Use of serologic responses against enteropathogens to assess the impact of a point-of-use water filter

A randomized controlled trial in western province, Rwanda

Laura Divens Zambrano, Jeffrey W. Priest, Emil Ivan, John Rusine, Corey Nagel, Miles Kirby, Ghislaine Rosa, Thomas F. Clasen

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Diarrhea is a leading contributor to childhood morbidity and mortality in sub-Saharan Africa. Given the challenge of blinding most water, sanitation, and hygiene (WASH) interventions, diarrheal disease outcome measures in WASH intervention trials are subject to potential bias and misclassification. Using the platform of a cluster-randomized controlled trial of a household-based drinking water filter in western province, Rwanda, we assessed the impact of the drinking water filter on enteric seroconversion in young children as a health outcome and examined the association between serologic responses and caregiver-reported diarrhea. Among the 2,179 children enrolledin the trial, 189 children 6-12 months of age were enrolled in a nested serology study. These children had their blood drawn at baseline and 6-12 months after the intervention was distributed. Multiplex serologic assays for Giardia, Cryptosporidium, Entamoeba histolytica, norovirus, Campylobacter, enterotoxigenic Escherichia coli and Vibrio cholerae were performed. Despite imperfect uptake, receipt of the water filter was associated with a significant decrease in seroprevalence of IgG directed against Cryptosporidium parvum Cp17 and Cp23 (relative risk [RR]: 0.62, 95% confidence interval [CI]: 0.44-0.89). Serologic responses were positively associated with reported diarrhea in the previous 7 days for both Giardia intestinalis (RR: 1.94, 95% CI: 1.04-3.63) and C. parvum (RR: 2.21, 95% CI: 1.09-4.50). Serologic responses for all antigens generally increased in the follow-up round, rising sharply after 12 months of age. The water filter is associated with reduced serologic responses against C. parvum, a proxy for exposure and infection; therefore, serologic responses against protozoa may be a suitable health outcome measure for WASH trials among children with diarrhea.

Original languageEnglish (US)
Pages (from-to)876-887
Number of pages12
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume97
Issue number3
DOIs
StatePublished - 2017

Fingerprint

Rwanda
Cryptosporidium parvum
Randomized Controlled Trials
Sanitation
Diarrhea
Hygiene
Water
Confidence Intervals
Drinking Water
Outcome Assessment (Health Care)
Norovirus
Enterotoxigenic Escherichia coli
Giardia
Giardia lamblia
Cryptosporidium
Entamoeba histolytica
Campylobacter
Vibrio cholerae
Africa South of the Sahara
Seroepidemiologic Studies

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology

Cite this

Use of serologic responses against enteropathogens to assess the impact of a point-of-use water filter : A randomized controlled trial in western province, Rwanda. / Zambrano, Laura Divens; Priest, Jeffrey W.; Ivan, Emil; Rusine, John; Nagel, Corey; Kirby, Miles; Rosa, Ghislaine; Clasen, Thomas F.

In: American Journal of Tropical Medicine and Hygiene, Vol. 97, No. 3, 2017, p. 876-887.

Research output: Contribution to journalArticle

Zambrano, Laura Divens ; Priest, Jeffrey W. ; Ivan, Emil ; Rusine, John ; Nagel, Corey ; Kirby, Miles ; Rosa, Ghislaine ; Clasen, Thomas F. / Use of serologic responses against enteropathogens to assess the impact of a point-of-use water filter : A randomized controlled trial in western province, Rwanda. In: American Journal of Tropical Medicine and Hygiene. 2017 ; Vol. 97, No. 3. pp. 876-887.
@article{2c4e5116b1c94d589b7fdeeaf54af068,
title = "Use of serologic responses against enteropathogens to assess the impact of a point-of-use water filter: A randomized controlled trial in western province, Rwanda",
abstract = "Diarrhea is a leading contributor to childhood morbidity and mortality in sub-Saharan Africa. Given the challenge of blinding most water, sanitation, and hygiene (WASH) interventions, diarrheal disease outcome measures in WASH intervention trials are subject to potential bias and misclassification. Using the platform of a cluster-randomized controlled trial of a household-based drinking water filter in western province, Rwanda, we assessed the impact of the drinking water filter on enteric seroconversion in young children as a health outcome and examined the association between serologic responses and caregiver-reported diarrhea. Among the 2,179 children enrolledin the trial, 189 children 6-12 months of age were enrolled in a nested serology study. These children had their blood drawn at baseline and 6-12 months after the intervention was distributed. Multiplex serologic assays for Giardia, Cryptosporidium, Entamoeba histolytica, norovirus, Campylobacter, enterotoxigenic Escherichia coli and Vibrio cholerae were performed. Despite imperfect uptake, receipt of the water filter was associated with a significant decrease in seroprevalence of IgG directed against Cryptosporidium parvum Cp17 and Cp23 (relative risk [RR]: 0.62, 95{\%} confidence interval [CI]: 0.44-0.89). Serologic responses were positively associated with reported diarrhea in the previous 7 days for both Giardia intestinalis (RR: 1.94, 95{\%} CI: 1.04-3.63) and C. parvum (RR: 2.21, 95{\%} CI: 1.09-4.50). Serologic responses for all antigens generally increased in the follow-up round, rising sharply after 12 months of age. The water filter is associated with reduced serologic responses against C. parvum, a proxy for exposure and infection; therefore, serologic responses against protozoa may be a suitable health outcome measure for WASH trials among children with diarrhea.",
author = "Zambrano, {Laura Divens} and Priest, {Jeffrey W.} and Emil Ivan and John Rusine and Corey Nagel and Miles Kirby and Ghislaine Rosa and Clasen, {Thomas F.}",
year = "2017",
doi = "10.4269/ajtmh.16-1006",
language = "English (US)",
volume = "97",
pages = "876--887",
journal = "American Journal of Tropical Medicine and Hygiene",
issn = "0002-9637",
publisher = "American Society of Tropical Medicine and Hygiene",
number = "3",

}

TY - JOUR

T1 - Use of serologic responses against enteropathogens to assess the impact of a point-of-use water filter

T2 - A randomized controlled trial in western province, Rwanda

AU - Zambrano, Laura Divens

AU - Priest, Jeffrey W.

AU - Ivan, Emil

AU - Rusine, John

AU - Nagel, Corey

AU - Kirby, Miles

AU - Rosa, Ghislaine

AU - Clasen, Thomas F.

PY - 2017

Y1 - 2017

N2 - Diarrhea is a leading contributor to childhood morbidity and mortality in sub-Saharan Africa. Given the challenge of blinding most water, sanitation, and hygiene (WASH) interventions, diarrheal disease outcome measures in WASH intervention trials are subject to potential bias and misclassification. Using the platform of a cluster-randomized controlled trial of a household-based drinking water filter in western province, Rwanda, we assessed the impact of the drinking water filter on enteric seroconversion in young children as a health outcome and examined the association between serologic responses and caregiver-reported diarrhea. Among the 2,179 children enrolledin the trial, 189 children 6-12 months of age were enrolled in a nested serology study. These children had their blood drawn at baseline and 6-12 months after the intervention was distributed. Multiplex serologic assays for Giardia, Cryptosporidium, Entamoeba histolytica, norovirus, Campylobacter, enterotoxigenic Escherichia coli and Vibrio cholerae were performed. Despite imperfect uptake, receipt of the water filter was associated with a significant decrease in seroprevalence of IgG directed against Cryptosporidium parvum Cp17 and Cp23 (relative risk [RR]: 0.62, 95% confidence interval [CI]: 0.44-0.89). Serologic responses were positively associated with reported diarrhea in the previous 7 days for both Giardia intestinalis (RR: 1.94, 95% CI: 1.04-3.63) and C. parvum (RR: 2.21, 95% CI: 1.09-4.50). Serologic responses for all antigens generally increased in the follow-up round, rising sharply after 12 months of age. The water filter is associated with reduced serologic responses against C. parvum, a proxy for exposure and infection; therefore, serologic responses against protozoa may be a suitable health outcome measure for WASH trials among children with diarrhea.

AB - Diarrhea is a leading contributor to childhood morbidity and mortality in sub-Saharan Africa. Given the challenge of blinding most water, sanitation, and hygiene (WASH) interventions, diarrheal disease outcome measures in WASH intervention trials are subject to potential bias and misclassification. Using the platform of a cluster-randomized controlled trial of a household-based drinking water filter in western province, Rwanda, we assessed the impact of the drinking water filter on enteric seroconversion in young children as a health outcome and examined the association between serologic responses and caregiver-reported diarrhea. Among the 2,179 children enrolledin the trial, 189 children 6-12 months of age were enrolled in a nested serology study. These children had their blood drawn at baseline and 6-12 months after the intervention was distributed. Multiplex serologic assays for Giardia, Cryptosporidium, Entamoeba histolytica, norovirus, Campylobacter, enterotoxigenic Escherichia coli and Vibrio cholerae were performed. Despite imperfect uptake, receipt of the water filter was associated with a significant decrease in seroprevalence of IgG directed against Cryptosporidium parvum Cp17 and Cp23 (relative risk [RR]: 0.62, 95% confidence interval [CI]: 0.44-0.89). Serologic responses were positively associated with reported diarrhea in the previous 7 days for both Giardia intestinalis (RR: 1.94, 95% CI: 1.04-3.63) and C. parvum (RR: 2.21, 95% CI: 1.09-4.50). Serologic responses for all antigens generally increased in the follow-up round, rising sharply after 12 months of age. The water filter is associated with reduced serologic responses against C. parvum, a proxy for exposure and infection; therefore, serologic responses against protozoa may be a suitable health outcome measure for WASH trials among children with diarrhea.

UR - http://www.scopus.com/inward/record.url?scp=85028983148&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028983148&partnerID=8YFLogxK

U2 - 10.4269/ajtmh.16-1006

DO - 10.4269/ajtmh.16-1006

M3 - Article

VL - 97

SP - 876

EP - 887

JO - American Journal of Tropical Medicine and Hygiene

JF - American Journal of Tropical Medicine and Hygiene

SN - 0002-9637

IS - 3

ER -