Due to necessary scheduled maintenance, the JMIR Publications website will be unavailable from Wednesday, July 01, 2020 at 8:00 PM to 10:00 PM EST. We apologize in advance for any inconvenience this may cause you.
Who will be affected?
Readers: No access to all 28 journals. We recommend accessing our articles via PubMed Central
Authors: No access to the submission form or your user account.
Reviewers: No access to your user account. Please download manuscripts you are reviewing for offline reading before Wednesday, July 01, 2020 at 7:00 PM.
Editors: No access to your user account to assign reviewers or make decisions.
Copyeditors: No access to user account. Please download manuscripts you are copyediting before Wednesday, July 01, 2020 at 7:00 PM.
Tadesse BT, Khanam F, Ahmmed F, Liu X, Islam MT, Kim DR, Kang SS, Im J, Chowdhury F, Ahmed T, Aziz AB, Hoque M, Park J, Pak G, Jeon HJ, Zaman K, Khan AI, Kim JH, Marks F, Qadri F, Clemens JD
Association Among Household Water, Sanitation, and Hygiene (WASH) Status and Typhoid Risk in Urban Slums: Prospective Cohort Study in Bangladesh
Better Existing Water, Sanitation and Hygiene (WASH) is Associated with a Reduced Risk of Typhoid in Urban Slums: Results from a Prospective Cohort Study in Bangladesh
Birkneh Tilahun Tadesse;
Farhana Khanam;
Faisal Ahmmed;
Xinxue Liu;
Md. Taufiqul Islam;
Deok Ryun Kim;
Sophie SY Kang;
Justin Im;
Fahima Chowdhury;
Tasnuva Ahmed;
Asma Binte Aziz;
Masuma Hoque;
Juyeon Park;
Gideok Pak;
Hyon Jin Jeon;
Khalequ Zaman;
Ashraful Islam Khan;
Jerome H. Kim;
Florian Marks;
Firdausi Qadri;
John D. Clemens
ABSTRACT
Background:
Reduction in typhoid burden in low-income countries requires implementation of feasible water, sanitation, and hygiene (WASH), particularly in densely populated urban slums.
Objective:
To investigate the association between existing improvements in WASH in a contemporary slum in Dhaka and the risk of typhoid fever.
Methods:
Using a large prospective cohort in a densely populated contemporary slum in Mirpur, Bangladesh, we assessed the association between household WASH status and typhoid risk in a training subpopulation (n=98,087). We applied a machine learning algorithm to create dichotomous (“Better”, “Not Better”) composite WASH variable based on three variables – private toilet facility, safe drinking water source and presence of water filter – followed by evaluation of sensitivity and specificity in a distinct validation subpopulation (n=65,286). Using Cox regression models, we evaluated protection associated with living in “Better” WASH households and in clusters with increasing levels of “Better” WASH prevalence during 2 years of follow-up.
Results:
Residence in “Better” WASH households was associated with 38% reduction in typhoid risk (adjusted hazard ratio [aHR]=0.62; 95% confidence interval [CI]: 0.49–0.78; p<0.001). This reduction was mainly observed in persons <10 years old at first census participation: aHR=0.49; (95%CI: 0.36–0.66; p<0.001). The prevalence of “Better” WASH in clusters appeared inversely related to typhoid incidence; however, this association was not significant in the multivariable model. The adjusted hazard of typhoid decreased by 0.996 (95%CI: 0.986–1.006) for each percent increase in prevalence of “Better” WASH in the cluster (p=0.396).
Conclusions:
In conclusion, existing variations in household WASH were associated with typhoid risk in a densely populated urban slum. The findings suggest that achievable improvements in WASH facilities may enhance typhoid control in slums where major infrastructural improvements are challenging. Clinical Trial: The Cluster Randomised Trial is registered at ISRCTN11643110
Citation
Please cite as:
Tadesse BT, Khanam F, Ahmmed F, Liu X, Islam MT, Kim DR, Kang SS, Im J, Chowdhury F, Ahmed T, Aziz AB, Hoque M, Park J, Pak G, Jeon HJ, Zaman K, Khan AI, Kim JH, Marks F, Qadri F, Clemens JD
Association Among Household Water, Sanitation, and Hygiene (WASH) Status and Typhoid Risk in Urban Slums: Prospective Cohort Study in Bangladesh