Effects of an urban sanitation intervention on childhood enteric infection and diarrhea in Maputo, Mozambique: a controlled before-and-after trial
We conducted a controlled before-and-after trial to evaluate the impact of an onsite urban sanitation intervention on the prevalence of enteric infection, soil transmitted helminth re-infection, and diarrhea among children in Maputo, Mozambique. A non-governmental organization replaced existing poor-quality latrines with pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1-48 months at baseline and measured outcomes before and 12 and 24 months after the intervention, with concurrent measurement among children in a comparable control arm. Despite nearly exclusive use, we found no evidence that intervention affected the prevalence of any measured outcome after 12 or 24 months of exposure. Among children born into study sites after intervention, we observed a reduced prevalence of Trichuris and Shigella infection relative to the same age group at baseline (<2 years old). Protection from birth may be important to reduce exposure to and infection with enteric pathogens in this setting.
All data generated or analysed during this study are included in the manuscript and supporting files. Source data files and code have been provided for all analyses and specifically for Figure 1 and Tables 1, 2, and 3. Additionally, we have archived all data and code at Open Science Framework (https://osf.io/me2tx, DOI 17605/OSF.IO/ME2TX).
Article and author information
Bill and Melinda Gates Foundation (OPP1137224)
- Oliver Cumming
- Joe Brown
United States Agency for International Development (GHS-A-00-09-00015-00)
- Oliver Cumming
- Joe Brown
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Human subjects: The study protocol was approved by the Comité Nacional de Bioética para a Saúde (CNBS),Ministério da Saúde (333/CNBS/14), the Research Ethics Committee of the London School of Hygiene & Tropical Medicine (reference # 8345), and the Institutional Review Board of theGeorgia Institute of Technology (protocol # H15160).
- Joseph Lewnard, University of California Berkeley, United States
- Received: August 20, 2020
- Accepted: April 3, 2021
- Accepted Manuscript published: April 9, 2021 (version 1)
- Accepted Manuscript updated: April 15, 2021 (version 2)
- Version of Record published: May 14, 2021 (version 3)
© 2021, Knee et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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- Epidemiology and Global Health
Affectionate touch, which is vital for mental and physical health, was restricted during the Covid-19 pandemic. This study investigated the association between momentary affectionate touch and subjective well-being, as well as salivary oxytocin and cortisol in everyday life during the pandemic.
In the first step, we measured anxiety and depression symptoms, loneliness and attitudes toward social touch in a large cross-sectional online survey (N = 1050). From this sample, N = 247 participants completed ecological momentary assessments over 2 days with six daily assessments by answering smartphone-based questions on affectionate touch and momentary mental state, and providing concomitant saliva samples for cortisol and oxytocin assessment.
Multilevel models showed that on a within-person level, affectionate touch was associated with decreased self-reported anxiety, general burden, stress, and increased oxytocin levels. On a between-person level, affectionate touch was associated with decreased cortisol levels and higher happiness. Moreover, individuals with a positive attitude toward social touch experiencing loneliness reported more mental health problems.
Our results suggest that affectionate touch is linked to higher endogenous oxytocin in times of pandemic and lockdown and might buffer stress on a subjective and hormonal level. These findings might have implications for preventing mental burden during social contact restrictions.
The study was funded by the German Research Foundation, the German Psychological Society, and German Academic Exchange Service.
- Epidemiology and Global Health
Background: Home-based self-sampling for human papillomavirus (HPV) testing may be an alternative for women not attending clinic-based cervical cancer screening.
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Results: Over half of 233 survey participants reported that clinic-based screening (Pap) is uncomfortable (67.8%), embarrassing (52.4%), and discomfort seeing male providers (63.1%). The last two factors were significantly more prevalent among Spanish versus English speakers (66.4% vs. 30% (p=0.000) and 69.9 vs. 52.2% (p=0.006), respectively). Most women who completed the kit found Pap more embarrassing (69.3%), stressful (55.6%), and less convenient (55.6%) than the kit. The first factor was more prevalent among Spanish versus English speakers (79.6% vs. 53.38%, p=0.001) and among patients with elementary education or below.
Conclusions: The COVID-19 pandemic influenced most (59.5%) to participate in the trial due to fear of COVID, difficulty making appointments, and ease of using kits. HPV self-sampling kits may reduce barriers among under-screened women in a safety-net system.
Funding: This study is supported by a grant from the National Institute for Minority Health and Health Disparities (NIMHD, R01MD013715, PI: JR Montealegre).
Clinical trial number: NCT03898167.