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WASH Benefits Bangladesh

Primary Purpose

Malnutrition, Diarrhea, Child Development

Status
Active
Phase
Not Applicable
Locations
Bangladesh
Study Type
Interventional
Intervention
Water quality
Sanitation
Hand washing
Water quality, Sanitation, Hand washing (Combined WASH)
Nutrition
Nutrition, Water quality, Sanitation, Hand washing
Sponsored by
International Centre for Diarrhoeal Disease Research, Bangladesh
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Malnutrition focused on measuring Chlorine water treatment, Point-of-use water treatment, Household water treatment with safe storage, Hand washing with soap, Hand hygiene, Latrines, Child potties, Point-of-use fortification, Lipid-based nutrient supplement, Environmental enteropathy, Tropical enteropathy, Gut function, Intestinal parasitic infection, Soil transmitted helminths, Intestinal protozoans, Antibody response, Water, Sanitation, Hand washing, Breast Feeding, Complementary Feeding, Micronutrients, Malnutrition, Nutrition Disorders, Diarrhea, Child Development

Eligibility Criteria

1 Day - 63 Years (Child, Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

(1) Infants (target child) will be eligible to participate in the study if they are:

  1. They are in utero at the baseline survey
  2. Their parents/guardians are planning to stay in the study village for the next 12 months (if a mother is planning to give birth at her natal home and then return, she will still be a candidate for enrollment)

(2) Children < 36 months old at baseline that are living in the compound of a target child will be eligible to participate in diarrhea measurement if:

  1. They are < 36 months old at the baseline survey
  2. Their parents/guardians are planning to stay in the study village for the next 12 months

(3) Children 18 - 27 months old at baseline that are living in the compound of a target child will be eligible to participate in intestinal parasite specimen collection if:

  1. They are 18 - 27 months old at the baseline survey
  2. Their parents/guardians are planning to stay in the study village for the next 12 months

Sites / Locations

  • Dr. Mahbubur Rahman

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm Type

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Active Comparator

No Intervention

Arm Label

Water quality

Sanitation

Hand washing

Combined WASH

Nutrition

Nutrition + Combined WASH

Non-intervention

Arm Description

90 clusters, approx. 720 newborns

90 clusters, approx. 720 newborns

90 clusters, approx. 720 newborns

90 clusters, approx. 720 newborns

90 clusters, approx. 720 newborns

90 clusters, approx. 720 newborns

180 clusters, approx. 1,440 newborns

Outcomes

Primary Outcome Measures

Length-for-Age Z-scores
Child's recumbent length, standardized to Z-scores using the WHO 2006 growth standards, measured 24monthsafter intervention. Measurement techniques follow the FANTA 2003 protocol.
Diarrhea Prevalence Diarrhea Prevalence Diarrhea Prevalence Diarrhea Prevalence
Diarrhea is defined as 3+ loose or watery stools in 24 hours or 1+ stools with blood in 24 hours. Diarrhea will be measured in interviews using caregiver-reported symptoms with 2-day and 7-day recall, measured 12- and 24-monthsafter intervention.

Secondary Outcome Measures

Length-for-Age Z-scores
Child's recumbent length, standardized to Z-scores using the WHO 2006 growth standards, measured 12monthsafter intervention. Measurement techniques follow the FANTA 2003 protocol.
Stunting Prevalence
Child's recumbent length, standardized to Z-scores using the WHO 2006 growth standards, measured 24monthsafter intervention. Measurement techniques follow the FANTA 2003 protocol. Children with length-for-age Z-scores < - 2 will be classified as stunted.
Enteropathy Biomarkers
The lactulose / mannitol dual sugar permeability test will be administered to children. The ratio of the recovery of the two sugars in the urine will be used to calculate the L:M ratio, and we will compare groups using logged values of the ratio. We will additionally measure Total IgG antibody titers in the blood, and we will compare groups using logged values of the antibody levels.
ASQ Child Development Scores
Interviewers will administer a locally adapted version of the Ages and Stages Questionnaire (ASQ)to children after 24 months of intervention. The ASQ includes item sets of caregiver-reported milestones that measure child development in three separate domains (gross motor, communication, personal/social skills).

Full Information

First Posted
April 30, 2012
Last Updated
April 12, 2022
Sponsor
International Centre for Diarrhoeal Disease Research, Bangladesh
Collaborators
University of California, Berkeley, University of California, Davis, Stanford University, Emory University, Innovations for Poverty Action
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1. Study Identification

Unique Protocol Identification Number
NCT01590095
Brief Title
WASH Benefits Bangladesh
Official Title
WASH Benefits Bangladesh: A Cluster Randomized Controlled Trial of the Benefits of Water, Sanitation, Hygiene Plus Nutrition Interventions on Child Growth
Study Type
Interventional

2. Study Status

Record Verification Date
January 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
May 2012 (undefined)
Primary Completion Date
December 2022 (Anticipated)
Study Completion Date
December 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
International Centre for Diarrhoeal Disease Research, Bangladesh
Collaborators
University of California, Berkeley, University of California, Davis, Stanford University, Emory University, Innovations for Poverty Action

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Brief Summary: The purpose of this study is to measure the independent and combined effects of interventions that improve water quality, sanitation, hand washing, and nutrition on child growth and development in the first years of life.
Detailed Description
Detailed Description: Infection and inadequate diet are proximate risk factors for under-nutrition and early life growth faltering; the two processes likely act reciprocally in a vicious cycle that perpetuates physiologic and metabolic deficits and increases the risk of mortality. Children who exhibit growth faltering are more likely to have deficits in cognitive development and long-term human capital, and are more likely to have children who also suffer from growth deficits - perpetuating the cycle into the next generation. There are two probable interdependent pathways that link enteric infections to child growth and development. The first pathway includes repeated infections the lead to acute illness or parasitic infection in the first years of life, which increase the risk of stunting and subsequent cognitive deficits in childhood and later in life. The second pathway is through a subclinical condition called environmental enteropathy (EE). There is limited evidence to demonstrate whether or not water quality, sanitation, and hand washing (WASH) interventions can improve measures of EE, child growth and development, and whether nutritional interventions could be enhanced if provided concurrently with WASH interventions. To help fill this evidence gap, the WASH Benefits study will deliver randomized interventions designed to reduce infection and improve nutrition, and will measure intervention effects on child illness, growth and development. WASH Benefits includes two, comparable but standalone trials in Bangladesh and Kenya that are registered under separate protocols. In Bangladesh, the study will include 720 clusters, and each cluster will enroll 8 household compounds (baris) with pregnant women in their second or third trimester. The study will randomize 90 clusters to each of 6 active intervention arms (water quality, sanitation, hand washing, combined WSH, nutrition, nutrition+WSH), and 180 clusters to a standard practices non-intervention arm. Children born into the cohort will be followed for 2 years after the intervention, with measurements at 12 and 24 months after intervention delivery. (anticipated age range: 20 - 27 months old at the final measurement). At the 12- and 24-month follow-up visits, the study will collect child anthropometric measurements and caregiver-reported diarrhea. In the final visit the study will administer a test to measure child development outcomes. The study will collect urine, blood, and stool specimens from a subsample of 1,500 children distributed across four arms of the study (Control, combined WSH, Nutrition, Nutrition+WSH) to measure biomarkers of gut function and intestinal parasitic infections at the 12- and 24-month follow-up visits. In addition, the study will collect specimens (blood, stool) from children 18 - 27 months old at baseline who are living in the same compound as target children to test for intestinal parasitic infections. At 24-months in all arms, the study will collect specimens stool from target children, children 18 - 27 months old at baseline, a school-aged child, and an adult who are living in the same compound as target children to test for intestinal parasitic infections. At 36-months in all arms, the study will collect specimens stool from target children, a school-aged child, and an adult who are living in the same compound as target children to test for intestinal parasitic infections.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malnutrition, Diarrhea, Child Development
Keywords
Chlorine water treatment, Point-of-use water treatment, Household water treatment with safe storage, Hand washing with soap, Hand hygiene, Latrines, Child potties, Point-of-use fortification, Lipid-based nutrient supplement, Environmental enteropathy, Tropical enteropathy, Gut function, Intestinal parasitic infection, Soil transmitted helminths, Intestinal protozoans, Antibody response, Water, Sanitation, Hand washing, Breast Feeding, Complementary Feeding, Micronutrients, Malnutrition, Nutrition Disorders, Diarrhea, Child Development

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
5040 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Water quality
Arm Type
Active Comparator
Arm Description
90 clusters, approx. 720 newborns
Arm Title
Sanitation
Arm Type
Active Comparator
Arm Description
90 clusters, approx. 720 newborns
Arm Title
Hand washing
Arm Type
Active Comparator
Arm Description
90 clusters, approx. 720 newborns
Arm Title
Combined WASH
Arm Type
Active Comparator
Arm Description
90 clusters, approx. 720 newborns
Arm Title
Nutrition
Arm Type
Active Comparator
Arm Description
90 clusters, approx. 720 newborns
Arm Title
Nutrition + Combined WASH
Arm Type
Active Comparator
Arm Description
90 clusters, approx. 720 newborns
Arm Title
Non-intervention
Arm Type
No Intervention
Arm Description
180 clusters, approx. 1,440 newborns
Intervention Type
Behavioral
Intervention Name(s)
Water quality
Intervention Description
Hardware: Free supplies chlorine tablets (Aquatabs; NaDCC) and a safe storage vessel to treat and store drinking water. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on the treatment of all drinking water for children < 36 months of age.
Intervention Type
Behavioral
Intervention Name(s)
Sanitation
Intervention Description
Hardware: Free child potties, sani-scoop hoes to remove feces from household environments, latrine upgrades to a dual pit latrine Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on the use of latrines for defecation and the removal of human and animal feces from the compound.
Intervention Type
Behavioral
Intervention Name(s)
Hand washing
Intervention Description
Hardware: Hand washing stations, soapy water bottles located at hand washing locations, detergent soap to supply soapy water bottles. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on hand washing with soap at critical times around food preparation, defecation, and contact with feces.
Intervention Type
Behavioral
Intervention Name(s)
Water quality, Sanitation, Hand washing (Combined WASH)
Intervention Description
Hardware: Free supplies Aquatabs; (NaDCC) and a safe storage vessel to treat and store drinking water. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on the treatment of all drinking water for children < 36 months of age. Hardware: Free child potties, sani-scoop hoes to remove feces from household environments, latrine upgrades to a dual pit latrine. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on the use of latrines for defecation and the removal of human and animal feces from the compound. Hardware: Hand washing stations, soapy water bottles located at hand washing locations, detergent soap to supply soapy water bottles. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages that focus on hand washing with soap at critical times around food preparation, defecation, and contact with feces.
Intervention Type
Behavioral
Intervention Name(s)
Nutrition
Intervention Description
Supplement: Lipid-based Nutrient Supplement (LNS) delivered daily from ages 6 to 24 months. Promotion: Local promoters will visit study compounds at least monthly to deliver behavior change messages modeled on those recommended in the Guiding Principles for Complementary Feeding of the Breastfed Child and the recent UNICEF Program Guide for Infant and Young Child Feeding Practices.General messages will include (1) practice exclusive breastfeeding from birth to 6 months of age and introduce complementary foods at 6 months of age while continuing to breastfeed; (2) continue breast feeding as you did before receiving LNS; (3) provide your child micronutrient-rich foods such as meat, fish, eggs, and vitamin A rich fruits and vegetables; and (4) feed your child at least 2-3 times per day when 6-8 months old and 3-4 times per day when 9-24 months old.
Intervention Type
Behavioral
Intervention Name(s)
Nutrition, Water quality, Sanitation, Hand washing
Intervention Description
Each of the interventions described above for Water Quality, Sanitation & Hand washing (Combined WASH) Plus the intervention described above for nutrition.
Primary Outcome Measure Information:
Title
Length-for-Age Z-scores
Description
Child's recumbent length, standardized to Z-scores using the WHO 2006 growth standards, measured 24monthsafter intervention. Measurement techniques follow the FANTA 2003 protocol.
Time Frame
Measured 24 months after intervention
Title
Diarrhea Prevalence Diarrhea Prevalence Diarrhea Prevalence Diarrhea Prevalence
Description
Diarrhea is defined as 3+ loose or watery stools in 24 hours or 1+ stools with blood in 24 hours. Diarrhea will be measured in interviews using caregiver-reported symptoms with 2-day and 7-day recall, measured 12- and 24-monthsafter intervention.
Time Frame
Measured 12- and 24-months after intervention
Secondary Outcome Measure Information:
Title
Length-for-Age Z-scores
Description
Child's recumbent length, standardized to Z-scores using the WHO 2006 growth standards, measured 12monthsafter intervention. Measurement techniques follow the FANTA 2003 protocol.
Time Frame
Measured 12 months after intervention
Title
Stunting Prevalence
Description
Child's recumbent length, standardized to Z-scores using the WHO 2006 growth standards, measured 24monthsafter intervention. Measurement techniques follow the FANTA 2003 protocol. Children with length-for-age Z-scores < - 2 will be classified as stunted.
Time Frame
Measured 24 months after intervention
Title
Enteropathy Biomarkers
Description
The lactulose / mannitol dual sugar permeability test will be administered to children. The ratio of the recovery of the two sugars in the urine will be used to calculate the L:M ratio, and we will compare groups using logged values of the ratio. We will additionally measure Total IgG antibody titers in the blood, and we will compare groups using logged values of the antibody levels.
Time Frame
Measured 12- and 24 months after intervention
Title
ASQ Child Development Scores
Description
Interviewers will administer a locally adapted version of the Ages and Stages Questionnaire (ASQ)to children after 24 months of intervention. The ASQ includes item sets of caregiver-reported milestones that measure child development in three separate domains (gross motor, communication, personal/social skills).
Time Frame
Measured 24 months after intervention
Other Pre-specified Outcome Measures:
Title
Infection with ascaris, trichuris, hookworm, and giardia
Description
Infection with soil transmitted helminths (ascaris, trichuris, hookworm) will be enumerated in stool collected from all index children and one older child per study compound. Giardia will also be measured in stool samples collected from these children. Prevalence and eggs per gram of feces will be recorded.
Time Frame
Measured 24 months after interventions began
Title
Hemoglobin concentration and anemia
Description
Hemoglobin concentrations will be measured using venous blood samples with a Hemocue 301 analyzer
Time Frame
Measured 24 months after interventions began
Title
Micronutrient status, including iron, vitamin A, folate, and B12
Description
Iron status will be assessed using the biomarkers of ferritin, soluble transferrin receptor (sTfR), and hepcidin. Vitamin A status will be assessed using retinol binding protein. Folate and B12 status will be measured using plasma folate and B12.
Time Frame
Measured 24 months after interventions began

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Day
Maximum Age & Unit of Time
63 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: (1) Infants (target child) will be eligible to participate in the study if they are: They are in utero at the baseline survey Their parents/guardians are planning to stay in the study village for the next 12 months (if a mother is planning to give birth at her natal home and then return, she will still be a candidate for enrollment) (2) Children < 36 months old at baseline that are living in the compound of a target child will be eligible to participate in diarrhea measurement if: They are < 36 months old at the baseline survey Their parents/guardians are planning to stay in the study village for the next 12 months (3) Children 18 - 27 months old at baseline that are living in the compound of a target child will be eligible to participate in intestinal parasite specimen collection if: They are 18 - 27 months old at the baseline survey Their parents/guardians are planning to stay in the study village for the next 12 months
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Stephen P Luby, MD
Organizational Affiliation
Stanford University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Dr. Mahbubur Rahman
City
Dhaka
ZIP/Postal Code
1212
Country
Bangladesh

12. IPD Sharing Statement

Citations:
PubMed Identifier
35939520
Citation
Contreras JD, Islam M, Mertens A, Pickering AJ, Arnold BF, Benjamin-Chung J, Hubbard AE, Rahman M, Unicomb L, Luby SP, Colford JM Jr, Ercumen A. Evaluation of an on-site sanitation intervention against childhood diarrhea and acute respiratory infection 1 to 3.5 years after implementation: Extended follow-up of a cluster-randomized controlled trial in rural Bangladesh. PLoS Med. 2022 Aug 8;19(8):e1004041. doi: 10.1371/journal.pmed.1004041. eCollection 2022 Aug.
Results Reference
derived
PubMed Identifier
34494545
Citation
Lin A, Mertens AN, Arnold BF, Tan S, Lin J, Stewart CP, Hubbard AE, Ali S, Benjamin-Chung J, Shoab AK, Rahman MZ, Famida SL, Hossen MS, Mutsuddi P, Akther S, Rahman M, Unicomb L, Naved RT, Mamun MMA, Parvin K, Dhabhar FS, Kariger P, Fernald LC, Luby SP, Colford JM Jr. Telomere length is associated with growth in children in rural Bangladesh. Elife. 2021 Sep 8;10:e60389. doi: 10.7554/eLife.60389.
Results Reference
derived
PubMed Identifier
34319986
Citation
Kwong LH, Sen D, Islam S, Shahriar S, Benjamin-Chung J, Arnold BF, Hubbard A, Parvez SM, Islam M, Unicomb L, Rahman MM, Nelson K, Colford JM Jr, Luby SP, Ercumen A. Effect of sanitation improvements on soil-transmitted helminth eggs in courtyard soil from rural Bangladesh: Evidence from a cluster-randomized controlled trial. PLoS Negl Trop Dis. 2021 Jul 28;15(7):e0008815. doi: 10.1371/journal.pntd.0008815. eCollection 2021 Jul.
Results Reference
derived
PubMed Identifier
34086447
Citation
Contreras JD, Islam M, Mertens A, Pickering AJ, Kwong LH, Arnold BF, Benjamin-Chung J, Hubbard AE, Alam M, Sen D, Islam S, Rahman M, Unicomb L, Luby SP, Colford JM, Ercumen A. Longitudinal Effects of a Sanitation Intervention on Environmental Fecal Contamination in a Cluster-Randomized Controlled Trial in Rural Bangladesh. Environ Sci Technol. 2021 Jun 15;55(12):8169-8179. doi: 10.1021/acs.est.1c01114. Epub 2021 Jun 4.
Results Reference
derived
PubMed Identifier
33407549
Citation
Parvez SM, Rahman MJ, Azad R, Rahman M, Unicomb L, Ashraf S, Mondol MH, Jahan F, Winch PJ, Luby SP. Achieving equitable uptake of handwashing and sanitation by addressing both supply and demand-based constraints: findings from a randomized controlled trial in rural Bangladesh. Int J Equity Health. 2021 Jan 6;20(1):16. doi: 10.1186/s12939-020-01353-7.
Results Reference
derived
PubMed Identifier
31050672
Citation
Ercumen A, Benjamin-Chung J, Arnold BF, Lin A, Hubbard AE, Stewart C, Rahman Z, Parvez SM, Unicomb L, Rahman M, Haque R, Colford JM Jr, Luby SP. Effects of water, sanitation, handwashing and nutritional interventions on soil-transmitted helminth infections in young children: A cluster-randomized controlled trial in rural Bangladesh. PLoS Negl Trop Dis. 2019 May 3;13(5):e0007323. doi: 10.1371/journal.pntd.0007323. eCollection 2019 May.
Results Reference
derived
PubMed Identifier
30963177
Citation
Lin A, Ali S, Arnold BF, Rahman MZ, Alauddin M, Grembi J, Mertens AN, Famida SL, Akther S, Hossen MS, Mutsuddi P, Shoab AK, Hussain Z, Rahman M, Unicomb L, Ashraf S, Naser AM, Parvez SM, Ercumen A, Benjamin-Chung J, Haque R, Ahmed T, Hossain MI, Choudhury N, Jannat K, Alauddin ST, Minchala SG, Cekovic R, Hubbard AE, Stewart CP, Dewey KG, Colford JM, Luby SP. Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Environmental Enteric Dysfunction in Young Children: A Cluster-randomized, Controlled Trial in Rural Bangladesh. Clin Infect Dis. 2020 Feb 14;70(5):738-747. doi: 10.1093/cid/ciz291.
Results Reference
derived
PubMed Identifier
30624600
Citation
Stewart CP, Dewey KG, Lin A, Pickering AJ, Byrd KA, Jannat K, Ali S, Rao G, Dentz HN, Kiprotich M, Arnold CD, Arnold BF, Allen LH, Shahab-Ferdows S, Ercumen A, Grembi JA, Naser AM, Rahman M, Unicomb L, Colford JM Jr, Luby SP, Null C. Effects of lipid-based nutrient supplements and infant and young child feeding counseling with or without improved water, sanitation, and hygiene (WASH) on anemia and micronutrient status: results from 2 cluster-randomized trials in Kenya and Bangladesh. Am J Clin Nutr. 2019 Jan 1;109(1):148-164. doi: 10.1093/ajcn/nqy239.
Results Reference
derived
PubMed Identifier
29976251
Citation
Parvez SM, Azad R, Rahman M, Unicomb L, Ram PK, Naser AM, Stewart CP, Jannat K, Rahman MJ, Leontsini E, Winch PJ, Luby SP. Achieving optimal technology and behavioral uptake of single and combined interventions of water, sanitation hygiene and nutrition, in an efficacy trial (WASH benefits) in rural Bangladesh. Trials. 2018 Jul 6;19(1):358. doi: 10.1186/s13063-018-2710-8.
Results Reference
derived
PubMed Identifier
29976234
Citation
Rahman M, Ashraf S, Unicomb L, Mainuddin AKM, Parvez SM, Begum F, Das KK, Naser AM, Hussain F, Clasen T, Luby SP, Leontsini E, Winch PJ. WASH Benefits Bangladesh trial: system for monitoring coverage and quality in an efficacy trial. Trials. 2018 Jul 6;19(1):360. doi: 10.1186/s13063-018-2708-2.
Results Reference
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PubMed Identifier
29669039
Citation
Lin A, Ercumen A, Benjamin-Chung J, Arnold BF, Das S, Haque R, Ashraf S, Parvez SM, Unicomb L, Rahman M, Hubbard AE, Stewart CP, Colford JM Jr, Luby SP. Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Child Enteric Protozoan Infections in Rural Bangladesh: A Cluster-Randomized Controlled Trial. Clin Infect Dis. 2018 Oct 30;67(10):1515-1522. doi: 10.1093/cid/ciy320.
Results Reference
derived
PubMed Identifier
29616235
Citation
Tofail F, Fernald LC, Das KK, Rahman M, Ahmed T, Jannat KK, Unicomb L, Arnold BF, Ashraf S, Winch PJ, Kariger P, Stewart CP, Colford JM Jr, Luby SP. Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial. Lancet Child Adolesc Health. 2018 Apr;2(4):255-268. doi: 10.1016/S2352-4642(18)30031-2.
Results Reference
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PubMed Identifier
28980942
Citation
Lin A, Arnold BF, Mertens AN, Lin J, Benjamin-Chung J, Ali S, Hubbard AE, Stewart CP, Shoab AK, Rahman MZ, Hossen MS, Mutsuddi P, Famida SL, Akther S, Rahman M, Unicomb L, Dhabhar FS, Fernald LCH, Colford JM Jnr, Luby SP. Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh. Elife. 2017 Oct 5;6:e29365. doi: 10.7554/eLife.29365.
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PubMed Identifier
23996605
Citation
Arnold BF, Null C, Luby SP, Unicomb L, Stewart CP, Dewey KG, Ahmed T, Ashraf S, Christensen G, Clasen T, Dentz HN, Fernald LC, Haque R, Hubbard AE, Kariger P, Leontsini E, Lin A, Njenga SM, Pickering AJ, Ram PK, Tofail F, Winch PJ, Colford JM Jr. Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open. 2013 Aug 30;3(8):e003476. doi: 10.1136/bmjopen-2013-003476.
Results Reference
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Links:
URL
http://clinicaltrials.gov/ct2/show/NCT01704105
Description
Related protocol
URL
http://www.washbenefits.net
Description
Click here for more informaiton about the study

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WASH Benefits Bangladesh

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