Water, Sanitation, Hygiene, Nutrition (Bangladesh & Kenya)

The WASH-Benefits study took place in Bangladesh and Kenya, and were cluster-randomized trials represent a large-scale collaboration, with colleagues from UC Berkeley, UC Davis, Stanford, Emory, Johns Hopkins, and the ICDDR,B in Bangladesh.  In these studies, enrolling over 10,000 pregnant women from villages in rural Bangladesh and Kenya, we assessed whether water quality, sanitation, handwashing and nutrition interventions reduced diarrhea or improved growth among children when they were 1-2 years old. We are currently following up the children when they are 4-5 years old.

Collaborators: Steve Luby (Stanford), Mahbubur Rahman (icddr,b), Fahmida Tofail (icddr,b), Peter Winch (Johns Hopkins), Jenna Forsyth (Stanford), Laura (Layla) Kwong (Berkeley), Christine Stewart (UC Davis).

Findings 

The WASH-Benefits findings relating to health outcomes in Kenya (Lancet Global Health), and Bangladesh (Lancet Global Health), were not as substantial as expected, based on what we had hypothesized, although there were effects on diarrhea and stunting prevalence. We did not find effects on cognitive outcomes in Kenya, (Lancet Child and Adolescent Health), but we did find benefits of the WASH-B interventions in Bangladesh (Lancet Child and Adolescent Health). Our most interesting finding was that all interventions, when delivered either individually or in combination, contributed to improvements in child development in Bangladesh, and that these results are likely to have been driven by reductions in maternal depression. Several other analyses are underway, two of which have been published about telomere length (eLife and eLife). We have recently secured additional funding from the Bill and Melinda Gates Foundation and the National Institutes of Child Health and Human Development to follow-up the children to examine whether the cognitive development are sustained, using a collection of tests looking at cognitive, language and social-emotional development. We will also use our data, some of which was collected before the pandemic and some of which was collected during the pandemic, to explore effects of the pandemic on child development.

Publications: 

Tofail, F., Fernald, L.C.H., Das, K.K., Rahman, M., Unicomb, L., Arnold, B.F., Ashraf, S., Winch, P.J., Kariger, P.K., Stewart, C.P., Colford, J.M., Luby, S.P.  Effects of water quality, sanitation, hand washing and nutrition interventions on child development in rural Bangladesh: a cluster randomized trial. Lancet Child and Adolescent Health (2018) Apr;2(4):255-268.

Stewart, C.P., Kariger, P., Fernald, L.C.H., Pickering, A.J., Arnold, C.D., Arnold, B.F., Hubbard, A.E., Dentz, H.N., Lin, A., Meerkerk, T.J., Milner, E., Swarthout, J., Colford, J.M., Null, C.  Effects of water, sanitation, handwashing, and nutritional interventions on child development: a cluster-randomized controlled trial in rural Kenya. Lancet Child and Adolescent Health (2018) Apr;2(4):269-280.

Null, C., Stewart, C.P., Pickering, A.J., Dentz, H.N., Arnold, B.F., Arnold, C.D., Benjamin-Chung, J., Clasen, T., Dewey, K.G., Fernald, L.C.H., Hubbard, A.E., Kariger, P., Lin, A., Luby, S.P., Mertens, A., Njenga,S.M., Nyambane, G., Ram, P.K., and Colford, J.M.  Effects of water quality, sanitation, handwashing and nutritional interventions on diarrhoea and child growth in rural Kenya: A cluster randomized trial.  Lancet Global Health (2018) Mar;6(3):e316-e329.

Luby, S., Mahbubur Rahman; Benjamin F Arnold, PhD; Unicomb Leanne, PhD; Sania Ashraf, MPH; Peter J Winch, PM; Christine P Stewart, PhD; Farzana  Begum, MPH; Faruqe Hussain, MSS; Jade Benjamin-Chung; Elli Leontsini; Abu M Naser; Sarker M Parvez; Alan E Hubbard; Audrie Lin; Fosiul A Nizame; Kaniz Jannat; Ayse Ercumen; Pavani K Ram; Kishor K Das; Jaynal Abedin; Thomas F Clasen; Kathryn G Dewey; Fernald, L.C.H.; Clair Null; Tahmeed Ahmed; John M Colford.  Effects of water quality, sanitation, handwashing and nutritional interventions on diarrhoea and child growth in rural Bangladesh: A cluster randomized trial. Lancet Global Health (2018) Mar;6(3):e302-e315.

Lin, A., Arnold, B.F., Mertens, A.N., Lin, J., Benjamin-Chung, J., Ali, S., Hubbard, A. E., Stewart, C.P., Shoab, A.K., Rahman, M. Z., Hossen, M.S., Mutsuddi, P., Famida, S.L., Akther, S.,  Rahman, M., Parvez, S.M., Unicomb, L., Dhabhar, F.S., Kariger, P.K., Fernald, L.C.H.,  Colford, J.M., Luby, S. Effects of a water quality, sanitation, handwashing and nutritional intervention on telomere length among children in Bangladesh. eLife (2017) Oct 5; 6.

Lin, A., Arnold, B.F., Mertens, A.N., Lin, J., Benjamin-Chung, J., Ali, S., Hubbard, A. E., Stewart, C.P., Shoab, A.K., Rahman, M. Z., Hossen, M.S., Mutsuddi, P., Famida, S.L., Akther, S.,  Rahman, M., Parvez, S.M., Unicomb, L., Dhabhar, F.S., Kariger, P.K., Fernald, L.C.H.,  Luby, S., Colford, J.M. Telomere length is associated with growth in children in rural Bangladesh. eLife (2021) 

Funders: Bill and Melinda Gates Foundation, National Institutes of Child Health and Human Development.