Household-level risk factors for water contamination and antimicrobial resistance in drinking water among households with children under 5 in rural San Marcos, Cajamarca, Peru.

Household water contamination at point of use depends on human, animal and environmental factors embodying all aspects of a One Health approach. This study investigated the association between household factors, the presence of thermotolerant coliform, and the presence of antibiotic resistant bacteria in drinking water among 314 households with children under 5 in Cajamarca, Peru. This study analysed data from a baseline sampling of a randomized controlled trial, including household surveys covering household water management and factors such as household animals, as well as microbiological data from samples collected from drinking water. Data were analysed using generalized linear models. Drinking water samples collected from narrow-mouthed containers were less likely to be contaminated than samples collected from the faucet (OR = 0.55, p = 0.030) or wide mouthed containers. The presence of thermotolerant coliform was associated with owning farm birds, which increased the proportion of contamination from 42.2% to 59.1% (OR = 1.98, p = 0.017) and with animal waste observed in the kitchen area, which increased the prevalence of contamination from 51.4% to 65.6% (OR = 1.80, p = 0.024). Resistance to any antibiotic was higher among pig owners at 60%, relative to non-pig owners at 36.4% (OR = 1.97, p = 0.012) as well as households with free-roaming animals in the kitchen area at 59.6% compared to households without free-roaming animals at 39.7% (OR = 2.24, p = 0.035). Recent child antibiotic use increased the prevalence of trimethoprim-sulfamethoxazole resistance among E. coli isolates to 22.3% relative to 16.7% (OR = 3.00, p = 0.037). Overall, these findings suggest that water storage in a secure container to protect from in-home contamination is likely to be important in providing safe drinking water at point of use. In addition, transmission of thermotolerant coliform and AMR between domestic animals and human drinking water supplies is likely. Further research should explore transmission pathways and methods to support safe drinking water access in multi-species households.

Improving household air, drinking water and hygiene in rural Peru: a community-randomized-controlled trial of an integrated environmental home-based intervention package to improve child health.

Background: Diarrhoea and acute lower respiratory infections are leading causes of childhood morbidity and mortality, which can be prevented by simple low-cost interventions. Integrated strategies can provide additional benefits by addressing multiple health burdens simultaneously. Methods: We conducted a community-randomized-controlled trial in 51 rural communities in Peru to evaluate whether an environmental home-based intervention package, consisting of improved solid-fuel stoves, kitchen sinks, solar disinfection of drinking water and hygiene promotion, reduces lower respiratory infections, diarrhoeal disease and improves growth in children younger than 36 months. The attention control group received an early child stimulation programme. Results: We recorded 24 647 child-days of observation from 250 households in the intervention and 253 in the attention control group during 12-month follow-up. Mean diarrhoea incidence was 2.8 episodes per child-year in the intervention compared with 3.1 episodes in the control arm. This corresponds to a relative rate of 0.78 [95% confidence interval (CI): 0.58-1.05] for diarrhoea incidence and an odds ratio of 0.71 (95% CI: 0.47-1.06) for diarrhoea prevalence. No effects on acute lower respiratory infections or children's growth rates were observed. Conclusions: Combined home-based environmental interventions slightly reduced childhood diarrhoea, but the confidence interval included unity. Effects on growth and respiratory outcomes were not observed, despite high user compliance of the interventions. The absent effect on respiratory health might be due to insufficient household air quality improvements of the improved stoves and additional time needed to achieve attitudinal and behaviour change when providing composite interventions.

Chimney stoves modestly improved indoor air quality measurements compared with traditional open fire stoves: results from a small-scale intervention study in rural Peru.

Nearly half of the world's population depends on biomass fuels to meet domestic energy needs, producing high levels of pollutants responsible for substantial morbidity and mortality. We compare carbon monoxide (CO) and particulate matter (PM2.5) exposures and kitchen concentrations in households with study-promoted intervention (OPTIMA-improved stoves and control stoves) in San Marcos Province, Cajamarca Region, Peru. We determined 48-h indoor air concentration levels of CO and PM2.5 in 93 kitchen environments and personal exposure, after OPTIMA-improved stoves had been installed for an average of 7 months. PM2.5 and CO measurements did not differ significantly between OPTIMA-improved stoves and control stoves. Although not statistically significant, a post hoc stratification of OPTIMA-improved stoves by level of performance revealed mean PM2.5 and CO levels of fully functional OPTIMA-improved stoves were 28% lower (n = 20, PM2.5, 136 µg/m(3) 95% CI 54-217) and 45% lower (n = 25, CO, 3.2 ppm, 95% CI 1.5-4.9) in the kitchen environment compared with the control stoves (n = 34, PM2.5, 189 µg/m(3), 95% CI 116-261; n = 44, CO, 5.8 ppm, 95% CI 3.3-8.2). Likewise, although not statistically significant, personal exposures for OPTIMA-improved stoves were 43% and 17% lower for PM2.5 (n = 23) and CO (n = 25), respectively. Stove maintenance and functionality level are factors worthy of consideration for future evaluations of stove interventions.

A community randomised controlled trial evaluating a home-based environmental intervention package of improved stoves, solar water disinfection and kitchen sinks in rural Peru: rationale, trial design and baseline findings.

INTRODUCTION: Pneumonia and diarrhoea are leading causes of death in children. There is a need to develop effective interventions. OBJECTIVE: We present the design and baseline findings of a community-randomised controlled trial in rural Peru to evaluate the health impact of an Integrated Home-based Intervention Package in children aged 6 to 35 months. METHODS: We randomised 51 communities. The intervention was developed through a community-participatory approach prior to the trial. They comprised the construction of improved stoves and kitchen sinks, the promotion of hand washing, and solar drinking water disinfection (SODIS). To reduce the potential impact of non-blinding bias, a psychomotor stimulation intervention was implemented in the control arm. The baseline survey included anthropometric and socio-economic characteristics. In a sub-sample we determined the level of faecal contamination of drinking water, hands and kitchen utensils and the prevalence of diarrhoegenic Escherichia coli in stool specimen. RESULTS: We enrolled 534 children. At baseline all households used open fires and 77% had access to piped water supplies. E. coli was found in drinking water in 68% and 64% of the intervention and control households. Diarrhoegenic E. coli strains were isolated from 45/139 stool samples. The proportion of stunted children was 54%. CONCLUSIONS: Randomization resulted in comparable study arms. Recently, several critical reviews raised major concerns on the reliability of open health intervention trials, because of uncertain sustainability and non-blinding bias. In this regard, the presented trial featuring objective outcome measures, a simultaneous intervention in the control communities and a 12-month follow up period will provide valuable evidence.