Effects of water quality, sanitation, handwashing and nutritional interventions on enteric pathogen seroconversion in rural Kenya: a cluster randomised trial

In rural Kenya’s WASH Benefits Kenya trial, IgG seroprevalence rose rapidly in early life, exceeding 90% for norovirus, Campylobacter, and LT-ETEC by 2 years.

• Why it matters: High early-life exposure to enteric pathogens in high-transmission settings leaves a gap on whether household WASH and nutrition can meaningfully reduce infection-related immune responses.
• What they did: In a 2x2 factorial cluster-randomised design, dried blood spots from 3030 children in 384 of 391 clusters were tested by multiplex IgG assays for 12 pathogens at 6, 12, and 2 years.
• The result: Intervention effects were small and none met the 5% Benjamini-Hochberg false discovery rate threshold; WASH lowered T. solium by -3.3 percentage points and nutrition lowered V. cholerae by -1.1, implying adherence-limited reductions.

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