Bio

Bio


Dr. Luby studied philosophy and earned a Bachelor of Arts summa cum laude from Creighton University. He earned his medical degree from the University of Texas Southwestern Medical School at Dallas and completed his residency in internal medicine at the University of Rochester-Strong Memorial Hospital. He studied epidemiology and preventive medicine at the Centers for Disease Control and Prevention.

Dr. Luby's previous positions include directing the Centre for Communicable Diseases at the International Centre for Diarrhoeal Diseases Research, Bangladesh in Dhaka, Bangladesh from 2004 - 2012, conducting research and teaching epidemiology at the Aga Khan University in Karachi, Pakistan from 1993 - 1998, and working as an epidemiologist in the Foodborne and Diarrheal Diseases Branch of the U.S. Centers for Disease Control and Prevention.

Academic Appointments


Administrative Appointments


  • Director of Research, Stanford Center for Innovation in Global Health (2012 - Present)

Honors & Awards


  • Begum Rokeya Sakhawat Hossain Teaching Excellence Award, James P Grant School of Public Health (2012, 2014, 2015)
  • Medal of Excellence in Global Health, Center for Global Health, Centers for Disease Control and Prevention (2012)
  • International WaTER Prize, Oklahoma University (2009)
  • Shepard Award, Centers for Disease Control and Prevention (2006 & 2014)
  • Favourite paper in infectious diseases, Lancet Infectious Diseases (2005)
  • Alexander D. Langmuir Prize, Centers for Disease Control and Prevention (2001)

Professional Education


  • Fellowship, Centers for Disease Control and Prevention, Epidemiology (1992)
  • Residency, Strong Memorial Hospital, Internal Medicine (1989)
  • Internship, Strong Memorial Hospital, Internal Medicine (1987)
  • MD, University of Texas, Southwestern, Medicine (1986)
  • BA, Creighton University, Philosophy (1981)
  • Board Certification, American Board of Internal Medicine, Internal Medicine (1989)

Community and International Work


  • WASH Benefits, Rural Bangladesh

    Topic

    Water, sanitation, hygiene, nutrition

    Partnering Organization(s)

    icddrb, UC Berkeley

    Populations Served

    Children

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Lotus Water, Dhaka, Bangladesh

    Topic

    Water quality and health

    Partnering Organization(s)

    icddr,b

    Populations Served

    urban

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Improving communal toilets, Dhaka, Bangladesh

    Topic

    urban sanitation, behavior change

    Partnering Organization(s)

    icddr,b, Johns Hopkins Bloomberg School of Public Health

    Populations Served

    Low income urban residents

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • Leveraging social networks to improve child immunizations, Bangladesh

    Topic

    social networks, child immunization

    Partnering Organization(s)

    icddr,b

    Populations Served

    urban

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • Burden of pneumococcal disease, Bangladesh

    Topic

    pneumococcal disease, immunization, surveillance

    Partnering Organization(s)

    Child Health Research Foundation

    Populations Served

    children

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Lead exposure in rural Bangladesh, Bangladesh

    Topic

    Lead

    Partnering Organization(s)

    icddr,b

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


Dr. Luby’s research interests include identifying and interrupting pathways of infectious disease transmission in low income countries. He works primarily in Bangladesh. His ongoing work includes 1) developing and evaluating strategies to improve community water, sanitation and hygiene including characterizing the impact of a fecally contaminated environment on enteric dysfunction and community health; 2) characterizing emerging infections, especially henipaviruses and influenza viruses and developing and evaluating practical strategies to prevent transmission; 3) evaluating the impact of the Bangladesh national vaccine program on the burden of pneumococcal and Haemophilus influenzae type B infection.

Clinical Trials


  • WASH Benefits Bangladesh Recruiting

    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.

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Teaching

Graduate and Fellowship Programs


Publications

All Publications


  • Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial PLOS ONE Ercumen, A., Naser, A. M., Unicomb, L., Arnold, B. F., Colford, J. M., Luby, S. P. 2015; 10 (3)

    Abstract

    Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells, at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh.We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage, safe storage and control. We followed households with monthly visits for one year to promote the interventions, track their uptake, test participants' source and stored water for fecal contamination, and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias, we also collected data on health outcomes that are not expected to be impacted by our interventions.Both interventions had high uptake. Safe storage, alone or combined with chlorination, reduced heavy contamination of stored water. Compared to controls, diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio, PR = 0.64, 0.55-0.73) and 31% in the safe storage arm (PR = 0.69, 0.60-0.80), with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However, the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms, suggesting minimal reporting bias.Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh.ClinicalTrials.gov NCT01350063.

    View details for DOI 10.1371/journal.pone.0121907

    View details for Web of Science ID 000352133600126

    View details for PubMedID 25816342

  • Differences in Field Effectiveness and Adoption between a Novel Automated Chlorination System and Household Manual Chlorination of Drinking Water in Dhaka, Bangladesh: A Randomized Controlled Trial. PloS one Pickering, A. J., Crider, Y., Amin, N., Bauza, V., Unicomb, L., Davis, J., Luby, S. P. 2015; 10 (3)

    Abstract

    The number of people served by networked systems that supply intermittent and contaminated drinking water is increasing. In these settings, centralized water treatment is ineffective, while household-level water treatment technologies have not been brought to scale. This study compares a novel low-cost technology designed to passively (automatically) dispense chlorine at shared handpumps with a household-level intervention providing water disinfection tablets (Aquatab), safe water storage containers, and behavior promotion. Twenty compounds were enrolled in Dhaka, Bangladesh, and randomly assigned to one of three groups: passive chlorinator, Aquatabs, or control. Over a 10-month intervention period, the mean percentage of households whose stored drinking water had detectable total chlorine was 75% in compounds with access to the passive chlorinator, 72% in compounds receiving Aquatabs, and 6% in control compounds. Both interventions also significantly improved microbial water quality. Aquatabs usage fell by 50% after behavioral promotion visits concluded, suggesting intensive promotion is necessary for sustained uptake. The study findings suggest high potential for an automated decentralized water treatment system to increase consistent access to clean water in low-income urban communities.

    View details for DOI 10.1371/journal.pone.0118397

    View details for PubMedID 25734448

  • Microbiological evaluation of the efficacy of soapy water to clean hands: a randomized, non-inferiority field trial. The American journal of tropical medicine and hygiene Amin, N., Pickering, A. J., Ram, P. K., Unicomb, L., Najnin, N., Homaira, N., Ashraf, S., Abedin, J., Islam, M. S., Luby, S. P. 2014; 91 (2): 415-423

    Abstract

    We conducted a randomized, non-inferiority field trial in urban Dhaka, Bangladesh among mothers to compare microbial efficacy of soapy water (30 g powdered detergent in 1.5 L water) with bar soap and water alone. Fieldworkers collected hand rinse samples before and after the following washing regimens: scrubbing with soapy water for 15 and 30 seconds; scrubbing with bar soap for 15 and 30 seconds; and scrubbing with water alone for 15 seconds. Soapy water and bar soap removed thermotolerant coliforms similarly after washing for 15 seconds (mean log10 reduction = 0.7 colony-forming units [CFU], P < 0.001 for soapy water; mean log10 reduction = 0.6 CFU, P = 0.001 for bar soap). Increasing scrubbing time to 30 seconds did not improve removal (P > 0.05). Scrubbing hands with water alone also reduced thermotolerant coliforms (mean log10 reduction = 0.3 CFU, P = 0.046) but was less efficacious than scrubbing hands with soapy water. Soapy water is an inexpensive and microbiologically effective cleansing agent to improve handwashing among households with vulnerable children.

    View details for DOI 10.4269/ajtmh.13-0475

    View details for PubMedID 24914003

  • The Role of Landscape Composition and Configuration on Pteropus giganteus Roosting Ecology and Nipah Virus Spillover Risk in Bangladesh AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Hahn, M. B., Gurley, E. S., Epstein, J. H., Islam, M. S., Patz, J. A., Daszak, P., Luby, S. P. 2014; 90 (2): 247-255

    Abstract

    Nipah virus has caused recurring outbreaks in central and northwest Bangladesh (the "Nipah Belt"). Little is known about roosting behavior of the fruit bat reservoir, Pteropus giganteus, or factors driving spillover. We compared human population density and ecological characteristics of case villages and control villages (no reported outbreaks) to understand their role in P. giganteus roosting ecology and Nipah virus spillover risk. Nipah Belt villages have a higher human population density (P < 0.0001), and forests that are more fragmented than elsewhere in Bangladesh (0.50 versus 0.32 patches/km(2), P < 0.0001). The number of roosts in a village correlates with forest fragmentation (r = 0.22, P = 0.03). Villages with a roost containing Polyalthia longifolia or Bombax ceiba trees were more likely case villages (odds ratio [OR] = 10.8, 95% confidence interval [CI] = 1.3-90.6). This study suggests that, in addition to human population density, composition and structure of the landscape shared by P. giganteus and humans may influence the geographic distribution of Nipah virus spillovers.

    View details for DOI 10.4269/ajtmh.13-0256

    View details for Web of Science ID 000331009000010

    View details for PubMedID 24323516

  • The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings BMC PUBLIC HEALTH Dreibelbis, R., Winch, P. J., Leontsini, E., Hulland, K. R., Ram, P. K., Unicomb, L., Luby, S. P. 2013; 13

    Abstract

    Promotion and provision of low-cost technologies that enable improved water, sanitation, and hygiene (WASH) practices are seen as viable solutions for reducing high rates of morbidity and mortality due to enteric illnesses in low-income countries. A number of theoretical models, explanatory frameworks, and decision-making models have emerged which attempt to guide behaviour change interventions related to WASH. The design and evaluation of such interventions would benefit from a synthesis of this body of theory informing WASH behaviour change and maintenance.We completed a systematic review of existing models and frameworks through a search of related articles available in PubMed and in the grey literature. Information on the organization of behavioural determinants was extracted from the references that fulfilled the selection criteria and synthesized. Results from this synthesis were combined with other relevant literature, and from feedback through concurrent formative and pilot research conducted in the context of two cluster-randomized trials on the efficacy of WASH behaviour change interventions to inform the development of a framework to guide the development and evaluation of WASH interventions: the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM-WASH).We identified 15 WASH-specific theoretical models, behaviour change frameworks, or programmatic models, of which 9 addressed our review questions. Existing models under-represented the potential role of technology in influencing behavioural outcomes, focused on individual-level behavioural determinants, and had largely ignored the role of the physical and natural environment. IBM-WASH attempts to correct this by acknowledging three dimensions (Contextual Factors, Psychosocial Factors, and Technology Factors) that operate on five-levels (structural, community, household, individual, and habitual).A number of WASH-specific models and frameworks exist, yet with some limitations. The IBM-WASH model aims to provide both a conceptual and practical tool for improving our understanding and evaluation of the multi-level multi-dimensional factors that influence water, sanitation, and hygiene practices in infrastructure-constrained settings. We outline future applications of our proposed model as well as future research priorities needed to advance our understanding of the sustained adoption of water, sanitation, and hygiene technologies and practices.

    View details for DOI 10.1186/1471-2458-13-1015

    View details for Web of Science ID 000329290200003

    View details for PubMedID 24160869

  • The pandemic potential of Nipah virus ANTIVIRAL RESEARCH Luby, S. P. 2013; 100 (1): 38-43

    Abstract

    Nipah virus, a paramyxovirus whose wildlife reservoir is Pteropus bats, was first discovered in a large outbreak of acute encephalitis in Malaysia in 1998 among persons who had contact with sick pigs. Apparently, one or more pigs was infected from bats, and the virus then spread efficiently from pig to pig, then from pigs to people. Nipah virus outbreaks have been recognized nearly every year in Bangladesh since 2001 and occasionally in neighboring India. Outbreaks in Bangladesh and India have been characterized by frequent person-to-person transmission and the death of over 70% of infected people. Characteristics of Nipah virus that increase its risk of becoming a global pandemic include: humans are already susceptible; many strains are capable of limited person-to-person transmission; as an RNA virus, it has an exceptionally high rate of mutation: and that if a human-adapted strain were to infect communities in South Asia, high population densities and global interconnectedness would rapidly spread the infection. Appropriate steps to estimate and manage this risk include studies to explore the molecular and genetic basis of respiratory transmission of henipaviruses, improved surveillance for human infections, support from high-income countries to reduce the risk of person-to-person transmission of infectious agents in low-income health care settings, and consideration of vaccination in communities at ongoing risk of exposure to the secretions and excretions of Pteropus bats.

    View details for DOI 10.1016/j.antiviral.2013.07.011

    View details for Web of Science ID 000328179300006

    View details for PubMedID 23911335

  • Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. The American journal of tropical medicine and hygiene Lin, A., Arnold, B. F., Afreen, S., Goto, R., Huda, T. M., Haque, R., Raqib, R., Unicomb, L., Ahmed, T., Colford, J. M., Luby, S. P. 2013; 89 (1): 130-137

    Abstract

    We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = -0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.24 SDs (95% CI = -0.63, 0.16) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.33 SDs decrease in HAZ (95% CI = -0.62, -0.05). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.

    View details for DOI 10.4269/ajtmh.12-0629

    View details for PubMedID 23629931

  • Nipah virus outbreak in Bangladesh with nosocomial and corpse to human transmission. Emerging Infectious Diseases Sazzad HMS, Hossain MJ, Gurley ES, Ameen KMH, Parveen S, Islam MS, Faruque LI, Podder G, Banu SS, Lo MK, Rollin PE, Rota PA, Daszak P, Rahman M, Luby SP. 2013; 19 (2): 210-17
  • Improvements in child development following a cluster-randomized, controlled trial of intensive handwashing promotion in Karachi, Pakistan. Arch PediatrAdolesct Med Bowen A, Agboatwalla M, Luby S, Tobery T, Ayers T, Hoekstra RM. 2012; 166 (11): 1037-44
  • Explaining low rates of sustained use of siphon water filter: evidence from follow-up of a randomised controlled trial in Bangladesh TROPICAL MEDICINE & INTERNATIONAL HEALTH Najnin, N., Arman, S., Abedin, J., Unicomb, L., Levine, D. I., Mahmud, M., Leder, K., Yeasmin, F., Luoto, J. E., Albert, J., Luby, S. P. 2015; 20 (4): 471-483

    Abstract

    To assess sustained siphon filter usage among a low-income population in Bangladesh and study relevant motivators and barriers.After a randomised control trial in Bangladesh during 2009, 191 households received a siphon water filter along with educational messages. Researchers revisited households after 3 and 6 months to assess filter usage and determine relevant motivators and barriers. Regular users were defined as those who reported using the filter most of the time and were observed to be using the filter at follow-up visits. Integrated behavioural model for water, sanitation and hygiene (IBM-WASH) was used to explain factors associated with regular filter use.Regular filter usage was 28% at the 3-month follow-up and 21% at the 6-month follow-up. Regular filter users had better quality water at the 6-month, but not at the 3-month visit. Positive predictors of regular filter usage explained through IBM-WASH at both times were willingness to pay >US$1 for filters, and positive attitude towards filter use (technology dimension at individual level); reporting boiling drinking water at baseline (psychosocial dimension at habitual level); and Bengali ethnicity (contextual dimension at individual level). Frequently reported barriers to regular filter use were as follows: considering filter use an additional task, filter breakage and time required for water filtering (technology dimension at individual level).The technological, psychosocial and contextual dimensions of IBM-WASH contributed to understanding the factors related to sustained use of siphon filter. Given the low regular usage rate and the hardware-related problems reported, the contribution of siphon filters to improving water quality in low-income urban communities in Bangladesh is likely to be minimal.

    View details for DOI 10.1111/tmi.12448

    View details for Web of Science ID 000350755800008

    View details for PubMedID 25495859

  • A duplex recombinant viral nucleoprotein microbead immunoassay for simultaneous detection of seroresponses to human respiratory syncytial virus and metapneumovirus infections. Journal of virological methods Zhang, Y., Brooks, W. A., Goswami, D., Rahman, M., Luby, S. P., Erdman, D. D. 2014; 206: 55-62

    Abstract

    Serologic diagnosis of human respiratory syncytial virus (hRSV) and human metapneumovirus (hMPV) infections has been shown to complement virus detection methods in epidemiologic studies. Enzyme immunoassays (EIAs) using cultured virus lysate antigens are often used to diagnose infection by demonstration of a ≥4-fold rises in antibody titer between acute and convalescent serum pairs. In this study, hRSV and hMPV nucleocapsid (recN) proteins were expressed in a baculovirus system and their performance compared with virus culture lysate antigen in EIAs using paired serum specimens collected from symptomatic children. The recN proteins were also used to develop a duplex assay based on the Luminex microbead-based suspension array technology, where diagnostic rises in antibody levels could be determined simultaneously at a single serum dilution. Antibody levels measured by the recN and viral lysate EIAs correlated moderately (hRSV, r(2)=0.72; hMPV, r(2)=0.76); the recN EIAs identified correctly 35 of 37 (94.6%) and 48 of 50 (96%) serum pairs showing diagnostic antibody rises by viral lysate EIAs. Purified recN proteins were then coupled to microbeads and serum pairs were tested at a single dilution on a Luminex MAGPIX(®) analyzer. The duplex recN assay identified correctly 33 of 39 (85%) and 41 of 47 (86.7%) serum pairs showing diagnostic rises to hRSV and hMPV, respectively. The recN assay permits simultaneous testing for acute hRSV and hMPV infections and offers a platform for expanded multiplexing of other respiratory virus assays.

    View details for DOI 10.1016/j.jviromet.2014.05.008

    View details for PubMedID 24859050

  • Nudging to use: Achieving safe water behaviors in Kenya and Bangladesh JOURNAL OF DEVELOPMENT ECONOMICS Luoto, J., Levine, D., Albert, J., Luby, S. 2014; 110: 13-21
  • Incidence of and Risk Factors for Hospital-Acquired Diarrhea in Three Tertiary Care Public Hospitals in Bangladesh AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Bhuiyan, M. U., Luby, S. P., Zaman, R. U., Rahman, M. W., Sharker, M. A., Hossain, M. J., Rasul, C. H., Ekram, A. R., Rahman, M., Sturm-Ramirez, K., Azziz-Baumgartner, E., Gurley, E. S. 2014; 91 (1): 165-172
  • Identification and Epidemiology of a Rare HoBi-Like Pestivirus Strain in Bangladesh TRANSBOUNDARY AND EMERGING DISEASES Haider, N., Rahman, M. S., KHAN, S. U., Mikolon, A., Gurley, E. S., Osmani, M. G., Shanta, I. S., Paul, S. K., Macfarlane-Berry, L., Islam, A., Desmond, J., Epstein, J. H., Daszak, P., Azim, T., Luby, S. P., Zeidner, N., Rahman, M. Z. 2014; 61 (3): 193-198

    Abstract

    The genus pestivirus of the family flaviviridae consists of four recognized species: bovine viral diarrhoea virus 1 (BVDV-1), bovine viral diarrhoea virus 2 (BVDV-2), classical swine fever virus and border disease virus. A new putative pestivirus species tentatively named as either 'HoBi-like pestivirus' or BVDV-3 has recently been identified in Brazil, Italy and Thailand. Despite reports of serological evidence of BVDV in Bangladesh, the types of the virus circulating in cattle have not been identified. We conducted surveillance in cattle from May 2009 to August 2010 in three government veterinary hospitals to characterize BVDV in cattle of Bangladesh. We tested serum for BVDV using an antigen-capture ELISA. Of 638 cattle samples, 3% (16/638) tested positive for BVDV antigen. The ELISA-positive samples were selected for further molecular detection and characterization of BVDV. Molecular analysis of the partial 5' untranslated region (UTR) nucleotide sequences of BVDV-positive samples identified the rare HoBi-like pestivirus or BVDV-3 virus circulating in cattle of Bangladesh. The identification of this rare HoBi-like pestivirus or BVDV-3 strain in Bangladesh warrants further surveillance to evaluate its impact on livestock production.

    View details for DOI 10.1111/tbed.12218

    View details for Web of Science ID 000334298300001

    View details for PubMedID 24650238

  • Household Air Quality Risk Factors Associated with Childhood Pneumonia in Urban Dhaka, Bangladesh AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Ram, P. K., Dutt, D., Silk, B. J., Doshi, S., Rudra, C. B., Abedin, J., Goswami, D., Fry, A. M., Brooks, W. A., Luby, S. P., Cohen, A. L. 2014; 90 (5): 968-975

    Abstract

    To inform interventions to reduce the high burden of pneumonia in urban settings such as Kamalapur, Bangladesh, we evaluated household air quality risk factors for radiographically confirmed pneumonia in children. In 2009-2010, we recruited children < 5 years of age with pneumonia and controls from a population-based surveillance for respiratory and febrile illnesses. Piped natural gas was used by 85% of 331 case and 91% of 663 control households. Crowding, a tin roof in the living space, low socioeconomic status, and male sex of the child were risk factors for pneumonia. The living space in case households was 28% less likely than in control households to be cross-ventilated. Particulate matter concentrations were not significantly associated with pneumonia. With increasing urbanization and supply of improved cooking fuels to urban areas, the high burden of respiratory illnesses in urban populations such as Kamalapur may be reduced by decreasing crowding and improving ventilation in living spaces.

    View details for DOI 10.4269/ajtmh.13-0532

    View details for Web of Science ID 000335707600033

    View details for PubMedID 24664785

  • Toys and toilets: cross-sectional study using children's toys to evaluate environmental faecal contamination in rural Bangladeshi households with different sanitation facilities and practices TROPICAL MEDICINE & INTERNATIONAL HEALTH Vujcic, J., Ram, P. K., Hussain, F., Unicomb, L., Gope, P. S., Abedin, J., Mahmud, Z. H., Islam, M. S., Luby, S. P. 2014; 19 (5): 528-536

    Abstract

    To evaluate household faecal contamination using children's toys among 100 rural Bangladeshi households categorised as 'cleaner' (toilet that reliably separates faeces from the environment and no human faeces in/around living space) or 'less clean' (no toilet or toilet that does not reliably separate faeces from the environment and human faeces in/around living space).We distributed toy balls to each household and rinsed each study toy and a toy already owned by the household in 200 ml of Ringer's solution. We enumerated faecal coliforms and faecal streptococci from each rinse using membrane filtration methods.Study toys from 39 cleaner households had lower mean faecal coliform contamination than toys from 61 less clean households (2.4 log10 colony-forming units (CFU)/200 ml vs. 3.2 log10 CFU/200 ml, P = 0.03). However, wealth measures explained a portion of this relationship. Repeat measures were moderately variable [coefficient of variation (CV) = 6.5 between two toys in the household at the same time, CV = 37.6 between toys in the household at two different times 3-4 days apart]. Too few households owned a non-porous toy to compare groups without risk of bias.In rural Bangladesh, improved sanitation facilities and practices were associated with less environmental contamination. Whether this association is independent of household wealth and whether the difference in contamination improves child health merit further study. The variation found was typical for measures of environmental contamination, and requires large sample sizes to ascertain differences between groups with statistical significance.

    View details for DOI 10.1111/tmi.12292

    View details for Web of Science ID 000333984600006

    View details for PubMedID 24645919

  • Kala-azar in Pregnancy in Mymensingh, Bangladesh: A Social Autopsy PLOS NEGLECTED TROPICAL DISEASES Rahman, K. M., Olsen, A., Harley, D., Butler, C. D., Mondal, D., Luby, S. P., Sleigh, A. C. 2014; 8 (5)

    View details for DOI 10.1371/journal.pntd.0002710

    View details for Web of Science ID 000337735100006

    View details for PubMedID 24786280

  • Coverage and cost of a large oral cholera vaccination program in a high-risk cholera endemic urban population in Dhaka, Bangladesh VACCINE Khan, I. A., Saha, A., Chowdhury, F., Khan, A. I., Uddin, M. J., Begum, Y. A., Riaz, B. K., Islam, S., Ali, M., Luby, S. P., Clemens, J. D., Cravioto, A., Qadri, F. 2013; 31 (51): 6058-6064

    Abstract

    A feasibility study of an oral cholera vaccine was carried out to test strategies to reach high-risk populations in urban Mirpur, Dhaka, Bangladesh. The study was cluster randomized, with three arms: vaccine, vaccine plus safe water and hand washing practice, and no intervention. High risk people of age one year and above (except pregnant woman) from the two intervention arms received two doses of the oral cholera vaccine, Shanchol™. Vaccination was conducted between 17th February and 16th April 2011, with a minimum interval of fourteen days between two doses. Interpersonal communication preceded vaccination to raise awareness amongst the target population. The number of vaccine doses used, the population vaccinated, left-out, drop out, vaccine wastage and resources required were documented. Fixed outreach site vaccination strategy was adopted as the mode of vaccine delivery. Additionally, mobile vaccination sites and mop-up activities were carried out to reach the target communities. Of the 172,754 target population, 141,839 (82%) and 123,666 (72%) received complete first and second doses of the vaccine, respectively. Dropout rate from the first to the second dose was 13%. Two complete doses were received by 123,661 participants. Vaccine coverage in children was 81%. Coverage was significantly higher in females than in males (77% vs. 66%, P<0.001). Vaccine wastage for delivering the complete doses was 1.2%. The government provided cold-chain related support at no cost to the project. Costs for two doses of vaccine per-person were US$3.93, of which US$1.63 was spent on delivery. Cost for delivering a single dose was US$0.76. We observed no serious adverse events. Mass vaccination with oral cholera vaccine is feasible for reaching high risk endemic population through the existing national immunization delivery system employed by the government.

    View details for DOI 10.1016/j.vaccine.2013.10.021

    View details for Web of Science ID 000329010400005

    View details for PubMedID 24161413

  • Handwashing before Food Preparation and Child Feeding: A Missed Opportunity for Hygiene Promotion AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Nizame, F. A., Unicomb, L., Sanghvi, T., Roy, S., Nuruzzaman, M., Ghosh, P. K., Winch, P. J., Luby, S. P. 2013; 89 (6): 1179-1185

    Abstract

    Enteric diseases are often caused by poor hygiene and can contribute to stunting. From 50 randomly selected villages in Bangladesh, we collected quantitative and qualitative data on handwashing linked to child feeding to integrate handwashing promotion into a young child complementary feeding program. Most participants stated that the community knew the importance of handwashing with soap before food preparation and feeding a child, but had not developed the habit. We observed no handwashing with soap at these key times; sometimes hands were rinsed with water only. Most participants cited the unavailability of soap and water near the cooking place as a barrier to handwashing before food preparation. Most caregivers ranked nurturing messages as the best motivator to encourage handwashing with soap. An integrated intervention should include having soap and water available near the food preparation area and should use nurturing themes to encourage habitual handwashing with soap.

    View details for DOI 10.4269/ajtmh.13-0434

    View details for Web of Science ID 000328726100019

    View details for PubMedID 24080638

  • Designing a handwashing station for infrastructure-restricted communities in Bangladesh using the integrated behavioural model for water, sanitation and hygiene interventions (IBM-WASH) BMC PUBLIC HEALTH Hulland, K. R., Leontsini, E., Dreibelbis, R., Unicomb, L., Afroz, A., Dutta, N. C., Nizame, F. A., Luby, S. P., Ram, P. K., Winch, P. J. 2013; 13

    Abstract

    In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations--a dedicated, convenient location where both soap and water are available for handwashing--are associated with improved handwashing practices. Our aim was to identify a locally feasible and acceptable handwashing station that enabled frequent handwashing for two subsequent randomized trials testing the health effects of this behaviour.We conducted formative research in the form of household trials of improved practices in urban and rural Bangladesh. Seven candidate handwashing technologies were tested by nine to ten households each during two iterative phases. We conducted interviews with participants during an introductory visit and two to five follow up visits over two to six weeks, depending on the phase. We used the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to guide selection of candidate handwashing stations and data analysis. Factors presented in the IBM-WASH informed thematic coding of interview transcripts and contextualized feasibility and acceptability of specific handwashing station designs.Factors that influenced selection of candidate designs were market availability of low cost, durable materials that were easy to replace or replenish in an infrastructure-restricted and shared environment. Water storage capacity, ease of use and maintenance, and quality of materials determined the acceptability and feasibility of specific handwashing station designs. After examining technology, psychosocial and contextual factors, we selected a handwashing system with two different water storage capacities, each with a tap, stand, basin, soapy water bottle and detergent powder for pilot testing in preparation for the subsequent randomized trials.A number of contextual, psychosocial and technological factors influence use of handwashing stations at five aggregate levels, from habitual to societal. In interventions that require a handwashing station to facilitate frequent handwashing with soap, elements of the technology, such as capacity, durability and location(s) within the household are key to high feasibility and acceptability. More than one handwashing station per household may be required. IBM-WASH helped guide the research and research in-turn helped validate the framework.

    View details for DOI 10.1186/1471-2458-13-877

    View details for Web of Science ID 000329279200002

    View details for PubMedID 24060247

  • Household Environmental Conditions Are Associated with Enteropathy and Impaired Growth in Rural Bangladesh AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Lin, A., Arnold, B. F., Afreen, S., Goto, R., Huda, T. M., Haque, R., Raqib, R., Unicomb, L., Ahmed, T., Colford, J. M., Luby, S. P. 2013; 89 (1): 130-137
  • 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 Arnold, B. F., Null, C., Luby, S. P., Unicomb, L., Stewart, C. P., Dewey, K. G., Ahmed, T., Ashraf, S., Christensen, G., Clasen, T., Dentz, H. N., Fernald, L. C., Haque, R., Hubbard, A. E., Kariger, P., Leontsini, E., Lin, A., Njenga, S. M., Pickering, A. J., Ram, P. K., Tofail, F., Winch, P. J., Colford, J. M. 2013; 3 (8)

    Abstract

    Enteric infections are common during the first years of life in low-income countries and contribute to growth faltering with long-term impairment of health and development. Water quality, sanitation, handwashing and nutritional interventions can independently reduce enteric infections and growth faltering. There is little evidence that directly compares the effects of these individual and combined interventions on diarrhoea and growth when delivered to infants and young children. The objective of the WASH Benefits study is to help fill this knowledge gap.WASH Benefits includes two cluster-randomised trials to assess improvements in water quality, sanitation, handwashing and child nutrition-alone and in combination-to rural households with pregnant women in Kenya and Bangladesh. Geographically matched clusters (groups of household compounds in Bangladesh and villages in Kenya) will be randomised to one of six intervention arms or control. Intervention arms include water quality, sanitation, handwashing, nutrition, combined water+sanitation+handwashing (WSH) and WSH+nutrition. The studies will enrol newborn children (N=5760 in Bangladesh and N=8000 in Kenya) and measure outcomes at 12 and 24 months after intervention delivery. Primary outcomes include child length-for-age Z-scores and caregiver-reported diarrhoea. Secondary outcomes include stunting prevalence, markers of environmental enteropathy and child development scores (verbal, motor and personal/social). We will estimate unadjusted and adjusted intention-to-treat effects using semiparametric estimators and permutation tests.Study protocols have been reviewed and approved by human subjects review boards at the University of California, Berkeley, Stanford University, the International Centre for Diarrheal Disease Research, Bangladesh, the Kenya Medical Research Institute, and Innovations for Poverty Action. Independent data safety monitoring boards in each country oversee the trials. This study is funded by a grant from the Bill & Melinda Gates Foundation to the University of California, Berkeley.Trial registration identifiers (http://www.clinicaltrials.gov): NCT01590095 (Bangladesh), NCT01704105 (Kenya).

    View details for DOI 10.1136/bmjopen-2013-003476

    View details for PubMedID 23996605

  • 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 Arnold, B. F., Null, C., Luby, S. P., Unicomb, L., Stewart, C. P., Dewey, K. G., Ahmed, T., Ashraf, S., Christensen, G., Clasen, T., Dentz, H. N., Fernald, L. C., Haque, R., Hubbard, A. E., Kariger, P., Leontsini, E., Lin, A., Njenga, S. M., Pickering, A. J., Ram, P. K., Tofail, F., Winch, P. J., Colford, J. M. 2013; 3 (8)
  • Maternal and neonatal deaths associated with jaundice during pregnancy in Bangladesh: Using verbal autopsy data to estimate of the burden of endemic hepatitis E infection. Am J Public Health Gurley ES, Halder AK, Streatfield PK, Sazzad HMS, Huda MT, Hossain MJ, Luby SP 2012; 102 (12): 2248-54
  • Epidemiology of Henipavirus Disease in Humans HENIPAVIRUS: ECOLOGY, MOLECULAR VIROLOGY, AND PATHOGENESIS Luby, S. P., Gurley, E. S. 2012; 359: 25-40

    Abstract

    All seven recognized human cases of Hendra virus (HeV) infection have occurred in Queensland, Australia. Recognized human infections have all resulted from a HeV infected horse that was unusually efficient in transmitting the virus and a person with a high exposure to infectious secretions. In the large outbreak in Malaysia where Nipah virus (NiV) was first identified, most human infections resulted from close contact with NiV infected pigs. Outbreak investigations in Bangladesh have identified drinking raw date palm sap as the most common pathway of NiV transmission from Pteropus bats to people, but person-to-person transmission of NiV has been repeatedly identified in Bangladesh and India. Although henipaviruses are not easily transmitted to people, these newly recognized, high mortality agents warrant continued scientific attention.

    View details for DOI 10.1007/82_2012_207

    View details for Web of Science ID 000330362500004

  • The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: An observational study. PLoS Med Luby SP, Halder AK, Huda T, Tronchet C, Unicomb L, Johnston RB. 2011; 8 (6): e1001052

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