{"doi":"10.1093/cid/ciac911","title":"Survey-Based Assessment of Water, Sanitation, and Animal-Associated Risk Factors for Moderate-to-Severe Diarrhea in the Vaccine Impact on Diarrhea in Africa (VIDA) Study: The Gambia, Mali, and Kenya, 2015–2018","abstract":"BACKGROUND: Pediatric exposures to unsafe sources of water, unsafely managed sanitation, and animals are prevalent in low- and middle-income countries. In the Vaccine Impact on Diarrhea in Africa case-control study, we examined associations between these risk factors and moderate-to-severe diarrhea (MSD) in children <5 years old in The Gambia, Kenya, and Mali. METHODS: We enrolled children <5 years old seeking care for MSD at health centers; age-, sex-, and community-matched controls were enrolled at home. Conditional logistic regression models, adjusted for a priori confounders, were used to evaluate associations between MSD and survey-based assessments of water, sanitation, and animals living in the compound. RESULTS: From 2015 to 2018, 4840 cases and 6213 controls were enrolled. In pan-site analyses, children with drinking water sources below \"safely managed\" (onsite, continuously accessible sources of good water quality) had 1.5-2.0-fold higher odds of MSD (95% confidence intervals [CIs] ranging from 1.0 to 2.5), driven by rural site results (The Gambia and Kenya). In the urban site (Mali), children whose drinking water source was less available (several hours/day vs all the time) had higher odds of MSD (matched odds ratio [mOR]: 1.4, 95% CI: 1.1, 1.7). Associations between MSD and sanitation were site-specific. Goats were associated with slightly increased odds of MSD in pan-site analyses, whereas associations with cows and fowl varied by site. CONCLUSIONS: Poorer types and availability of drinking water sources were consistently associated with MSD, whereas the impacts of sanitation and household animals were context-specific. The association between MSD and access to safely managed drinking water sources post-rotavirus introduction calls for transformational changes in drinking water services to prevent acute child morbidity from MSD.","journal":"Clinical Infectious Diseases","year":2023,"id":340981,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":15,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9286,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1061517,"name":"Kirsten Fagerli","orcid":"0000-0001-7471-6317","position":1,"is_corresponding":false},{"id":1076076,"name":"Sun Kyung Kim","orcid":"0000-0001-8839-5577","position":2,"is_corresponding":false},{"id":821941,"name":"Dilruba Nasrin","orcid":null,"position":3,"is_corresponding":false},{"id":917572,"name":"Helen Powell","orcid":"0000-0002-6145-6226","position":4,"is_corresponding":false},{"id":1069031,"name":"Irene N Kasumba","orcid":null,"position":5,"is_corresponding":false},{"id":260735,"name":"Sharon M. Tennant","orcid":"0000-0002-0651-5748","position":6,"is_corresponding":false},{"id":479282,"name":"Anna Roose","orcid":"0000-0001-7020-0380","position":7,"is_corresponding":false},{"id":389009,"name":"M. Jahangir Hossain","orcid":"0009-0009-1584-3282","position":8,"is_corresponding":false},{"id":1064684,"name":"Joquina Chiquita M Jones","orcid":"0009-0001-4213-1493","position":9,"is_corresponding":false},{"id":1068458,"name":"Syed M. A. Zaman","orcid":"0000-0001-7556-7114","position":10,"is_corresponding":false},{"id":479281,"name":"Richard Omore","orcid":"0000-0003-3702-3030","position":11,"is_corresponding":false},{"id":1068459,"name":"John B. Ochieng","orcid":"0000-0002-5301-4559","position":12,"is_corresponding":false},{"id":616173,"name":"Jennifer R. Verani","orcid":"0000-0001-5267-1883","position":13,"is_corresponding":false},{"id":227044,"name":"Marc‐Alain Widdowson","orcid":"0000-0002-0682-6933","position":14,"is_corresponding":false},{"id":299788,"name":"Samba O. Sow","orcid":"0000-0002-6335-5066","position":15,"is_corresponding":false},{"id":908757,"name":"Doh Sanogo","orcid":null,"position":16,"is_corresponding":false},{"id":1076492,"name":"Ciara E Sugerman","orcid":null,"position":17,"is_corresponding":false},{"id":1076493,"name":"Eric D. Mintz","orcid":null,"position":18,"is_corresponding":false},{"id":242121,"name":"Karen L. Kotloff","orcid":"0000-0003-1808-6431","position":19,"is_corresponding":false},{"id":328792,"name":"David Berendes","orcid":"0000-0002-8303-9298","position":0,"is_corresponding":true}],"reference_count":46,"raw_metadata":null,"created_at":"2026-07-19T01:10:58.548803Z","pmid":"37074438","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}