The effects of an integrated nutrition-sensitive WASH, gender and poultry-value chain intervention on enteropathogen carriage in Burkinabe children: A secondary outcome analysis of the SELEVER cluster-randomized trial

BACKGROUND: We examined effects of a 3-year poultry- and livestock-focused Water, Sanitation and Hygiene intervention (WASH) on enteropathogen prevalence and density (SELEVER trial; ISRCTN16686478). METHODS: Clusters of peri-urban and rural Burkinabe households were randomly assigned to: Control (no intervention), SELEVER (poultry rearing, nutrition, basic hygiene practices, and women empowerment) and SELEVER+WASH (additional intensive poultry- and livestock-focused community-led total sanitation). Base- and endline fecal samples were collected from children aged 24-59 months and analyzed using real-time qPCR to detect and quantify 24 enteropathogen targets. Analysis of effects on enteropathogen carriage and density was by intent to treat using logistic, log-linear and two-part regression. RESULTS: We enrolled 1,054 children and analyzed 883 children with endline fecal samples (attrition 15.0%). Almost all children (94.6%) were infected with at least one pathogen. Children in SELEVER+WASH arm had lower prevalence of Shigella/EIEC infection and unconditional mean DNA content compared to control (prevalence difference: -9.0%, 95% CI: -15.4%, -2.6%; unconditional DNA content: -56.5%, 95% CI: -78.8%, -11.1%) and SELEVER arms (prevalence difference: -7.7%, 95% CI: -14.2%, -1.3%; unconditional DNA content: -67.5%, 95% CI: -86.0%, -24.2%). Prevalence and unconditional DNA density of Hymenolepis nana was also lower in the SELEVER+WASH arm compared to control (prevalence difference: -4.9%, 95% CI: -9.4%, -0.5%; unconditional mean DNA content: -52.4%, 95% CI: -77.0%, -1.4%) and SELEVER (prevalence difference: -5.2%, 95% CI: -9.8%, -0.6%; unconditional mean DNA content: -52.7%, 95% CI: -79.0%, -0.7%). CONCLUSIONS: A poultry- and livestock-focused WASH intervention was associated with reductions in prevalence and density of Shigella/EIEC and Hymenolepis nana infections in young children in Burkina Faso.