Pathways through which water, sanitation, hygiene, and nutrition interventions reduce antibiotic use in young children: a mediation analysis of a cohort nested within a cluster-randomized trial
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Le résumé fourni par la source
Background: Low-cost, household-level water, sanitation, and hygiene (WASH) and nutrition interventions can reduce pediatric antibiotic use, but the mechanism through which interventions reduce antibiotic use has not been investigated. Methods: We conducted a causal mediation analysis using data collected between September 2013 and October 2015 from a cohort nested within the WASH Benefits Bangladesh cluster-randomized trial (NCT01590095). Among a subsample of children within the WASH, nutrition, nutrition + WASH, and control arms (N = 1409 children; 267 clusters), we recorded caregiver-reported antibiotic use at ages 14 and 28 months and collected stool at age 14 months. Our primary outcome was any caregiver-reported antibiotic use by index children within the past 30 or 90 days measured at age 14 and 28 months. Mediators included caregiver-reported child diarrhea, acute respiratory infection (ARI), and fever; and enteric pathogen carriage in stool measured by qPCR. Both intervention-mediator and mediator-outcome models were controlled for mediator-outcome confounders. Findings: The receipt of any WASH or nutrition intervention reduced caregiver-reported antibiotic use through all pathways in the past month by 5.5 percentage points (95% CI 1.2, 9.9), from 49.5% (95% CI 45.9%, 53.0%) in the control group to 45.0% (95% CI 42.7%, 47.2%) in the pooled intervention group. When separating this effect into different pathways, we found that interventions reduced antibiotic use by 0.6 percentage points (95% CI 0.1, 1.3) through reduced diarrhea, 0.7 percentage points (95% CI 0.1, 1.5) through reduced ARI with fever, and 1.5 percentage points (95% CI 0.4, 3.0) through reduced prevalence of enteric viruses. Interventions reduced antibiotic use through any of these measured mediators by 2.1 percentage points (95% CI -0.3, 4.5). Interpretation: WASH and nutrition interventions reduced pediatric antibiotic use through the prevention of enteric and respiratory infections in a rural, low-income population. Given that many of these infections are caused by viruses or parasites, WASH and nutrition interventions may help reduce inappropriate antibiotic use in similar settings. Funding: Bill & Melinda Gates Foundation, National Institute of Allergy and Infectious Diseases.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Pathways through which water, sanitation, hygiene, and nutrition interventions reduce antibiotic use in young children: a mediation analysis of a cohort nested within a cluster-randomized trial
- Date Crossref
- 01/04/2025
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Stanford University pays non établi dans la noticeUniversité ou école supérieure
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University of California Francis I. Proctor Foundation and Department of Ophthalmology pays non établi dans la noticeUniversité ou école supérieure
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International Centre for Diarrhoeal Disease Research pays non établi dans la noticeStructure de recherche
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San Francisco Foundation pays non établi dans la noticeOrganisation à but non lucratif
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North Carolina State University Department of Forestry and Environmental Resources pays non établi dans la noticeUniversité ou école supérieure
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Chan Zuckerberg Initiative (United States) pays non établi dans la noticeEntreprise
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School of Medicine Department of Epidemiology and Population Health pays non établi dans la noticeUniversité ou école supérieure
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School of Public Health Division of Epidemiology and Biostatistics pays non établi dans la noticeUniversité ou école supérieure
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Environmental Interventions Unit pays non établi dans la noticeInstitution
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Department of Microbiology and Environmental Toxicology pays non établi dans la noticeInstitution
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Infectious Disease Division pays non établi dans la noticeInstitution
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Chan Zuckerberg Biohub pays non établi dans la noticeInstitution
Stanford University, Francis I. Proctor Foundation and Department of Ophthalmology — University of California et International Centre for Diarrhoeal Disease Research, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.