2 (2.8)1.4 (1.8)0.31
Number of latrines in compound1.1 (0.62)1.1 (0.65)0.011 (0.25)1 (0.19)0.041.2 (0.82)1.3 (0.99)0.08
Compound population density0.084 (0.049)0.079 (0.042)0.130.072 (0.038)0.075 (0.04)0.050.096 (0.055)0.084 (0.044)0.23
  1. 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.

  2. 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.

  3. §Could not be calculated.

Appendix 1—table 5
Balance of characteristics measured at 12-month visits between children with repeat observations at baseline and 12-month and children with observations at the 12-month phase only.
All ChildrenControlIntervention
BL and 12M*12M onlyStd. Diff.BL and 12M12M onlyStd. Diff.BL and 12M12M onlyStd. Diff.Std. Diff. Control v. Interv.§
Child sex, female319/614 (52%)156/313 (50%)0.04169/312 (54%)73/155 (47%)0.14150/302 (50%)83/158 (53%)0.060.11
Child breastfed27/562 (4.8%)161/305 (53%)1.2513/280 (4.6%)76/151 (50%)1.1914/282 (5%)85/154 (55%)1.310.10
Child exclusively breastfed3/562 (0.53%)38/305 (12%)0.502/280 (0.71%)16/151 (11%)0.441/282 (0.35%)22/154 (14%)0.560.11
Caregiver completed primary school305/614 (50%)144/309 (47%)0.06156/312 (50%)62/153 (41%)0.19149/302 (49%)82/156 (53%)0.060.24
Child wears diapers83/563 (15%)194/305 (64%)1.1640/281 (14%)92/151 (61%)1.1043/282 (15%)102/154 (66%)1.210.11
Respondent is child's mother365/563 (65%)236/305 (77%)0.28188/281 (67%)121/151 (80%)0.30177/282 (63%)115/154 (75%)0.260.13
Household floors covered584/615 (95%)305/321 (95%)0.00299/313 (96%)155/163 (95%)0.02285/302 (94%)150/158 (95%)0.030.01
Household walls made of sturdy material398/615 (65%)189/321 (59%)0.12212/313 (68%)101/163 (62%)0.12186/302 (62%)88/158 (56%)0.120.13
Household crowding,≥3 persons/room210/615 (34%)106/321 (33%)0.02111/313 (35%)54/163 (33%)0.0599/302 (33%)52/158 (33%)0.000.00
Compound electricity normally functions575/615 (94%)304/324 (94%)0.01286/313 (91%)152/164 (93%)0.05289/302 (96%)152/160 (95%)0.030.10
Any animal observed505/611 (83%)275/324 (85%)0.06235/309 (76%)131/164 (80%)0.09270/302 (89%)144/160 (90%)0.020.29
Dog observed134/611 (22%)81/324 (25%)0.0757/309 (18%)37/164 (23%)0.1077/302 (26%)44/160 (28%)0.050.11
Chicken or duck observed77/611 (13%)42/324 (13%)0.0134/309 (11%)18/164 (11%)0.0043/302 (14%)24/160 (15%)0.020.12
Cat observed469/611 (77%)249/324 (77%)0.00218/309 (71%)118/164 (72%)0.03251/302 (83%)131/160 (82%)0.030.24
Compound floods during rain220/615 (36%)119/324 (37%)0.02132/313 (42%)64/164 (39%)0.0688/302 (29%)55/160 (34%)0.110.10
Child age at survey, days1114 (415)622 (502)1.071105 (413)684 (535)0.881122 (417)560 (461)1.280.25
Child age at sampling, days1102 (417)605 (484)1.101080 (414)649 (516)0.921122 (420)563 (450)1.290.18
Number of household members6.5 (3.2)6.3 (3.3)0.066.2 (3)6.4 (3.5)0.056.8 (3.3)6.2 (3.2)0.170.05
Household wealth score, 0–10.4 (0.11)0.39 (0.11)0.020.4 (0.11)0.39 (0.11)0.120.39 (0.1)0.4 (0.1)0.100.11
Number of households in compound5.2 (4.7)5.4 (5.5)0.044.2 (2.9)4 (2.3)0.096.3 (5.9)6.9 (7.3)0.090.53
Compound population23 (22)24 (26)0.0418 (9.7)18 (8.7)0.0528 (29)30 (35)0.070.50
Compound population density0.086 (0.049)0.084 (0.051)0.040.08 (0.043)0.078 (0.044)0.050.091 (0.054)0.089 (0.058)0.030.22
  1. 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.

  2. 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.

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

Appendix 1—table 6
Balance of characteristics measured at 24-month visits between children with repeat observations at baseline and 24-month and children with observations at the 24-month phase only.
All ChildrenControlIntervention
BL and 24M*24M onlyStd. Diff.BL and 24M24M onlyStd. Diff.BL and 24M24M onlyStd. Diff.Std. Diff. Control v. Interv.§
Child sex, female260/503 (52%)190/428 (44%)0.15124/241 (51%)96/222 (43%)0.16136/262 (52%)94/206 (46%)0.130.05
Child breastfed0/418 (0.0%)129/381 (34%)1.010/195 (0.0%)68/194 (35%)1.040/223 (0.0%)61/187 (33%)0.980.05
Child exclusively breastfed0/418 (0.0%)36/381 (9.4%)0.460/195 (0.0%)16/194 (8.3%)0.420/223 (0.0%)20/187 (11%)0.490.08
Caregiver completed primary school199/507 (39%)164/427 (38%)0.0288/245 (36%)82/221 (37%)0.02111/262 (42%)82/206 (40%)0.050.06
Child wears diapers3/419 (0.72%)196/381 (51%)1.421/196 (0.51%)101/194 (52%)1.442/223 (0.9%)95/187 (51%)1.390.03
Respondent is child's mother259/419 (62%)298/381 (78%)0.36129/196 (66%)161/194 (83%)0.40130/223 (58%)137/187 (73%)0.320.24
Household floors covered484/507 (95%)459/467 (98%)0.16237/245 (97%)234/239 (98%)0.07247/262 (94%)225/228 (99%)0.240.06
Household walls made of sturdy material352/507 (69%)296/467 (63%)0.13180/245 (73%)157/239 (66%)0.17172/262 (66%)139/228 (61%)0.100.10
Household crowding,≥3 persons/room137/507 (27%)108/467 (23%)0.0974/245 (30%)66/239 (28%)0.0663/262 (24%)42/228 (18%)0.140.22
Compound electricity normally functions485/507 (96%)472/494 (96%)0.01230/245 (94%)237/254 (93%)0.02255/262 (97%)235/240 (98%)0.040.23
Any animal observed384/507 (76%)359/494 (73%)0.07162/245 (66%)182/254 (72%)0.12222/262 (85%)177/240 (74%)0.270.05
Dog observed70/507 (14%)78/494 (16%)0.0630/245 (12%)40/254 (16%)0.1040/262 (15%)38/240 (16%)0.020.00
Chicken or duck observed63/507 (12%)52/494 (11%)0.0622/245 (9%)32/254 (13%)0.1241/262 (16%)20/240 (8.3%)0.230.14
Cat observed360/507 (71%)340/494 (69%)0.05154/245 (63%)174/254 (69%)0.12206/262 (79%)166/240 (69%)0.220.01
Compound floods during rain182/507 (36%)184/494 (37%)0.0389/245 (36%)107/254 (42%)0.1293/262 (36%)77/240 (32%)0.070.21
Child age at survey, days1518 (407)740 (518)1.671520 (406)749 (541)1.611516 (408)731 (494)1.730.04
Child age at sampling, days1510 (415)694 (478)1.821505 (408)716 (512)1.701516 (422)672 (439)1.960.09
Number of household members6.6 (3.1)6.3 (3.4)0.106.5 (3)6.6 (3.8)0.046.7 (3.1)6 (2.8)0.260.20
Household wealth score, 0–10.41 (0.11)0.41 (0.11)0.010.41 (0.12)0.4 (0.11)0.110.41 (0.1)0.42 (0.097)0.150.19
Number of households in compound5.3 (4.9)5.5 (5.5)0.044.3 (2.8)4.4 (3.2)0.036.2 (6.1)6.6 (6.9)0.060.41
Compound population21 (15)21 (16)0.0418 (9.5)17 (8.9)0.0725 (19)25 (21)0.000.47
Compound population density0.08 (0.047)0.08 (0.047)0.010.074 (0.037)0.075 (0.042)0.030.087 (0.053)0.085 (0.052)0.030.22
  1. 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.

  2. 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.

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

Appendix 1—table 7
Sensitivity analysis assessing the impact of reported deworming on STH effect estimates 12 and 24 months after the intervention.
12-month Prevalence ratio24-month Prevalence ratio
Main analysis, all children*Adjusted for reported deworming †Restricted to children dewormed at baseline ‡Main analysis, all children*Adjusted for reported deworming †Adjusted for time since deworming§
n = 1239n = 1239n = 1031n = 1161n = 1161N = 1159
Any STH infection1.11 (0.89–1.38)1.09 (0.87–1.35)1.06 (0.84–1.33)0.95 (0.77–1.17)0.93 (0.77–1.16)0.93 (0.75–1.14)
Trichuris1.01 (0.79–1.28)0.98 (0.77–1.24)0.96 (0.74–1.23)0.86 (0.67–1.10)0.85 (0.66–1.08)0.86 (0.67–1.09)
Ascaris1.33 (0.92–1.93)1.30 (0.90–1.88)1.30 (0.87–1.94)0.83 (0.54–1.27)0.84 (0.55–1.29)0.78 (0.51–1.18)
Coinfection,≥2 STH1.17 (0.76–1.79)1.12 (0.73–1.71)1.16 (0.73–1.85)0.63 (0.37–1.07)0.63 (0.37–1.08)0.60 (0.35–1.03)
  1. 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.

  2. †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.

  3. § 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.

Appendix 1—table 8
Sensitivity analysis assessing impact of independent upgrading of control sanitation facilities on effect estimates.
12-month adjusted prevalence ratio24 month adjusted prevalence ratio
Main analysis, all children*Excluding controls with upgraded sanitation†Main analysis, all children*Excluding controls with upgraded sanitation†
Any bacterial or protozoan infection1.04 (0.94–1.15), n = 15101.05 (0.95–1.16), n = 14910.99 (0.91–1.09), n = 15361.00 (0.91–1.10), n = 1502
Any STH infection1.11 (0.89–1.38), n = 12391.11 (0.89–1.38), n = 12250.95 (0.77–1.17), n = 11610.94 (0.76–1.16), n = 1148
Diarrhea1.69 (0.89–3.21), n = 15941.76 (0.91–3.39), n = 15750.84 (0.47–1.51), n = 15020.81 (0.45–1.48), n = 1471
  1. 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).

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

Appendix 1—table 9
Confounding assessment for primary outcome and both secondary outcomes (any STH, diarrhea) at 12 months.
n/N (%) or mean (SD) at BaselineStd diff.*Primary outcome UnadjustedPrimary outcome AdjustedAny STH UnadjustedAny STH AdjustedDiarrhea UnadjustedDiarrhea Adjusted
VariableControlInter-vention.Comparator PR: 1.04 (0.94–1.15)Comparator aPR: 1.04 (0.94–1.15)Comparator PR: 1.12 (0.89–1.40)Comparator aPR: 1.11 (0.90–1.38)Comparator PR: 1.41 (0.80–2.48)Comparator aPR: 1.32 (0.75–2.33)
Female266/520 (51%)227/444 (51%)0.001.04 (0.94–1.15)1.04 (0.94–1.15)1.14 (0.91–1.42)1.11 (0.89–1.38)1.39 (0.79–2.46)1.32 (0.75–2.33)
Any breastfeeding169/526 (32%)143/448 (32%)0.001.05 (0.95–1.15)1.05 (0.95–1.15)1.11 (0.90–1.38)1.11 (0.90–1.38)1.39 (0.79–2.45)1.33 (0.75–2.35)
Caregiver completed primary school287/528 (54%)239/451 (53%)0.031.04 (0.94–1.15)1.04 (0.94–1.15)1.12 (0.90–1.41)1.11 (0.89–1.38)1.40 (0.80–2.48)1.32 (0.75–2.33)
Respondent is mother368/519 (71%)284/443 (64%)0.151.05 (0.95–1.16)1.04 (0.94–1.15)1.13 (0.90–1.42)1.11 (0.89–1.38)1.37 (0.78–2.42)1.29 (0.73–2.28)
Household floors covered511/530 (96%)413/453 (91%)0.221.04 (0.94–1.15)1.04 (0.94–1.15)1.12 (0.89–1.40)1.12 (0.90–1.39)1.39 (0.79–2.47)1.32 (0.74–2.34)
Household walls made of sturdy material370/530 (70%)272/453 (60%)0.211.04 (0.94–1.15)1.04 (0.94–1.15)1.12 (0.89–1.40)1.11 (0.89–1.38)1.41 (0.80–2.48)1.32 (0.75–2.33)
Drinking water source in compound386/522 (74%)367/448 (82%)0.191.03 (0.93–1.15)1.03 (0.93–1.14)1.08 (0.85–1.36)1.05 (0.83–1.33)1.65 (0.89–3.06)1.59 (0.85–2.95)
Faeces visible around compound grounds282/521 (54%)171/447 (38%)0.321.03 (0.93–1.13)1.03 (0.93–1.13)1.14 (0.91–1.43)1.12 (0.90–1.40)1.43 (0.81–2.54)1.35 (0.76–2.40)
Compound floods when it rains348/533 (65%)255/454 (56%)0.191.04 (0.94–1.15)1.04 (0.94–1.15)1.12 (0.89–1.40)1.11 (0.89–1.38)1.41 (0.80–2.49)1.32 (0.74–2.33)
Latrine drop-hole has cover278/521 (53%)274/447 (61%)0.161.04 (0.94–1.15)1.03 (0.93–1.15)1.11 (0.88–1.40)1.08 (0.85–1.36)1.74 (0.92–3.30)1.69 (0.89–3.20)
Latrine has ceramic/concrete slab or pedestal181/518 (35%)176/447 (39%)0.091.04 (0.94–1.15)1.04 (0.93–1.15)1.10 (0.87–1.39)1.07 (0.85–1.35)1.71 (0.90–3.24)1.65 (0.87–3.14)
Latrine walls made of sturdy material142/521 (27%)161/447 (36%)0.191.03 (0.93–1.14)1.03 (0.93–1.13)1.14 (0.91–1.43)1.12 (0.90–1.40)1.42 (0.80–2.51)1.33 (0.75–2.37)
Standing water observed around compound14/521 (2.7%)56/447 (13%)0.381.03 (0.93–1.14)1.03 (0.93–1.13)1.14 (0.91–1.42)1.12 (0.90–1.39)1.42 (0.80–2.51)1.34 (0.75–2.38)
Leaking or standing wastewater observed around grounds363/521 (70%)241/447 (54%)0.331.03 (0.93–1.14)1.03 (0.93–1.13)1.14 (0.91–1.43)1.12 (0.90–1.40)1.42 (0.80–2.51)1.34 (0.75–2.38)
Compound has electricity that normally functions467/533 (88%)420/454 (93%)0.161.04 (0.94–1.15)1.04 (0.94–1.15)1.11 (0.89–1.39)1.11 (0.89–1.38)1.41 (0.80–2.48)1.32 (0.75–2.34)
Any animal observed in compound318/533 (60%)303/454 (67%)0.151.04 (0.95–1.15)1.04 (0.95–1.15)1.13 (0.91–1.41)1.13 (0.91–1.40)1.39 (0.79–2.44)1.29 (0.73–2.28)
Dog observed28/533 (5.3%)46/454 (10%)0.181.05 (0.95–1.15)1.04 (0.95–1.15)1.13 (0.90–1.41)1.12 (0.90–1.39)1.38 (0.79–2.40)1.30 (0.75–2.27)
Chicken or duck observed70/533 (13%)60/454 (13%)0.001.05 (0.95–1.15)1.05 (0.95–1.16)1.12 (0.90–1.41)1.12 (0.90–1.40)1.37 (0.78–2.40)1.27 (0.72–2.23)
Cat observed287/533 (54%)259/454 (57%)0.061.05 (0.95–1.16)1.04 (0.95–1.15)1.14 (0.91–1.42)1.13 (0.91–1.41)1.39 (0.79–2.45)1.30 (0.74–2.29)
Compound density, terciles0.401.05 (0.95–1.16)1.05 (0.95–1.16)1.10 (0.88–1.38)1.10 (0.89–1.38)1.43 (0.81–2.50)1.32 (0.75–2.33)
0 (least dense)199/519 (38%)120/447 (27%)..............
1191/519 (37%)137/447 (31%)..............
2 (most dense)129/519 (25%)190/447 (43%)..............
Child age at survey, days700 (405)694 (403)0.02........1.33 (0.76–2.34)1.32 (0.75–2.33)
Child age at sample, days659 (396)669 (391)0.031.04 (0.94–1.14)1.04 (0.94–1.15)1.09 (0.88–1.36)1.11 (0.89–1.38)--
Cumulative monthly rainfall at survey, mm22 (23)23 (24)0.07........1.39 (0.79–2.44)1.30 (0.74–2.29)
Cumulative monthly rainfall at sample, mm25 (30)32 (38)0.191.04 (0.94–1.15)1.04 (0.95–1.15)1.13 (0.90–1.41)1.13 (0.91–1.40)....
Survey collected during rainy season155/526 (29%)222/448 (50%)0.42........1.44 (0.81–2.54)1.34 (0.76–2.38)
Sample collected during rainy season136/409 (33%)183/370 (49%)0.331.05 (0.95–1.16)1.05 (0.95–1.16)1.12 (0.90–1.40)1.12 (0.90–1.39)....
Wealth score0.44 (0.1)0.43 (0.1)0.161.04 (0.94–1.15)1.04 (0.94–1.15)1.12 (0.90–1.40)1.11 (0.89–1.38)1.39 (0.79–2.46)1.32 (0.75–2.33)
Number of household residents5.7 (2.7)6.6 (3.4)0.321.04 (0.94–1.15)1.04 (0.94–1.15)1.13 (0.90–1.41)1.12 (0.90–1.39)1.38 (0.78–2.44)1.31 (0.74–2.31)
Number of Compound residents16 (7.3)25 (19)0.641.04 (0.94–1.15)1.04 (0.94–1.15)1.10 (0.88–1.37)1.09 (0.88–1.35)1.39 (0.79–2.45)1.31 (0.74–2.32)
Number of households in compound4.1 (2.5)6.1 (5.9)0.421.04 (0.94–1.15)1.04 (0.94–1.15)1.11 (0.89–1.37)1.09 (0.88–1.36)1.40 (0.79–2.46)1.31 (0.74–2.32)
Number of compound latrines1.0 (0.22)1.2 (0.9)0.331.04 (0.94–1.15)1.04 (0.94–1.15)1.13 (0.91–1.40)1.12 (0.90–1.39)1.40 (0.79–2.47)1.33 (0.75–2.35)
Number of compound waterpoints0.99 (0.98)1.9 (2.4)0.471.03 (0.93–1.14)1.03 (0.93–1.14)1.13 (0.91–1.42)1.12 (0.90–1.39)1.45 (0.82–2.56)1.37 (0.77–2.43)
  1. *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).

Appendix 1—table 10
Effect estimates (prevalence ratios) for main analyses and all sub-group analyses adjusted for a priori covariates and age-squared.
Main analysis, all children†Sub-group analysis, children born after intervention*Sub-group analysis, children with repeated (longitudinal) measurements†Age stratified, children aged > 24 months old‡
12 month24 month12 month24 month12 month24 month24 month
Any bacterial or protozoan infection1.05 (0.96–1.15), p=0.291.00 (0.92–1.09), p=0.970.95 (0.64–1.42), p=0.810.97 (0.79–1.18), p=0.731.02 (0.91–1.14), p=0.730.99 (0.89–1.11), p=0.890.98 (0.91–1.05), p=0.57
Any STH infection1.16 (0.93–1.43), p=0.180.94 (0.77–1.15), p=0.541.38 (0.35–5.44), p=0.650.48 (0.26–0.92), p=0.0261.20 (0.91–1.59), p=0.201.22 (0.85–1.75), p=0.271.04 (0.83–1.32), p=0.72
Diarrhea1.73 (0.91–3.28), p=0.0940.84 (0.46–1.51), p=0.551.66 (0.32–8.68), p=0.551.32 (0.45–3.90), p=0.611.71 (0.79–3.71), p=0.170.68 (0.31–1.48), p=0.330.82 (0.36–1.87), p=0.64
Any Bacteria1.10 (0.96–1.26), p=0.151.01 (0.88–1.16), p=0.871.23 (0.75–2.02), p=0.420.88 (0.66–1.16), p=0.371.02 (0.86–1.20), p=0.851.02 (0.85–1.22), p=0.850.96 (0.84–1.11), p=0.61
Shigella1.14 (0.94–1.38), p=0.180.97 (0.81–1.16), p=0.750.87 (0.25–3.02), p=0.830.48 (0.28–0.84), p=0.0091.09 (0.87–1.35), p=0.470.96 (0.75–1.23), p=0.761.02 (0.85–1.23), p=0.82
ETEC0.97 (0.70–1.35), p=0.860.83 (0.57–1.20), p=0.320.80 (0.33–1.95), p=0.630.84 (0.47–1.49), p=0.550.86 (0.58–1.29), p=0.470.86 (0.52–1.40), p=0.530.75 (0.47–1.20), p=0.23
Campylobacter1.70 (0.83–3.49), p=0.151.29 (0.63–2.64), p=0.492.67 (0.59–12.00), p=0.21.63 (0.59–4.54), p=0.351.51 (0.60–3.76), p=0.381.52 (0.60–3.83), p=0.380.98 (0.30–3.21), p=0.97
C. difficile2.06 (0.76–5.53), p=0.151.38 (0.45–4.20), p=0.571.42 (0.43–4.65), p=0.571.45 (0.40–5.25), p=0.571.35 (0.23–7.78), p=0.740.23 (0.02–2.67), p=0.24..‡
E. coli O1570.47 (0.18–1.23), p=0.130.52 (0.17–1.59), p=0.250.00 (0.00–0.01), p=0.000.52 (0.07–4.14), p=0.540.68 (0.22–2.07), p=0.500.58 (0.12–2.86), p=0.510.48 (0.13–1.78), p=0.27
STEC0.15 (0.03–0.71), p=0.0170.24 (0.06–1.03), p=0.055..‡0.05 (0.00–1.26), p=0.0690.11 (0.01–1.32), p=0.0820.58 (0.07–5.00), p=0.621.70 (0.14–20.35), p=0.67
Y. enterocolitica..‡..‡..‡..‡..‡..‡..‡
V. cholerae..‡..‡..‡..‡..‡..‡..‡
Any Protozoa1.05 (0.89–1.23), p=0.60.92 (0.78–1.09), p=0.340.42 (0.14–1.26), p=0.120.86 (0.60–1.23), p=0.411.20 (0.97–1.48), p=0.0950.92 (0.73–1.16), p=0.490.94 (0.80–1.10), p=0.45
Giardia1.07 (0.91–1.26), p=0.430.95 (0.80–1.12), p=0.510.46 (0.15–1.47), p=0.190.89 (0.62–1.28), p=0.521.19 (0.96–1.47), p=0.110.92 (0.73–1.16), p=0.470.96 (0.81–1.13), p=0.6
Cryptosporidium0.89 (0.24–3.33), p=0.860.53 (0.13–2.17), p=0.380.33 (0.02–6.28), p=0.460.51 (0.09–2.78), p=0.441.46 (0.21–10.18), p=0.70.59 (0.06–5.45), p=0.640.20 (0.02–2.28), p=0.19
E. histolytica..‡..‡..‡..‡..‡..‡..‡
Any virus0.75 (0.44–1.28), p=0.291.03 (0.57–1.86), p=0.920.37 (0.14–1.03), p=0.0560.79 (0.35–1.78), p=0.571.09 (0.52–2.29), p=0.830.95 (0.41–2.19), p=0.911.44 (0.61–3.38), p=0.41
Norovirus GI/GII0.68 (0.36–1.28), p=0.231.10 (0.55–2.18), p=0.790.42 (0.12–1.41), p=0.161.25 (0.47–3.29), p=0.660.86 (0.37–2.00), p=0.730.74 (0.29–1.90), p=0.531.16 (0.45–3.04), p=0.76
Adenovirus 40/411.26 (0.32–4.95), p=0.740.96 (0.18–5.20), p=0.960.85 (0.09–8.30), p=0.89..‡3.77 (0.48–29.56), p=0.216.17 (0.51–75.19), p=0.157.51 (0.72–77.98), p=0.091
Rotavirus A..‡..‡..‡..‡..‡..‡..‡
Coinfection,≥2 GPP pathogens1.10 (0.93–1.30), p=0.270.94 (0.80–1.11), p=0.490.75 (0.33–1.71), p=0.490.83 (0.58–1.17), p=0.291.15 (0.93–1.42), p=0.190.97 (0.78–1.21), p=0.810.93 (0.78–1.11), p=0.44
Trichuris1.05 (0.83–1.32), p=0.680.85 (0.67–1.08), p=0.170.99 (0.23–4.27), p=0.980.24 (0.10–0.60), p=0.0021.11 (0.80–1.52), p=0.541.14 (0.76–1.70), p=0.540.99 (0.77–1.27), p=0.92
Ascaris1.38 (0.95–1.99), p=0.0880.83 (0.54–1.26), p=0.373.11 (0.30–32.54), p=0.340.65 (0.29–1.47), p=0.31.20 (0.76–1.92), p=0.430.86 (0.42–1.75), p=0.680.86 (0.51–1.44), p=0.56
Coinfection,≥2 STH1.21 (0.78–1.85), p=0.390.62 (0.37–1.06), p=0.0791.76 (0.15–21), p=0.660.12 (0.01–1.06), p=0.0571.01 (0.53–1.93), p=0.970.70 (0.30–1.62), p=0.400.72 (0.40–1.29), p=0.27
  1. 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).

  2. † 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.

Appendix 1—table 11
Comparison of effect estimates (prevalence ratios) at 12- and 24-month adjusted for a priori covariates only and for a priori covariates and seasonality.
12-month prevalence ratio (95% CI)24-month prevalence ratio (95% CI)
Adjusted (a priori only)*Adjusted + seasonality†Adjusted (a priori only)*Adjusted + seasonality†
Any bacterial or protozoan infection1.04 (0.94–1.15), p=0.411.05 (0.95–1.15), p=0.370.99 (0.91–1.09), p=0.891.00 (0.91–1.10), p=0.95
Any STH infection1.11 (0.89–1.38), p=0.351.12 (0.90–1.39), p=0.310.95 (0.77–1.17), p=0.620.94 (0.76–1.15), p=0.54
Diarrhea1.69 (0.89–3.21), p=0.111.67 (0.88–3.17), p=0.120.84 (0.47–1.51), p=0.560.81 (0.44–1.46), p=0.48
Any bacteria1.09 (0.95–1.26), p=0.201.10 (0.96–1.26), p=0.181.00 (0.87–1.15), p=0.951.03 (0.89–1.18), p=0.71
Shigella1.12 (0.92–1.38), p=0.271.12 (0.91–1.37), p=0.280.95 (0.79–1.16), p=0.640.97 (0.80–1.17), p=0.72
ETEC0.96 (0.69–1.33), p=0.810.98 (0.70–1.35), p=0.890.83 (0.57–1.19), p=0.310.88 (0.61–1.26), p=0.47
Campylobacter1.68 (0.82–3.45), p=0.161.72 (0.84–3.49), p=0.141.28 (0.62–2.62), p=0.51.33 (0.65–2.71), p=0.43
C. difficile2.09 (0.77–5.64), p=0.152.17 (0.81–5.86), p=0.131.41 (0.46–4.30), p=0.541.44 (0.48–4.37), p=0.52
E. coli O1570.46 (0.18–1.21), p=0.120.48 (0.18–1.26), p=0.140.52 (0.17–1.59), p=0.250.57 (0.19–1.74), p=0.32
STEC0.15 (0.03–0.70), p=0.0160.15 (0.03–0.74), p=0.0190.24 (0.05–1.01), p=0.0520.25 (0.06–1.06), p=0.061
Y. enterocolitica..‡..‡..‡..‡
V. cholerae..‡..‡..‡..‡
Any Protozoa1.03 (0.86–1.22), p=0.761.03 (0.87–1.23), p=0.720.91 (0.76–1.09), p=0.290.91 (0.76–1.09), p=0.31
Giardia1.05 (0.88–1.25), p=0.581.06 (0.88–1.26), p=0.540.93 (0.78–1.11), p=0.430.93 (0.78–1.12), p=0.45
Cryptosporidium0.89 (0.24–3.31), p=0.860.83 (0.22–3.11), p=0.780.53 (0.13–2.14), p=0.370.46 (0.12–1.73), p=0.25
E. histolytica..‡..‡..‡..‡
Any virus0.75 (0.44–1.27), p=0.290.74 (0.43–1.26), p=0.261.03 (0.57–1.86), p=0.920.97 (0.54–1.75), p=0.91
Norovirus GI/GII0.68 (0.36–1.27), p=0.230.67 (0.35–1.27), p=0.221.10 (0.55–2.18), p=0.791.04 (0.53–2.07), p=0.90
Adenovirus 40/411.24 (0.32–4.83), p=0.761.29 (0.33–5.13), p=0.710.97 (0.18–5.19), p=0.971.01 (0.19–5.30), p=0.99
Rotavirus..‡..‡..‡..‡
Coinfection,≥2 GPP pathogens1.08 (0.91–1.29), p=0.371.09 (0.91–1.30), p=0.350.93 (0.79–1.10), p=0.410.94 (0.79–1.12), p=0.49
Trichuris1.01 (0.79–1.28), p=0.961.02 (0.81–1.30), p=0.860.86 (0.67–1.10), p=0.220.85 (0.67–1.09), p=0.21
Ascaris1.33 (0.92–1.93), p=0.131.35 (0.93–1.95), p=0.110.83 (0.54–1.27), p=0.390.81 (0.53–1.25), p=0.34
Coinfection,≥2 STH1.17 (0.76–1.79), p=0.491.20 (0.78–1.83), p=0.400.63 (0.37–1.07), p=0.0840.62 (0.36–1.06), p=0.079
  1. 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.

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

Appendix 1—table 12
Effect of the intervention on enteric infection and diarrhea in children > 2 years old after 24 months.
PrevalencePrevalence ratio (95% CI), p-value
Baseline, aged > 2 years24 month, aged > 2 yearsUnadjustedAdjusted*
Any bacterial or protozoan infection†
Control155/164 (95%)315/340 (93%)....
Intervention149/160 (93%)312/344 (91%)0.99 (0.93–1.07), p=0.860.98 (0.91–1.05), p=0.60
Any STH infection†
Control103/155 (66%)113/175 (65%)....
Intervention86/146 (59%)121/208 (58%)1.03 (0.82–1.30), p=0.791.05 (0.83–1.32), p=0.69
Diarrhea‡
Control21/243 (8.6%)33/273 (12%)....
Intervention16/210 (7.6%)31/303 (10%)0.96 (0.45–2.07), p=0.930.82 (0.36–1.86), p=0.63
Any Bacteria
Control129/164 (79%)267/340 (79%)....
Intervention125/160 (78%)266/344 (77%)1.00 (0.87–1.15), p=0.980.97 (0.84–1.11), p=0.64
Shigella
Control112/164 (68%)227/340 (67%)....
Intervention103/160 (64%)223/344 (65%)1.05 (0.87–1.26), p=0.631.03 (0.85–1.24), p=0.79
ETEC
Control46/164 (28%)93/340 (27%)....
Intervention52/160 (33%)100/344 (29%)0.88 (0.56–1.38), p=0.580.74 (0.46–1.20), p=0.22
Campylobacter
Control12/164 (7.3%)33/340 (9.7%)....
Intervention7/160 (4.4%)20/344 (5.8%)0.97 (0.33–2.90), p=0.961.00 (0.30–3.28), p=0.99
C. difficile
Control2/164 (1.2%)6/340 (1.8%)....
Intervention0/160 (0.0%)4/344 (1.2%)..‡..‡
E. coli O157
Control6/164 (3.7%)21/340 (6.2%)....
Intervention9/160 (5.6%)13/344 (3.8%)0.39 (0.11–1.40), p=0.150.47 (0.13–1.78), p=0.27
STEC
Control2/164 (1.2%)15/340 (4.4%)....
Intervention1/160 (0.63%)13/344 (3.8%)1.54 (0.12–19.19), p=0.741.73 (0.14–20.75), p=0.67
Y. enterocolitica
Control0/164 (0.0%)0/340 (0.0%)....
Intervention0/160 (0.0%)1/344 (0.29%)..‡..‡
V. cholerae
Control0/164 (0.0%)0/340 (0.0%)....
Intervention0/160 (0.0%)0/344 (0.0%)..‡..‡
Any Protozoa
Control123/164 (75%)250/340 (74%)....
Intervention121/160 (76%)245/344 (71%)0.96 (0.82–1.13), p=0.660.94 (0.80–1.11), p=0.47
Giardia
Control122/164 (74%)244/340 (72%)....
Intervention118/160 (74%)240/344 (70%)0.99 (0.84–1.16), p=0.860.96 (0.81–1.13), p=0.62
Cryptosporidium
Control1/164 (0.61%)9/340 (2.6%)....
Intervention4/160 (2.5%)8/344 (2.3%)0.20 (0.02–2.27), p=0.190.21 (0.02–2.46), p=0.21
E. histolytica
Control0/164 (0.0%)2/340 (0.59%)....
Intervention3/160 (1.9%)10/344 (2.9%)..‡..‡
Any virus
Control19/164 (12%)39/340 (11%)....
Intervention16/160 (10%)43/344 (13%)1.24 (0.55–2.78), p=0.61.44 (0.61–3.38), p=0.41
Norovirus GI/GII
Control12/164 (7.3%)34/340 (10%)....
Intervention13/160 (8.1%)37/344 (11%)0.96 (0.39–2.34), p=0.921.17 (0.45–3.03), p=0.75
Adenovirus 40/41
Control6/164 (3.7%)2/340 (0.59%)....
Intervention2/160 (1.3%)6/344 (1.7%)11 (0.97–119), p=0.0537.5 (0.72–79), p=0.92
Rotavirus A
Control1/164 (0.61%)3/340 (0.88%)....
Intervention1/160 (0.63%)1/344 (0.29%)..‡..‡
Coinfection,≥2 GPP pathogens
Control114/164 (70%)243/340 (71%)....
Intervention111/160 (69%)236/344 (69%)0.97 (0.82–1.15), p=0.710.93 (0.78–1.12), p=0.45
Trichuris
Control91/155 (59%)102/175 (58%)....
Intervention76/146 (52%)110/208 (53%)1.04 (0.81–1.33), p=0.780.99 (0.77–1.27), p=0.96
Ascaris
Control50/155 (32%)61/175 (35%)....
Intervention39/146 (27%)47/208 (23%)0.78 (0.47–1.29), p=0.330.86 (0.51–1.44), p=0.57
Coinfection,≥2 STH
Control38/155 (25%)50/175 (29%)....
Intervention29/146 (20%)36/208 (17%)0.74 (0.42–1.28), p=0.280.72 (0.41–1.29), p=0.27
  1. 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.

  2. † Models did not converge due to sparse data.

Appendix 1—table 13
Effect of intervention on enteric infection and reported diarrhea in children born into study sites post implementation (post-baseline) and before 12 month visit compared with children of a similar age at baseline (<1 year old).
PrevalencePrevalence ratio
Baseline, children < 1 year old12 month, children born-in and <1 year oldunadjustedadjusted†
Any bacterial or protozoan infection
Control57/109 (52%)31/48 (65%)....
Intervention51/99 (52%)32/55 (58%)0.89 (0.60–1.33), p=0.580.97 (0.65–1.45), p=0.90
Any STH infection
Control17/93 (18%)3/25 (12%)....
Intervention13/92 (14%)4/32 (13%)1.31 (0.32–5.42), p=0.711.38 (0.35–5.45), p=0.65
Diarrhea
Control19/138 (14%)6/50 (12%)....
Intervention18/120 (15%)13/69 (19%)1.38 (0.47–4.01), p=0.561.80 (0.35–9.31), p=0.48
Any Bacteria
Control53/109 (49%)24/48 (50%)....
Intervention41/99 (41%)29/55 (53%)1.22 (0.75–1.98), p=0.431.28 (0.78–2.10), p=0.33
Shigella
Control10/109 (9.2%)9/48 (19%)....
Intervention9/99 (9.1%)9/55 (16%)0.87 (0.26–2.91), p=0.820.85 (0.26–2.81), p=0.79
ETEC
Control25/109 (23%)12/48 (25%)....
Intervention22/99 (22%)11/55 (20%)0.82 (0.34–1.99), p=0.660.80 (0.33–1.92), p=0.62
Campylobacter
Control14/109 (13%)4/48 (8.3%)....
Intervention8/99 (8.1%)5/55 (9.1%)1.76 (0.38–8.09), p=0.472.68 (0.59–12.2), p=0.20
C. difficile
Control13/109 (12%)7/48 (15%)....
Intervention10/99 (10%)9/55 (16%)1.37 (0.42–4.45), p=0.601.49 (0.46–4.89), p=0.51
E. coli O157
Control4/109 (3.7%)1/48 (2.1%)....
Intervention2/99 (2%)0/55 (0.0%)0.01 (0.00–0.19), p=0.001..‡
STEC
Control0/109 (0.0%)0/48 (0.0%)....
Intervention3/99 (3%)1/55 (1.8%)..‡..‡
Y. enterocolitica
Control0/109 (0.0%)0/48 (0.0%)....
Intervention0/99 (0.0%)0/55 (0.0%)..‡..‡
V. cholerae
Control0/109 (0.0%)0/48 (0.0%)....
Intervention0/99 (0.0%)0/55 (0.0%)..‡..‡
Any Protozoa
Control14/109 (13%)15/48 (31%)....
Intervention22/99 (22%)9/55 (16%)0.35 (0.12–1.02), p=0.0550.40 (0.13–1.20), p=0.10
Giardia
Control12/109 (11%)13/48 (27%)....
Intervention16/99 (16%)8/55 (15%)0.41 (0.13–1.24), p=0.110.44 (0.14–1.40), p=0.17
Cryptosporidium
Control2/109 (1.8%)2/48 (4.2%)....
Intervention8/99 (8.1%)2/55 (3.6%)0.25 (0.02–3.70), p=0.310.40 (0.02–7.9), p=0.55
E. histolytica
Control0/109 (0.0%)1/48 (2.1%)....
Intervention1/99 (1%)0/55 (0.0%)..‡..‡
Any virus
Control15/109 (14%)12/48 (25%)....
Intervention21/99 (21%)7/55 (13%)0.33 (0.12–0.92), p=0.0330.37 (0.14–1.03), p=0.056
Norovirus GI/GII
Control12/109 (11%)9/48 (19%)....
Intervention15/99 (15%)6/55 (11%)0.43 (0.13–1.40), p=0.160.44 (0.13–1.47), p=0.18
Adenovirus 40/41
Control4/109 (3.7%)4/48 (8.3%)....
Intervention3/99 (3%)2/55 (3.6%)0.56 (0.06–5.05), p=0.610.91 (0.09–9.49), p=0.94
Rotavirus A
Control0/109 (0.0%)0/48 (0.0%)....
Intervention3/99 (3%)0/55 (0.0%)..‡..‡
Coinfection,≥2 GPP pathogens
Control23/109 (21%)16/48 (33%)....
Intervention25/99 (25%)15/55 (27%)0.73 (0.31–1.71), p=0.470.74 (0.33–1.69), p=0.48
Trichuris
Control10/93 (11%)3/25 (12%)....
Intervention10/92 (11%)4/32 (13%)1.04 (0.21–5.01), p=0.960.98 (0.23–4.29), p=0.98
Ascaris
Control12/93 (13%)1/25 (4%)....
Intervention9/92 (9.8%)3/32 (9.4%)2.87 (0.30–27.85), p=0.363.10 (0.30–32.5), p=0.35
Coinfection,≥2 STH
Control5/93 (5.4%)1/25 (4%)....
Intervention6/92 (6.5%)3/32 (9.4%)1.90 (0.16–22.73), p=0.611.76 (0.15–21.0), p=0.66
  1. 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.

  2. † Models did not converge due to sparse data.

Appendix 1—table 14
Effect of the intervention on children with repeated observations at baseline and 12-month visit.
PrevalencePrevalence ratio
Baseline12 monthUnadjustedAdjusted†
Any bacterial or protozoan infection
Control161/207 (78%)187/207 (90%)....
Intervention174/228 (76%)207/228 (91%)1.02 (0.91–1.16), p=0.701.01 (0.90–1.14), p=0.84
Any STH infection
Control67/132 (51%)80/132 (61%)....
Intervention63/154 (41%)91/154 (59%)1.22 (0.92–1.61), p=0.171.16 (0.87–1.55), p=0.31
Diarrhea
Control36/277 (13%)17/277 (6.1%)....
Intervention42/279 (15%)34/279 (12%)1.71 (0.78–3.77), p=0.181.71 (0.79–3.70), p=0.17
Any Bacteria
Control141/207 (68%)165/207 (80%)....
Intervention142/228 (62%)170/228 (75%)1.02 (0.86–1.22), p=0.81.01 (0.85–1.20), p=0.92
Shigella
Control89/207 (43%)128/207 (62%)
Intervention90/228 (39%)142/228 (62%)1.10 (0.86–1.39), p=0.451.08 (0.85–1.37), p=0.54
ETEC
Control63/207 (30%)83/207 (40%)
Intervention71/228 (31%)79/228 (35%)0.84 (0.56–1.27), p=0.410.85 (0.57–1.28), p=0.44
Campylobacter
Control20/207 (9.7%)18/207 (8.7%)
Intervention13/228 (5.7%)18/228 (7.9%)1.54 (0.62–3.80), p=0.351.49 (0.60–3.71), p=0.39
C. difficile
Control15/207 (7.3%)4/207 (1.9%)
Intervention8/228 (3.5%)3/228 (1.3%)1.39 (0.24–8.00), p=0.711.45 (0.25–8.52), p=0.68
E. coli O157
Control9/207 (4.3%)15/207 (7.3%)....
Intervention9/228 (4.0%)10/228 (4.4%)0.67 (0.22–2.03), p=0.480.68 (0.22–2.06), p=0.49
STEC
Control1/207 (0.48%)6/207 (2.9%)....
Intervention6/228 (2.6%)4/227 (1.8%)0.11 (0.01–1.31), p=0.0810.11 (0.01–1.32), p=0.082
Y. enterocolitica
Control0/207 (0.0%)0/207 (0.0%)....
Intervention1/228 (0.44%)0/227 (0.0%)..‡..‡
V. cholerae
Control0/207 (0.0%)0/207 (0.0%)....
Intervention0/228 (0.0%)0/227 (0.0%)..‡..‡
Any Protozoa
Control109/207 (53%)130/207 (63%)....
Intervention117/228 (51%)166/228 (73%)1.19 (0.95–1.48), p=0.131.18 (0.94–1.47), p=0.15
Giardia
Control106/207 (51%)130/207 (63%)
Intervention113/228 (50%)164/228 (72%)1.18 (0.94–1.48), p=0.151.17 (0.93–1.47), p=0.17
Cryptosporidium
Control6/207 (2.9%)2/207 (0.97%)....
Intervention10/228 (4.4%)5/227 (2.2%)1.44 (0.21–9.82), p=0.711.45 (0.22–9.71), p=0.7
E. histolytica
Control0/207 (0.0%)0/207 (0.0)....
Intervention2/228 (0.88%)7/228 (3.1%)..‡..‡
Any virus
Control27/207 (13%)20/207 (9.7%)....
Intervention31/228 (14%)25/228 (11%)1.05 (0.50–2.22), p=0.891.08 (0.51–2.26), p=0.84
Norovirus GI/GII
Control20/207 (9.7%)19/207 (9.2%)
Intervention23/228 (11%)19/228 (8.3%)0.83 (0.36–1.94), p=0.670.86 (0.37–1.99), p=0.72
Adenovirus 40/41
Control7/207 (3.4%)2/207 (0.97%)....
Intervention6/228 (2.6%)6/228 (2.6%)3.56 (0.46–27.24), p=0.223.59 (0.46–27.91), p=0.22
Rotavirus A
Control1/207 (0.48%)1/207 (0.48%)....
Intervention4/228 (1.8%)1/228 (0.44%)..‡..‡
Coinfection,≥2 GPP pathogens
Control114/207 (55%)135/207 (65%)....
Intervention115/228 (50%)156/228 (68%)1.15 (0.92–1.43), p=0.231.14 (0.91–1.42), p=0.25
Trichuris
Control49/132 (37%)64/132 (48%)....
Intervention53/154 (34%)77/154 (50%)1.12 (0.81–1.54), p=0.501.06 (0.76–1.48), p=0.72
Ascaris
Control40/132 (30%)46/132 (35%)
Intervention35/154 (23%)49/154 (32%)1.22 (0.77–1.93), p=0.41.17 (0.73–1.86), p=0.51
Coinfection,≥2 STH
Control22/132 (17%)30/132 (23%)....
Intervention25/154 (16%)35/154 (23%)1.03 (0.55–1.93), p=0.940.97 (0.51–1.85), p=0.93
  1. 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.

  2. † Models would not converge due to sparse data.

Appendix 1—table 15
Effect of the intervention on children with repeated observations at baseline and 24-month visit.
PrevalencePrevalence ratio
Baseline24 monthUnadjustedAdjusted†
Any bacterial or protozoan infection
Control131/166 (79%)155/166 (93%)....
Intervention151/192 (79%)175/192 (91%)0.98 (0.87–1.10), p=0.730.98 (0.87–1.10), p=0.70
Any STH infection
Control48/95 (51%)65/95 (68%)....
Intervention38/106 (36%)62/106 (58%)1.20 (0.84–1.70), p=0.311.25 (0.87–1.78), p=0.23
Diarrhea
Control25/196 (13%)20/196 (10%)....
Intervention34/221 (15%)20/221 (9.1%)0.72 (0.33–1.58), p=0.410.69 (0.31–1.50), p=0.35
Any Bacteria
Control109/166 (66%)138/166 (83%)....
Intervention120/192 (63%)153/192 (80%)1.00 (0.84–1.21), p=0.961.01 (0.83–1.21), p=0.96
Shigella
Control66/166 (40%)121/166 (73%)
Intervention79/192 (41%)136/192 (71%)0.93 (0.71–1.22), p=0.600.93 (0.71–1.22), p=0.60
ETEC
Control47/166 (28%)47/166 (28%)
Intervention58/192 (30%)52/192 (27%)0.90 (0.55–1.46), p=0.660.85 (0.52–1.39), p=0.52
Campylobacter
Control16/166 (9.6%)12/166 (7.2%)
Intervention13/192 (6.8%)14/192 (7.3%)1.44 (0.56–3.72), p=0.451.52 (0.60–3.83), p=0.37
C. difficile
Control9/166 (5.4%)4/166 (2.4%)....
Intervention8/192 (4.2%)1/192 (0.52%)0.28 (0.03–2.95), p=0.290.26 (0.03–2.59), p=0.25
E. coli O157
Control7/166 (4.2%)9/166 (5.4%)....
Intervention9/192 (4.7%)8/192 (4.2%)0.69 (0.14–3.40), p=0.650.59 (0.12–2.93), p=0.52
STEC
Control2/166 (1.2%)7/166 (4.2%)....
Intervention3/192 (1.6%)7/192 (3.6%)0.66 (0.07–6.20), p=0.720.58 (0.07–4.89), p=0.61
Y. enterocolitica
Control0/166 (0.0%)0/166 (0.0%)....
Intervention0/192 (0.0%)1/192 (0.52%)..‡..‡
V. cholerae
Control0/166 (0.0%)0/166 (0.0%)....
Intervention0/192 (0.0%)0/192 (0.0%)..‡..‡
Any Protozoa
Control89/166 (54%)121/166 (73%)....
Intervention109/192 (57%)138/192 (72%)0.93 (0.73–1.19), p=0.560.90 (0.69–1.15), p=0.39
Giardia
Control86/166 (52%)120/166 (72%)
Intervention104/192 (54%)135/192 (70%)0.93 (0.73–1.18), p=0.550.89 (0.69–1.15), p=0.38
Cryptosporidium
Control5/166 (3%)3/166 (1.8%)....
Intervention11/192 (5.7%)4/192 (2.1%)0.57 (0.06–5.38), p=0.620.55 (0.06–4.93), p=0.59
E. histolytica
Control0/166 (0.0%)0/166 (0.0%)....
Intervention2/192 (1%)8/192 (4.2%)..‡..‡
Any virus
Control21/166 (13%)18/166 (11%)....
Intervention30/192 (16%)22/192 (11%)0.86 (0.37–1.97), p=0.720.95 (0.41–2.19), p=0.91
Norovirus GI/GII
Control15/166 (9%)15/166 (9%)....
Intervention26/192 (14%)17/192 (8.8%)0.65 (0.25–1.69), p=0.380.74 (0.28–1.90), p=0.53
Adenovirus 40/41
Control6/166 (3.6%)1/166 (0.6%)
Intervention5/192 (2.6%)5/192 (2.6%)6.12 (0.48–78.34), p=0.166.01 (0.49–73.94), p=0.16
Rotavirus A
Control1/166 (0.6%)2/166 (1.2%)....
Intervention1/192 (0.52%)1/192 (0.52%)..‡..‡
Coinfection,≥2 GPP pathogens
Control89/166 (54%)120/166 (72%)....
Intervention102/192 (53%)132/192 (69%)0.96 (0.77–1.19), p=0.690.95 (0.76–1.19), p=0.67
Trichuris
Control39/95 (41%)62/95 (65%)....
Intervention32/106 (30%)57/106 (54%)1.11 (0.74–1.67), p=0.601.16 (0.77–1.75), p=0.47
Ascaris
Control27/95 (28%)34/95 (36%)
Intervention19/106 (18%)21/106 (20%)0.88 (0.43–1.79), p=0.720.89 (0.44–1.79), p=0.74
Coinfection,≥2 STH
Control18/95 (19%)31/95 (33%)....
Intervention13/106 (12%)16/106 (15%)0.71 (0.30–1.70), p=0.440.72 (0.31–1.69), p=0.46
  1. 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.

  2. † Models would not converge due to sparse data.

Appendix 1—table 16
Outcome and covariate descriptions, coding, and % missing.
Baseline, n = 98712 month, n = 93924 month, n = 1001
% missing% missing% missingVariable descriptionData source
Outcome Data
Enteric infection outcome data available24148.0Binary; 0/1Based on collection of stool material and successful analysis by GPP
STH infection outcome data available303746Binary; 0/1Based on collection of stool material and successful analysis by Kato-Katz
Caregiver-reported diarrhea, 7-day recall1.37.820Binary; 0/1Child Survey
Covariate data
Child sex, female2.31.37.0Binary; 0=male, 1=femaleChild Survey
Respondent is child's mother2.57.620Binary; 0/1Child Survey
Caregiver completed primary school0.81.76.7Binary; 0/1Child Survey
Child breast feeds with or without complementary feeding1.37.720Binary; 0/1Child Survey
Child exclusively breastfeeds1.37.720Binary; 0/1Child Survey
Child wears a diaper1.47.620Binary; 0/1Child Survey
Child feces is disposed of in a latrine1.37.120Binary; 0/1Created from survey questions in Child Survey
Child age at sampling, days231617IntegerCreated from birthdate (Child Survey) and date of sampling
Child age at survey, days2.67.519IntegerCreated from birthdate (Child Survey) and date of Survey
30-day cumulative rainfall at sampling211410ContinuousCreated from sample date and data from data from the National Oceanic and Atmospheric Administration’s National Centers for Environmental Information (https://www.ncdc.noaa. gov/cdo-web/datatools/findstation)
30-day cumulative rainfall at survey1.37.119ContinuousCreated from survey date and data from data from the National Oceanic and Atmospheric Administration’s National Centers for Environmental Information (https://www.ncdc.noaa. gov/cdo-web/datatools/findstation)
Sample collection during rainy season211410Binary; 0/1Created from sample date. Rainy season defined as November – April.
Survey collection during rainy season1.37.119Binary; 0/1Created from survey date. Rainy season defined as November – April.
Household crowding, >3 persons/room0.40.32.7Binary; 0/1Created from questions in Household Survey
Household floor is covered0.40.32.7Binary; 0/1Observation
Household walls made of concrete, bricks or similar0.40.32.7Binary; 0/1Observation
Household population0.30.31.6IntegerHousehold survey
Number of rooms in household0.40.32.3IntegerCreated from questions in Household Survey
Wealth score, 0 (poorest) - 1 (wealthiest), unitless0.40.32.7ContinuousCreated from questions in Household Survey using Simple Poverty Scorecard for Mozambique (http://www.simplepovertyscorecard.com/MOZ_2008_ENG.pdf). Questions referencing latrine removed from 12 month and 24 month score. All scores normalized by total number of points available.
Household uses tap in compound as primary drinking water source1.71.02.0Binary 0/1Created from drinking water source question in Household Survey
Latrine has drop-hole cover1.90.00.0Binary; 0/1Observation
Latrine has a ventpipe1.80.00.0Binary; 0/1Observation
Latrine has a ceramic, tile, or concrete pedestal or slab2.20.10.1Binary; 0/1Observation
Latrine has sturdy walls made of concrete, bricks, or similar1.90.00.0Binary; 0/1Observation
Compound population0.00.00.0IntegerCompound Survey, enrollment checklists
Number of households in compound0.00.00.0IntegerCompound Survey, enrollment checklists
Number of latrines present in the compound0.10.00.0IntegerCompound Survey
Persons per latrine1.80.10.3ContinuousCreated by dividing the compound population by the number of latrines/drop-holes
Households per latrine1.80.10.3ContinuousCreated by dividing the number of households in the compound by the number of latrines in the compound
Number of water taps present in the compound1.10.00.0IntegerCompound Survey
Standing water visible around compound grounds1.90.30.0Binary; 0/1Observation
Standing or leaking wastewater visible around compound grounds1.90.30.0Binary; 0/1Observation
Faeces or used diapers observed around compound grounds or in solid waste1.90.30.0Binary; 0/1Observation
Compound floods when it rains0.00.00.0Binary; 0/1Compound Survey
Compound has electricity that normally functions0.00.00.0Binary; 0/1Compound Survey
Compound-level population density2.21.51.5Continuous, persons/m2Created by dividing the population of the compound by the measured area of the compound
Any animal present in the compound0.00.40.0Binary; 0/1Observation
Dog(s) present in the compound0.00.40.0Binary; 0/1Observation
Chicken(s) and/or duck(s) present in the compound0.00.40.0Binary; 0/1Observation
Cat(s) present in the compound0.00.40.0Binary; 0/1Observation
Any other animal(s) present in the compound0.00.40.0Binary; 0/1Observation

Additional files

Download links

A two-part list of links to download the article, or parts of the article, in various formats.

Downloads (link to download the article as PDF)

Download citations (links to download the citations from this article in formats compatible with various reference manager tools)

Open citations (links to open the citations from this article in various online reference manager services)