Associations between open drain flooding and pediatric enteric infections in the MAL-ED cohort in a low-income, urban neighborhood in Vellore, India

• Type of Material: Article
• Authors: David Berendes, Emory University; Juan Leon, Emory University; Amy Kirby, Emory University; Julie Clennon, Emory University; Suraja J. Raj, Emory University; Habib Yakubu, Emory University; Katharine A. Robb, Emory University; Arun Kartikeyan, Christian Medical College; Priya Hemavathy, Christian Medical College; Annai Gunasekaran, Christian Medical College; Sheela Roy, Christian Medical College; Ben Chirag Ghale, Christian Medical College; J. Senthil Kumar, Christian Medical College; Venkata Raghava Mohan, Christian Medical College; Gagandeep Kang, Christian Medical College; Christine Moe, Emory University
• Language: English
• Date: 2019-07-10
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s).
• Final Published Version (URL): http://dx.doi.org/10.1186/s12889-019-7268-1
• Title of Journal or Parent Work: BMC Public Health
• ISSN: 1471-2458
• Volume: 19
• Issue: 1
• Start Page: 926
• End Page: 926
• Grant/Funding Information: The SaniPath study was funded by the Bill and Melinda Gates Foundation, OPP1016151.; The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH and the National Institutes of Health/Fogarty International Center.
• Keywords: CHILDREN; ACCRA; Enteric infections; PATHOGENS; RISK; Urban infrastructure; Life Sciences & Biomedicine; CONTAMINATION; DRINKING-WATER; CHILDHOOD DIARRHEA; Science & Technology; BIRTH COHORT; Pediatric health; Public, Environmental & Occupational Health; Open drains; Flooding; FECAL SLUDGE MANAGEMENT; SANITATION; Environmental contamination
• Research Categories: Environmental Sciences; Biology, Biostatistics; Health Sciences, Public Health

Abstract

Background: Open drains are common methods of transporting solid waste and excreta in low-income urban neighborhoods. Open drains can overflow due to blockages with solid waste and during rainfall, posing exposure risks. The goal of this study was to evaluate whether pediatric enteric infection was associated with open drains and flooding in a dense, low-income, urban neighborhood. Methods: As part of the MAL-ED study in Vellore, India, a cohort of 230 children provided stool specimens at 14-17 scheduled home visits and during diarrheal episodes in the first two years of life. All specimens were analyzed for enteric pathogens. Caregivers in 100 households reported on flooding of drains and households and monthly frequency of contact with open drains and flood water. Household GPS points were collected. Monthly rainfall totals for the Vellore district were collected from the Indian Meteorological Department. Clustering of reported drain and house flooding were identified by Kulldorff's Bernoulli Spatial Scan. Differences in enteric infection were assessed for household responses and spatial clusters, with interactions between reported flooding and rainfall to approximate monthly drain flooding retrospectively, using multivariable, mixed-effects logistic regression models. Results: Coverage of household toilets was low (33%), and most toilets (82%) discharged directly into open drains, suggesting poor neighborhood fecal sludge management. Odds of enteric infection increased significantly with total monthly rainfall for children who lived in households that reported that the nearby drain flooded (4% increase per cm of rain: OR: 1.04, 95% CI: 1.00-1.08) and for children in households in a downstream spatial cluster of reported drain flooding (5% increase per cm of rain: OR: 1.05, 95% CI: 1.01-1.09). There was no association between odds of enteric infection and frequency of reported contact with drain or floodwater. Conclusions: Children in areas susceptible to open drain flooding had increased odds of enteric infection as rainfall increased. Results suggested that infection increased with rainfall due to neighborhood infrastructure (including poor fecal sludge management) and not frequency of contact. Thus, these exposures may not be mitigated by changes in personal behaviors alone. These results underscore the importance of improving the neighborhood environment to improve children's health in low-income, urban settings.