Multivariate analysis of observed handwashing behavior and subsequent diarrhea.

a<p>Odds ratio was calculated using a general estimated equations model that accounted for neighborhood clustering and repeated household sampling using a nested correlation structure.</p

Characteristics of participating households, rural Bangladesh 2007.

a<p>Items used to construct the wealth index.</p

Distribution of handwashing by most thorough behavior observed versus all observations.

<p>Distribution of handwashing by most thorough behavior observed versus all observations.</p

Bivariate relationship between baseline characteristics and observed handwashing behaviors with subsequent diarrhea among children under age 5 y in the ensuing 24 mo.

a<p>When multiple handwash opportunities were observed in the same household, the household's handwashing behavior was classified on the basis of the most thorough handwashing behavior observed.</p>b<p>Adjusted for repeated measures of the same child and village clustering.</p>c<p>There were 24 fewer observations in the analysis with fathers' education, because there data were missing for one of the households.</p>d<p>Optimal hand drying (air drying or drying with a clean towel) was compared with hands not dried or dried on dirty towel or clothing; this analysis was restricted to episodes where handwashing was observed.</p>e<p>Washed one hand with water only was selected as the baseline category because too few people did not wash their hands at all to permit robust statistical evaluation.</p

Criteria for assigning causes of death, Dhaka city, Bangladesh, 2006 & 2007.

<p>Criteria for assigning causes of death, Dhaka city, Bangladesh, 2006 & 2007.</p

Comparison of causes of under-five mortalities in urban Dhaka 2006–2007 with BDHS 2004.

a<p>Includes all deaths in the first 3 d of life and deaths after 3 d of life that were considered due to congenital anomaly, pre-maturity and complications of delivery.</p>b<p>Confirmed diagnosis and Possible diagnosis merged together.</p>c<p>Possible serious infections include possible ARI and diarrhea.</p>d<p>Causes includes umbilical hemorrhage (1), hemorrhage disorder of newborn (3), otitis media (1), neonatal malnutrition (1), intestinal obstruction (1), aspiration pneumonia (1), and congenital heart disease (1).</p

Comparison of mortality in different recall periods, urban Dhaka, Bangladesh.

<p>Comparison of mortality in different recall periods, urban Dhaka, Bangladesh.</p

The Interaction of Deworming, Improved Sanitation, and Household Flooring with Soil-Transmitted Helminth Infection in Rural Bangladesh

<div><p>Background</p><p>The combination of deworming and improved sanitation or hygiene may result in greater reductions in soil-transmitted helminth (STH) infection than any single intervention on its own. We measured STH prevalence in rural Bangladesh and assessed potential interactions among deworming, hygienic latrines, and household finished floors.</p><p>Methodology</p><p>We conducted a cross-sectional survey (n = 1,630) in 100 villages in rural Bangladesh to measure three exposures: self-reported deworming consumption in the past 6 months, access to a hygienic latrine, and household flooring material. We collected stool samples from children 1–4 years, 5–12 years, and women 15–49 years. We performed mini-FLOTAC on preserved stool samples to detect <i>Ascaris lumbricoides</i>, <i>Enterobius vermicularis</i>, hookworm, and <i>Trichuris trichiura</i> ova. Approximately one-third (32%) of all individuals and 40% of school-aged children had an STH infection. Less than 2% of the sample had moderate/heavy intensity infections. Deworming was associated with lower <i>Ascaris</i> prevalence (adjusted prevalence ratio (PR) = 0.53; 95% CI 0.40, 0.71), but there was no significant association with hookworm (PR = 0.93, 95% CI 0.60, 1.44) or <i>Trichuris</i> (PR = 0.90, 95% CI 0.74, 1.08). PRs for hygienic latrine access were 0.91 (95% CI 0.67,1.24), 0.73 (95% CI 0.43,1.24), and 1.03 (95% CI 0.84,1.27) for <i>Ascaris</i>, hookworm, and <i>Trichuris</i>, respectively. Finished floors were associated with lower <i>Ascaris</i> prevalence (PR = 0.56, 95% CI 0.32, 0.97) but not associated with hookworm (PR = 0.48 95% CI 0.16,1.45) or <i>Trichuris</i> (PR = 0.98, 95% CI 0.72,1.33). Across helminths and combinations of exposures, adjusted prevalence ratios for joint exposures were consistently more protective than those for individual exposures.</p><p>Conclusions</p><p>We found moderate STH prevalence in rural Bangladesh among children and women of childbearing age. This study is one of the first to examine independent and combined associations with deworming, sanitation, and hygiene. Our results suggest that coupling deworming with sanitation and flooring interventions may yield more sustained reductions in STH prevalence.</p></div

Helminth infection prevalence by age, helminth, and infection intensity.

<p>aIncludes <i>Enterobius</i> infections</p><p>Helminth infection prevalence by age, helminth, and infection intensity.</p

Cluster-level STH prevalence by cluster-level hygienic latrine coverage.

<p>Panel A shows the cluster-level prevalence of <i>Ascaris</i>, Panel B shows the prevalence of hookworm, and Panel C shows the prevalence of <i>Trichuris</i> by the proportion of respondents with hygienic latrines in each cluster.</p