Hi
Just wanted to know whether recruitment is over in this project. Also wanted to find out if there is a gender component in the study.
Rgds
Sujatha

I just wanted to share a couple more papers (links below) that have been published from the WASH Benefits trials (apologies if you’ve already seen these!).

There are also two side events at the Stockholm World Water Week that will touch upon these ideas:

-Side event on WASH Benefits at WWW Stockholm. programme.worldwaterweek.org/event/8062-...ld-growth-and-health

-WaterAid-led side event panel regarding research methods and improving collaboration between govt, academics and practitioners (with: Steve Luby, Richard Carter, Khairul Islam, Sanya Tahmina, Guy Howard, Robert Dreibelbis). programme.worldwaterweek.org/event/7865-...esearch-and-practice

[Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh.BMC Trials, July 2018. Rigorous implementation of interventions deployed at large scale in the context of an efficacy trial achieved high levels of technology and behavioral uptake in individual and combined WASH and nutrition intervention households.
trialsjournal.biomedcentral.com/articles...86/s13063-018-2710-8

WASH Benefits Bangladesh trial: management structure for achieving high coverage in an efficacy trial. BMC Trials, July 2018. The intensive intervention delivery system required for an efficacy trial differs in many respects from the system for a routine program. To implement a routine program at scale requires further research on how to optimize the supervisor-to-CHW-to-intervention household ratios, as well as other program costs without compromising program effectiveness.
trialsjournal.biomedcentral.com/articles...86/s13063-018-2709-1

WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial. BMC Trials, July 2018. An intensive implementation fidelity monitoring and rapid response system proved beneficial for this efficacy trial. To implement a routine program at scale requires further research into an adaptation of fidelity monitoring that supports program effectiveness.
trialsjournal.biomedcentral.com/articles...86/s13063-018-2708-2

Dear Elisabeth,

Frankly, I love findings, and the counter-findings in other papers. They enhance my knowledge.

In this case, as I said above, the findings are breaking news - to borrow words from TV!!. I respect Dr. Luby. He worked in Karachi, and produced interesting papers.

If you come across with papers, having different views, please add them to his thread.

Regards,
F H Mughal

Thanks, Mughal, for bringing this paper to our attention.
I have now moved it into this thread which deals with the research project from which this publication was produced.

Interesting finding - and counter-inuitive. But I guess another example of the "elusive effects of health benefits from sanitation". We know that the positive health effects should be there with better sanitation - but unless everything is perfect in the study design, it is very hard to prove!

I wonder if this aspect could explain the lower effect on health improvements than expected (I copy from their conclusions):

Because the sanitation intervention targeted compounds with pregnant women, these interventions only reached about 10% of residents in villages where interventions were implemented. If a higher threshold of sanitation coverage is necessary to achieve herd protection, then this study design would preclude the detection of this effect. We used compounds as the unit of intervention because they enabled us to deliver intensive interventions with high adherence for thousands of newborn children. In addition, we expected compound-level faecal contamination to represent the dominant source of exposure for index children because of the physical separation of compounds, and because children younger than 2 years of age in these communities spent nearly all of their time in their own compound.

The RCT trial which the paper is reporting on was funded by the Bill & Melinda Gates Foundation and is part of the project called:

Measuring the benefits of water quality, sanitation, handwashing and nutritional interventions for improving health and child development (WASH Benefits)
2009 - 2017 • University of California - Berkeley (UCB)
www.susana.org/en/knowledge-hub/projects/database/details/192

Regards,
Elisabeth

Does Improved Sanitation Helps in Preventing Stunted Growth in Children?

It is a generally-accepted belief that improved sanitation improves the hygiene in a community, which in turn, is helpful in preventing stunted growth in children. However, it appears, this view is not quite valid.

A recent paper by Stephen Luby, et al. tiled: Effects of water quality, sanitation, handwashing, and
nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial; says somewhat otherwise. Stephen Luby worked for some time at Aga Khan hospital, Karachi.

Luby’s study found that children born into housing compounds with improvements in drinking water quality, sanitation and handwashing infrastructure were not measurably taller after two years compared to those born into compounds with more contamination – although children who received the interventions were significantly healthier overall. In a trial study, improving sanitation and hygiene in poor regions of Bangladesh helped children’s health but did not improve their growth and development.

This constitutes almost a breaking news! Forum users need to look at the study, available at: www.thelancet.com/journals/langlo/articl...(17)30490-4/fulltext, for more interesting details.

F H Mughal

Hi John,

Thanks for your interest in WASH Benefits. The primary outcome results were recently presented at the 2016 meeting of the American Society of Tropical Medical and Hygiene. We are in the process of submitting manuscripts to peer-reviewed journals. We post all publications on our website as soon as they are available (www.washbenefits.net), and we will also update the SuSanA forum as well. Please check either for updates later this year.

thanks, Jack Colford

Dear Colleagues at WASH Benefits,

"The trials are currently conducting their final round of outcome measurement. We anticipate primary results in late 2016 (Bangladesh) and mid 2017 (Kenya)."

Are there any results to share for the Bangladesh study?

Very best
John Brogan
Terre des hommes

We would like to add the following list of recent publications in the WASH Benefits study to this thread about our WASH Benefits project.

The following articles related to WASH Benefits were published in 2016. Please check here: www.washbenefits.net/publications.html for an up-to-date list of all publications related to the study.


++++++++++++

Vitamin B-12 Concentrations in Breast Milk Are Low and Are Not Associated with Reported Household Hunger, Recent Animal-Source Food, or Vitamin B-12 Intake in Women in Rural Kenya. Williams AM, Chantry CJ, Young SL, Achando BS, Allen LH, Arnold BF, Colford JM Jr, Dentz HN, Hampel D, Kiprotich MC, Lin A, Null CA,Nyambane GM, Shahab-Ferdows S, Stewart CP. J Nutr. 2016 May;146(5):1125-31. www.ncbi.nlm.nih.gov/pubmed/27075905

Hand- and Object-Mouthing of Rural Bangladeshi Children 3-18 Months Old. Kwong LH, Ercumen A, Pickering AJ, Unicomb L, Davis J, Luby SP. Int J Environ Res Public Health. 2016 Jun 4;13(6). www.ncbi.nlm.nih.gov/pubmed/27271651 #1 (NCBI)
www.mdpi.com/1660-4601/13/6/563/htm #2 (MDPI)

Soil-Transmitted Helminth Eggs Are Present in Soil at Multiple Locations within Households in Rural Kenya. Lauren Steinbaum, Sammy M. Njenga, Jimmy Kihara, Alexandria B. Boehm, Jennifer Davis, Clair Null, Amy J. Pickering. PLOS. Published: June 24, 2016.

journals.plos.org/plosone/article?id=10....journal.pone.0157780

Hygiene Practices During Food Preparation in Rural Bangladesh: Opportunities to Improve the Impact of Handwashing Interventions. Fosiul A. Nizame, Elli Leontsini, Stephen P. Luby, Md. Nuruzzaman, Shahana Parveen, Peter J. Winch, Pavani K. Ram, Leanne Unicomb. Published online June 13, 2016, doi: 10.4269/ajtmh.15-0377. Am J Trop Med Hyg 2016 vol. 95 no. 2 288-297.

www.ajtmh.org/content/95/2/288.abstract?etoc

Towards a Scalable and Sustainable Intervention for Complementary Food Safety. Rahman MJ, Nizame FA, Nuruzzaman M, Akand F, Islam MA, Parvez SM, Stewart CP, Unicomb L, Luby SP, Winch PJ. - Food and Nutrition Bulletin. 2016 Jun;37(2):186-201.

fnb.sagepub.com/content/early/2016/03/03...72116631641.abstract

Occurrence of Host-Associated Fecal Markers on Child Hands, Household Soil, and Drinking Water in Rural Bangladeshi Households. Alexandria B. Boehm, Dan Wang, Ayse Ercumen, Meghan Shea, Angela R. Harris, Orin C. Shanks, Catherine Kelty, Alvee Ahmed, Zahid Hayat Mahmud, Benjamin F. Arnold, Claire Chase, Craig Kullmann, John M. ColfordJr., Stephen P. Luby, and Amy J. Pickering. Publication Date (Web): October 13, 2016. Environ. Sci. Technol. Lett. DOI: 10.1021/acs.estlett.6b00382.

pubs.acs.org/doi/pdf/10.1021/acs.estlett.6b00382

Adapting and Evaluating a Rapid, Low-Cost Method to Enumerate Flies in the Household Setting. Marlene K. Wolfe, Holly N. Dentz, Beryl Achando, MaryAnne Mureithi, Tim Wolfe, Clair Null, Amy J. Pickering. Am J Trop Med Hyg 2016 16-0162.

www.ajtmh.org/content/early/2016/12/08/ajtmh.16-0162

Nonrandomized Trial of Feasibility and Acceptability of Strategies for Promotion of Soapy Water as a Handwashing Agent in Rural Bangladesh. Sania Ashraf, Fosiul A. Nizame, Mahfuza Islam, Notan C. Dutta, Dahlia Yeasmin, Sadika Akhter, Jaynal Abedin, Peter J. Winch, Pavani K. Ram, Leanne Unicomb, Elli Leontsini, Stephen P. Luby. Am J Trop Med Hyg 2016 16-0304.

www.ajtmh.org/content/early/2016/12/22/ajtmh.16-0304.abstract

+++++++++



Jade Benjamin-Chung, PhD
Epidemiologist
Colford Research Group
Division of Epidemiology
University of California, Berkeley

WASH Benefits Studies Published in 2016 – The WASH Benefits Study provides rigorous evidence on the health and developmental benefits of water quality, sanitation, handwashing, and nutritional interventions during the first years of life. The study includes two, cluster-randomized controlled trials to measure the impact of intervention among newborn infants in rural Bangladesh and Kenya. The studies are large in scope (> 5,000 newborns per country) and will measure primary outcomes after two years of intervention.

December 2016 – Adapting and Evaluating a Rapid, Low-Cost Method to Enumerate Flies in the Household Setting . Marlene K. Wolfe, Holly N. Dentz, Beryl Achando, MaryAnne Mureithi, Tim Wolfe, Clair Null, Amy J. Pickering. Am J Trop Med Hyg 2016 16-0162.

October 2016 – Occurrence of Host-Associated Fecal Markers on Child Hands, Household Soil, and Drinking Water in Rural Bangladeshi Households . Alexandria B. Boehm, Dan Wang, Ayse Ercumen, Meghan Shea, Angela R. Harris, Orin C. Shanks, Catherine Kelty, Alvee Ahmed, Zahid Hayat Mahmud, Benjamin F. Arnold, Claire Chase, Craig Kullmann, John M. Colford Jr., Stephen P. Luby, and Amy J. Pickering. Publication Date (Web): October 13, 2016. Environ. Sci. Technol. Lett. DOI: 10.1021/acs.estlett.6b00382.

June 2016 – Towards a Scalable and Sustainable Intervention for Complementary Food Safety . Rahman MJ, Nizame FA, Nuruzzaman M, Akand F, Islam MA, Parvez SM, Stewart CP, Unicomb L, Luby SP, Winch PJ. Food and Nutrition Bulletin. 2016 Jun;37(2):186-201.

June 2016 – Hygiene Practices During Food Preparation in Rural Bangladesh: Opportunities to Improve the Impact of Handwashing Interventions . Fosiul A. Nizame, Elli Leontsini, Stephen P. Luby, Md. Nuruzzaman, Shahana Parveen, Peter J. Winch, Pavani K. Ram, Leanne Unicomb. Published online June 13, 2016, doi: 10.4269/ajtmh.15-0377. Am J Trop Med Hyg 2016 vol. 95 no. 2 288-297.

June 2016 – Soil-Transmitted Helminth Eggs Are Present in Soil at Multiple Locations within Households in Rural Kenya . Lauren Steinbaum, Sammy M. Njenga, Jimmy Kihara, Alexandria B. Boehm, Jennifer Davis, Clair Null, Amy J. Pickering. PLOS ONE, Published: June 24, 2016.

June 2016 – Hand-and Object-Mouthing of Rural Bangladeshi Children 3–18 Months Old . Kwong LH, Ercumen A, Pickering AJ, Unicomb L, Davis J, Luby SP. Int J Environ Res Public Health. 2016 Jun 4;13(6).

May 2016 – Vitamin B-12 Concentrations in Breast Milk Are Low and Are Not Associated with Reported Household Hunger, Recent Animal-Source Food, or Vitamin B-12 Intake in Women in Rural Kenya . Williams AM, Chantry CJ, Young SL, Achando BS, Allen LH, Arnold BF, Colford JM Jr, Dentz HN, Hampel D, Kiprotich MC, Lin A, Null CA,Nyambane GM, Shahab-Ferdows S, Stewart CP. J Nutr. 2016 May;146(5):1125-31.

Thank you, Dr. Jack. I'll be looking forward to the final reports.

Regards,
F H Mughal

Thanks for your interest in our project.

Unfortunately, adding a third country at this stage of the study isn't possible. Several years of preparation were required to conduct the study in Kenya and Bangladesh in order to pilot the appropriate interventions. Carrying out such work in another country would require time and support far above the current resources of the project.

The study is being carried out according to a pre-specified analysis plan. Interim reports are not part of the plan because we do not want to introduce any bias into the subsequent collection of data.

Thank you, Dr. Jack. I'm not sure, whether it would be possible for you, at this stage, to add a third country (e.g., Pakistan).

I believe, the final report(s) would be issued in Sep 2017. Perhaps, you may consider issuing interim reports.

Regards,

F H Mughal